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Tag: networked learning

  • Online learning completion rates in context: Rethinking success in digital learning networks

    Online learning completion rates in context: Rethinking success in digital learning networks

    The comprehensive analysis of 221 Massive Open Online Courses (MOOCs) by Katy Jordan provides crucial insights for health professionals navigating the rapidly evolving landscape of digital learning. Her study, published in the International Review of Research in Open and Distributed Learning, examined completion rates across diverse platforms including Coursera, Open2Study, and others from 78 institutions. 

    • With median completion rates of just 12.6% (ranging from 0.7% to 52.1%), traditional metrics may suggest disappointment. Jordan’s multiple regression analysis revealed that while total enrollments have decreased over time, completion rates have actually increased. 
    • The data showed striking patterns in how participants engage, with the first and second weeks proving critical—after which the proportion of active students and those submitting assessments remains remarkably stable, with less than 3% difference between them. 
    • The research challenges common assumptions about “lurking” as a participation strategy and provides compelling evidence that course design factors significantly impact learning outcomes. 

    These findings reveal important patterns that can transform how we approach professional learning in global health contexts.

    Beyond traditional completion metrics

    For global health epidemiologists accustomed to face-to-face training with financial incentives and dedicated time away from work, these completion rates might initially appear appalling. In traditional capacity building programs, participants receive per diems, travel stipends, and paid time away from work. They are removed from their work environment, and their presence in the activities is often assumed to be evidence of both participation (often without any actual process metrics) and learning (with measurement often limited to “smile sheets” that measure sentiment or intent, not learning). Outcomes such as “completion” are rarely measured. Instead, attendance remains the key metric. In fact, completion rates are often confused with attendance. From this perspective, even the highest reported MOOC completion rate of 52.1% could be interpreted as a dismal failure.

    However, this interpretation fundamentally misunderstands the different dynamics at play in digital learning environments. Unlike traditional training where external incentives and protected time create artificial conditions for participation, MOOCs operate in the reality of participants’ everyday professional lives. They typically do not require participants to stop work in order to learn, for example. The fact that up to half of enrollees in some courses complete them despite competing priorities, no financial incentives, and no dedicated work time represents remarkable commitment rather than failure.

    What drives completion?

    The accumulating evidence from MOOCs reveals three significant factors affecting completion:

    1. Course length: Shorter courses consistently achieved higher completion rates.
    2. Assessment type: Auto-grading showed better completion than peer assessment.
    3. Start date: More recent courses demonstrated higher completion rates.

    The critical engagement period occurs within the first two weeks, after which participant behavior stabilizes.

    This insight aligns with what emerging networked learning approaches have demonstrated in practice.

    Rather than judging digital learning by metrics designed for classroom settings, we must recognize that participation patterns may reflect authentic integration with professional practice.

    The measure of success should not necessarily be focused solely on how many complete the formal course. Rather, we should be considering how learning connects to real-world problem-solving and contributes to sustained professional networks.

    Moving beyond MOOCs: peer learning networks

    The Geneva Learning Foundation’s learning-to-action model offers a distinctly different model from conventional MOOCs. While MOOCs typically deliver standardized content to individual learners who progress independently, the Foundation’s digital learning initiatives are fundamentally network-based and practice-oriented. Rather than focusing on content consumption, their approach creates structured environments where health professionals connect, collaborate, and co-create knowledge while addressing real challenges in their work.

    These learning networks differ from MOOCs in several key ways:

    1. Participants engage primarily with peers rather than pre-recorded content.
    2. Learning is organized around actual workplace challenges rather than abstract concepts.
    3. The experience builds sustainable professional relationships rather than one-time course completion.
    4. Assessment occurs through peer review and real-world application rather than quizzes or assignments.
    5. Structure is provided through facilitation and process rather than predetermined pathways.

    The Foundation’s experience with over 60,000 health professionals across 137 countries demonstrates that when learning is connected to practice through networked approaches, different metrics of success emerge:

    • Knowledge application: Practitioners implement solutions directly in their contexts
    • Network formation: Sustainable learning relationships develop beyond formal “courses”
    • Knowledge creation: Participants contribute to collective understanding
    • System impact: Changes cascade through health systems

    Implications for global health training and learning

    For epidemiologists and health professionals designing learning initiatives, these findings suggest several strategic shifts:

    1. Modular design: Create shorter, more connected learning units rather than lengthy courses.
    2. Real-world integration: Link learning directly to participants’ practice contexts.
    3. Peer engagement: Provide structured opportunities for health workers to learn from each other.
    4. Network building: Focus on creating sustainable learning communities rather than isolated training events.

    The future of professional learning, beyond completion rates

    The research and practice point to a fundamental evolution in how we approach professional learning in global health. Rather than replicating traditional per diem-driven training models online, the most effective approaches harness the power of networks, enabling health professionals to learn continuously through structured peer interaction.

    This perspective helps explain why seemingly low completion rates should not necessarily be viewed as failure. When digital learning is designed to create lasting networks of practice, knowledge emerges through collaborative action. Completion metrics therefore capture only a fraction of the impact.

    For health systems facing complex challenges that include climate change, pandemic response, and health workforce shortages, this networked approach to learning offers a promising path forward—one that transforms how knowledge is created, shared, and applied to improve health outcomes globally.

    Reference

    Sculpture: The Geneva Learning Foundation Collection © 2025

  • What is networked learning?

    What is networked learning?

    Networked learning happens when people learn through connections with others facing similar challenges. Think about how market traders learn their business – not through formal classes, but by connecting with other traders, sharing tips, and learning from each other’s experiences. This natural way of learning through relationships is what networked learning tries to support.

    5 key features of networked learning:

    1. Learning from peers: In networked learning, people learn as much or more from others doing similar work as they do from experts. A community health worker in one village might discover an effective way to increase vaccination rates that could help workers in other villages.
    2. Knowledge flows in all directions: Unlike traditional training where knowledge flows only from the top down, networked learning allows knowledge to move in all directions – from national programs to local clinics, between regions, and from local implementers up to policy makers.
    3. Connections create value: The relationships between people become valuable resources for solving problems. Having a network of colleagues to ask for advice or share experiences with helps everyone work more effectively.
    4. Crossing boundaries: Networked learning connects people who might not normally work together – like doctors, nurses, community health workers, and managers. These diverse connections bring together different perspectives and create new solutions.
    5. Building on existing relationships: People already learn from colleagues they trust. Networked learning strengthens these natural connections and creates new ones, expanding who people can learn from.

    Why networked learning matters for health work:

    Health systems are full of isolated practitioners who could benefit from each other’s knowledge:

    • A nurse who developed an effective patient education approach
    • A community health worker who found a way to reach remote households
    • A clinic manager who improved medicine supply systems
    • A doctor who adapted treatment guidelines for local conditions

    Networked learning connects these isolated pockets of knowledge, allowing good ideas to spread and adapt across different contexts.

    Unlike traditional training that pulls people away from their work for workshops, networked learning happens through ongoing connections that support everyday problem-solving. When health workers participate in networked learning, they gain access to a community of practice that continues to provide support long after formal training ends.

    Networked learning doesn’t replace expertise, but it recognizes that valuable knowledge exists throughout the health system – not just at the top. By connecting this distributed knowledge, networked learning helps good practices spread more quickly and adapt more effectively to local needs.

  • The cost of inaction: Quantifying the impact of climate change on health

    The cost of inaction: Quantifying the impact of climate change on health

    This World Bank report ‘The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries’ presents new analysis of climate change impacts on health systems and outcomes in the regions that are bearing the brunt of these impacts.

    Key analytical insights to quantify climate change impacts on health

    The report makes three contributions to our understanding of climate-health interactions:

    First, it quantifies the massive scale of climate change impacts on health, projecting 4.1-5.2 billion climate-related disease cases and 14.5-15.6 million deaths in LMICs by 2050. This represents a significant advancement over previous estimates, which the report demonstrates were substantial underestimates.

    Second, it illuminates the profound economic consequences, calculating costs of $8.6-20.8 trillion by 2050 (0.7-1.3% of LMIC GDP). The report employs both Value of Statistical Life and Years of Life Lost approaches to provide a range of economic impact estimates.

    Third, it reveals stark geographic inequities in impact distribution, with Sub-Saharan Africa bearing approximately 71% of cases and nearly half of deaths, while South Asia faces about 18% of cases and a quarter of deaths. This spatial analysis helps identify where interventions are most urgently needed.

    Policy implications and systemic perspectives

    The report’s findings point to several critical policy directions:

    • The need for systemic rather than disease-specific interventions emerges as a central theme. The authors explicitly advocate for strengthening entire health systems rather than pursuing vertical disease programs.
    • The economic analysis makes a compelling case for immediate action, demonstrating that the costs of inaction far exceed potential investment requirements for climate-resilient health systems.
    • The geographic distribution of impacts highlights the need for globally coordinated responses while prioritizing support for the most vulnerable regions.

    The findings suggest that transforming systems to address climate change impacts on health requires not just technical solutions but fundamental rethinking of how health systems are organized and financed in vulnerable regions.

    This aligns with recent scholarship on complex adaptive systems and organizational transformation in global health.

    The report’s emphasis on systemic approaches represents a significant shift in thinking about climate-health interventions. This merits unpacking on several levels:

    1. Inadequacy of vertical disease silos: The report challenges the traditional vertical disease management paradigm that has dominated global health programming for decades. While vertical programs have achieved notable successes in areas like HIV/AIDS or malaria control, the report argues that climate change’s multifaceted health impacts require a fundamentally different approach.
    2. Need for systemic intervention: Climate change simultaneously affects multiple disease pathways, nutrition status, and health infrastructure. These interactions cannot be effectively addressed through isolated disease-specific programs. Building core health system capabilities (surveillance, emergency response, primary care) creates multiplicative benefits across various climate-related health challenges. Strong health systems can better identify and respond to emerging threats, whereas vertical programs often lack this flexibility.
    3. Implementation implications: The report suggests this systemic approach requires: integrated planning across health system components, flexible funding mechanisms that support system-wide capabilities, enhanced coordination between different health programmes and investment in cross-cutting infrastructure and capabilities.

    What about the health workforce facing impacts of climate change on health?

    Between this clear-eyed assessment and effective action lies a critical implementation gap.

    Interestingly, the report gives limited explicit attention to the health workforce dimension of climate-health challenges. Yet that is precisely where we need to focus attention, given that:

    • Health workers based in communities are first responders to climate-related health emergencies
    • Workforce capacity significantly determines a health system’s adaptive capabilities
    • Climate change itself affects health worker distribution and effectiveness

    Given the report’s emphasis on systemic approaches, the lack of detailed discussion about human resources for health represents a missed opportunity to explore what effective action might look like.

    The Geneva Learning Foundation’s network, developed through nearly a decade of research and practice, has led us to identify a path for supporting the health workforce to strengthen preparedness and response in response to climate change impacts on health.

    The network already connects over 60,000 health workers. They represent all job roles, rank, and levels of the health system.

    One distinguishing feature of this network is its deep integration with existing government health systems. Over half of network participants are government employees, from community health workers to district officers to national planners.

    62% of participants work in remote rural areas, 47% serve urban poor populations, and 21% operate in conflict zones.

    These are not just statistics: they represent an unprecedented capability to mobilize knowledge and action where it’s most needed.

    Since 2023, network participants have been sharing observations, experiences, and insights of climate change impacts on health. 

    The model connects different levels of health systems:

    • Community-based health workers share ground-level observations
    • District managers identify emerging patterns
    • National planners gauge system-wide implications
    • Global partners access real-time insights

    When a malaria control officer in Kenya observes changing disease patterns due to altered rainfall, the network enables rapid sharing of this insight with colleagues working on water safety, nutrition, and primary care. These cross-domain connections do not need to be left to chance – they can be enabled through structured peer learning processes that transcend traditional programme, geographic, and hierarchical boundaries

    This creates what organizational theorists call “embedded transformation” – where system change emerges through existing structures rather than requiring new ones.

    Rather than creating new coordination mechanisms, the network enables:

    • Health workers to learn directly from peers in other programs
    • Rapid identification of cross-cutting challenges
    • Spontaneous formation of problem-solving groups
    • Systematic sharing of effective practices

    Rather than replacing existing structures, TGLF’s model demonstrates how digital networks can enable health systems to:

    • Maintain necessary specialization while fostering crucial connections
    • Enable rapid learning and adaptation across programs
    • Optimize resource use through enhanced coordination
    • Build system-wide resilience through structured peer learning

    Such a network enables what complexity theorists call “distributed sensing” that can provide:

    • Early warning of emerging threats
    • Rapid sharing of local solutions
    • System-wide learning from local innovations
    • Continuous adaptation to changing conditions

    This has led us to posit that investment in such emergent digital networks could enable health systems to maintain necessary specialization while fostering crucial connections across domains.

    This is obviously critical to respond to the systems-level complexity of climate change impacts on health.

    World Bank findingTGLF model strategic fit
    Scale of impact (4.1-5.2B cases, 14.5-15.6M deaths by 2050)TGLF’s digital network model demonstrates scalability, already connecting over 60,000 health practitioners across 137 countries. More significantly, the model’s effectiveness increases with scale – as more practitioners join, the network’s ability to identify emerging threats and disseminate effective responses improves. Network analysis shows that larger scale enables more diverse inputs and faster adaptation, suggesting this approach could help health systems respond to the massive scale of projected impacts.
    Economic consequences ($8.6-20.8T by 2050)TGLF’s model offers remarkable cost-effectiveness through its networked learning structure. Rather than requiring massive new investments in parallel systems, it leverages existing health system resources while enabling and accelerating both learning and action. The model demonstrates how digital infrastructure can maximize return on investment – practitioners implement solutions using existing resources, with 82% reporting ability to continue without external support. This suggests potential for significant cost savings while building system resilience.
    Geographic inequities (71% SSA, 18% SA)TGLF’s network already demonstrates strongest presence precisely where the World Bank identifies greatest need – 70% of participants work in Sub-Saharan Africa and South Asia. This concentration is not coincidental; the model’s digital infrastructure and peer learning approach prove particularly effective in resource-constrained settings. The network enables rapid sharing of context-appropriate solutions between regions facing similar challenges, while maintaining sensitivity to local conditions.
    Need for systemic interventionThe network transcends traditional program boundaries through what organizational theorists call “structured emergence” – practitioners naturally form cross-program connections based on shared challenges. When a malaria control officer observes changing disease patterns due to climate shifts, the network enables rapid sharing with colleagues in water safety, nutrition, and primary care. This organic integration emerges through peer learning rather than requiring new coordination mechanisms.
    Urgency of investmentTGLF’s model offers an immediately scalable approach that builds on existing health system capabilities. Rather than waiting years to develop new infrastructure, the network can rapidly expand to connect more practitioners and regions. Evidence shows 7x acceleration in implementation of new approaches compared to conventional means of technical assistance, suggesting potential for rapid, sustainable strengthening of health system resilience.
    Global coordination needWhile enabling global connection, the network maintains strong local grounding through its emphasis on locally-led action and contextual adaptation. Government health workers comprise over 50% of participants, creating what scholars term “embedded transformation” – change emerging through existing structures rather than imposed from outside. This enables coordinated response while respecting local health system authority.
    System transformationThe model demonstrates how digital networks can fundamentally transform how health systems operate without requiring complete restructuring. By enabling rapid knowledge flow across traditional boundaries, supporting emergence of new coordination patterns, and fostering system-wide learning, it shows how transformation can emerge through enhanced connection rather than structural overhaul. Analysis reveals development of new capabilities in surveillance, response, and adaptation through networked learning.

    Reference

    Uribe, J.P., Rabie, T., 2024. The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries. The World Bank, Washington, D.C. https://doi.org/10.1596/42419

    Image: The Geneva Learning Foundation Collection © 2024

  • Knowing-in-action: Bridging the theory-practice divide in global health

    Knowing-in-action: Bridging the theory-practice divide in global health

    The gap between theoretical knowledge and practical implementation remains one of the most persistent challenges in global health. This divide manifests in multiple ways: research that fails to address practitioners’ urgent needs, innovations from the field that never inform formal evidence systems, and capacity building approaches that cannot meet the massive scale of learning required. Donald Schön’s seminal 1995 analysis of the “dilemma of rigor or relevance” in professional practice offers crucial insights for “knowing-in-action“. It can help us understand why transforming global health requires new ways of knowing – a new epistemology.

    Listen to this article below. Subscribe to The Geneva Learning Foundation’s podcast for more audio content.

    Schön’s analysis: The dilemma of rigor or relevance

    Schön begins by examining how knowledge becomes institutionalized through education. Using elementary school mathematics as an example, he describes how knowledge is broken into discrete units (“math facts”), organized into progressive modules, assembled into curricula, and measured through standardized tests. This systematization shapes not just content but the entire organization of time, space, and institutional arrangements.

    From this foundation, Schön introduces his central metaphor of two contrasting landscapes in professional practice that prevent “knowing-in-action”. As he describes it:

    “In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.”

    The cruel irony, Schön observes, lies in the relative importance of these terrains: “The problems of the high ground tend to be relatively unimportant to individuals or to society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.”

    This creates what Schön calls the “dilemma of rigor or relevance” – practitioners must choose between remaining on the high ground where they can maintain technical rigor or descending into the swamp where they must rely on experience, intuition, and what he terms “muddling through.”

    The historical roots of the divide

    Schön traces this dilemma to the epistemology embedded in modern research universities. Drawing on Edward Shils’s historical analysis, he describes how American scholars returning from Germany after the Civil War brought back “the German idea of the university as a place in which to do research that contributes to fundamental knowledge, preferably through science.”

    This was, as Schön notes, “a very strange idea in 1870,” running counter to the prevailing British model of universities as sanctuaries for liberal arts or finishing schools for gentlemen. The new model first took root at Johns Hopkins University, whose president embraced the “bizarre notion that professors should be recruited, promoted, and granted tenure on the basis of their contributions to fundamental knowledge.”

    This shift created what Schön terms the “Veblenian bargain” (named after Thorstein Veblen), establishing a separation between:

    • Research universities focused on “true scholarship” and fundamental knowledge
    • Professional schools dedicated to practical training

    Knowing-in-action in global health: From fragmentation to integration

    The historical division between theory and practice that Schön identified continues to shape global health in profound and often problematic ways. This manifests in three interconnected challenges that demand our urgent attention: the knowledge-practice gap, the scale challenge, and the complexity challenge. Yet emerging approaches suggest potential paths forward, particularly through structured peer learning networks that could help bridge Schön’s “high ground” and “swamp.”

    Three fundamental challenges

    Challenge #1: The knowing-in-action divide

    The separation between research institutions and field practice creates not just an academic concern but a practical crisis in healthcare delivery. Consider the response to COVID-19: while research institutions rapidly generated new knowledge about the virus, frontline health workers struggled to translate this into practical approaches for their specific contexts. Their hard-won insights about what worked in different settings rarely made it back into formal evidence systems, epitomizing the one-way flow of knowledge that impoverishes both research and practice.

    This pattern repeats across global health. Research agendas, shaped by academic incentives and funding priorities, often fail to address practitioners’ most pressing challenges. A community health worker in rural Bangladesh facing complex challenges around vaccine hesitancy may struggle to find relevant guidance – while global experts are convinced that they already have all the answers. Meanwhile, local solutions to building vaccine confidence remain uncaptured by formal knowledge systems.

    The rise of implementation science attempts to bridge this divide, yet often remains subordinate to “pure” research in academic hierarchies. This reflects Schön’s observation about the privileging of high ground problems over swampy ones, even when the latter hold greater practical significance.

    Challenge #2: The scale imperative

    Traditional approaches to professional education face fundamental limitations in meeting the massive need for health worker capacity building. The World Health Organization projects a shortfall of 10 million health workers by 2030, mostly in low- and middle-income countries. Conventional training approaches that rely on cascading knowledge through workshops and formal courses can reach only a fraction of those who need support.

    More fundamentally, these knowledge transmission models prove inadequate for addressing complex local realities. A standardized curriculum developed by experts, no matter how well-designed, cannot anticipate the diverse challenges health workers face across different contexts. When a district immunization manager in Nigeria must adapt vaccination strategies for nomadic populations during a drought, they need more than pre-packaged knowledge – they need ways to learn from others who are facing similar challenges.

    Resource constraints further limit the reach of conventional approaches. The cost of traditional training programmes, both in money and time away from service delivery, makes it impossible to scale them to meet the need. Yet the human cost of this capacity gap, measured in preventable illness and death, demands urgent solutions.

    Challenge #3: The complexity conundrum

    Contemporary global health faces challenges that fundamentally resist standardized technical solutions. Climate change exemplifies this complexity, creating cascading effects on health systems and communities that cannot be addressed through linear interventions. When rising temperatures alter disease patterns while simultaneously disrupting cold chains for vaccine delivery, no single technical fix suffices.

    Similarly, emerging and re-emerging infectious diseases demand responses that cross traditional boundaries between animal and human health, environmental factors, and social determinants. Health workforce development must grapple with complex systemic issues around motivation, retention, and capacity building. The COVID-19 pandemic demonstrated how traditional approaches to health system strengthening often prove inadequate in the face of complex adaptive challenges.

    Emerging solutions: A new paradigm for learning and practice

    Recent innovations suggest promising approaches to bridging these divides through structured peer learning networks. Digital platforms enable health workers to share experiences and solutions across geographical boundaries, creating new possibilities for scaled learning that maintains local relevance.

    Solution #1: The power of structured peer learning

    Experience from digital learning networks demonstrates how structured peer interaction can enable more efficient and effective knowledge sharing than traditional top-down approaches. When health workers can directly connect with peers facing similar challenges, they not only share solutions but collectively generate new knowledge through their interactions.

    These networks provide mechanisms for validating practical knowledge through peer review processes that complement traditional academic validation. A successful intervention developed by a rural clinic in Thailand can be critically examined by peers, adapted for different contexts, and rapidly disseminated across the network. This creates a more dynamic and responsive knowledge ecosystem than traditional publication cycles allow.

    Solution #2: Network effects and collective intelligence

    The potential of practitioner networks extends beyond simple knowledge sharing. When properly structured, these networks create possibilities for:

    1. Rapid adaptation to emerging challenges through real-time sharing of experiences
    2. Collective problem-solving that draws on diverse perspectives and contexts
    3. Systematic capture and analysis of field innovations
    4. Development of context-specific solutions that build on shared learning

    Most importantly, these networks can help bridge Schön’s high ground and swamp by creating dialogue between different forms of knowledge and practice. They provide spaces where academic research can inform field practice while simultaneously allowing field insights to shape research agendas.

    Four principles toward knowing-in-action for global health

    Drawing on Schön’s call for a “new epistemology,” we can identify four principles for transforming how we know what we know in global health:

    Principle #1: Valuing multiple forms of knowledge

    The complexity of contemporary health challenges demands recognition of multiple valid forms of knowledge. The practical wisdom developed by a community health worker through years of service deserves attention alongside randomized controlled trials. This requires challenging existing hierarchies of evidence while maintaining rigorous standards for validating knowledge claims.

    Principle #2: Enabling knowledge creation from practice

    Health workers must be supported as knowledge producers, not just knowledge consumers. This means creating structures for systematically capturing and validating field insights, building evidence from implementation experience, and enabling continuous learning from practice. Digital platforms can provide scaffolding for this knowledge creation while ensuring quality through peer review processes.

    Principle #3: Scaling through networked learning

    Traditional scaling approaches that rely on standardization and top-down dissemination must be complemented by networked learning to create and amplify knowing-in-action. This means building systems that can:

    1. Connect practitioners across contexts and boundaries
    2. Enable peer validation of knowledge
    3. Support rapid dissemination of innovations
    4. Build collective intelligence through structured interaction

    Principle #4: Embracing complexity

    Rather than seeking to reduce complexity through standardization, health systems must build capacity for working effectively within complex adaptive systems. This means supporting adaptive learning, enabling context-specific solutions, and building capacity for systems thinking at all levels.

    The challenges facing global health today demand new ways of creating, validating, and sharing knowledge. By embracing approaches that bridge Schön’s high ground and swamp, we may find paths toward health systems that are both more rigorous and more relevant to the communities they serve.

    Looking forward

    Schön’s analysis helps explain why traditional approaches to global health knowledge and learning often fall short. More importantly, it points toward solutions that could help bridge the theory-practice divide to support knowing-in-action:

    1. New digital platforms that enable peer learning at scale
    2. Networks that connect practitioners across contexts
    3. Approaches that validate practical knowledge
    4. Systems that support rapid learning and adaptation

    Schön’s insights remain remarkably relevant to contemporary global health challenges. His call for a new epistemology that can bridge theory and practice speaks directly to our current needs. By embracing new approaches to learning and knowledge creation that honor both rigor and relevance, we may find ways to address the complex challenges that lie ahead.

    The key lies not in choosing between high ground and swamp, but in building new kinds of bridges between them – bridges that can support the massive scale of learning needed while maintaining the local relevance essential for impact. Recent innovations in peer learning networks and digital platforms suggest this bridging may be increasingly possible, offering hope for more effective global health practice in an increasingly complex world.

    The challenge now is to develop and implement these bridging approaches at the scale needed to support global health workers worldwide. This will require new ways of thinking about knowledge, learning, and practice – ways that honor both the rigor of research and the wisdom of experience. The future of global health may depend on our success in this endeavor.

    Listen to the AI podcast deep dive about this article

    Reference

    Schön, Donald A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34. https://doi.org/10.1080/00091383.1995.10544673

    Image: The Geneva Learning Foundation Collection © 2024

  • Experience-sharing sessions in the Movement for Immunization Agenda 2030: A novel approach to localize global health collaboration

    Experience-sharing sessions in the Movement for Immunization Agenda 2030: A novel approach to localize global health collaboration

    As immunization programs worldwide struggle to recover from pandemic disruptions, the Movement for Immunization Agenda 2030 (IA2030) offers a novel, practitioner-led approach to accelerate progress towards global vaccination goals.

    From March to June 2022, the Geneva Learning Foundation (TGLF) conducted the first Full Learning Cycle (FLC) of the Movement for IA2030, engaging 6,185 health professionals from low- and middle-income countries.

    A cornerstone of this programme was a series of 44 experience-sharing sessions held between 7 March and 13 June 2022. These sessions brought together between 20 and 400 practitioners per session to discuss and solve real-world immunization challenges.

    IA2030 case study 16, by Charlotte Mbuh and François Gasse, offers valuable insights from these experience-sharing session:

    1. what we learned from the experiences themselves and how it can help practitioners; and
    2. what we learned about the significance and potential of the peer learning process itself.

    Download the full case study: IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation.

    For every challenge shared during the experience sharing sessions, there was always at least one member who had encountered or was encountering the same challenge and had carried out measures to resolve it.

    These sessions provided a space to share practical stories that are making a difference – and supported participants in considering their relevance to their own situations.

    Experience sharing also helped build confidence and motivation.

    Members were able to identify with experiences shared, realizing they were not alone in facing similar challenges.

    The sessions covered a wide range of critical immunization topics.

    For instance, a participant from Nigeria discussed strategies for reaching zero-dose children in Borno state.

    Facing the challenge of reaching approximately 600,000 unvaccinated children, the presenter received practical suggestions from peers, including developing a zero-dose reduction operational plan, leveraging new vaccine introductions, and partnering with the private sector for evening vaccination services.

    In another session, a subnational Ministry of Health staff member from Côte d’Ivoire presented challenges related to cross-border immunization campaigns.

    Peers shared experiences of organizing cross-border meetings to identify unvaccinated children, synchronize efforts, and involve community representatives in the process.

    Such context-specific, experience-based advice exemplifies the unique value of peer learning in addressing complex health system challenges.

    The case study of 44 sessions highlights how these sessions fostered multiple types of learning simultaneously.

    Participants reported learning from each other’s experiences, experiencing the power of solving problems together across distances, feeling a growing sense of belonging to a community, and connecting across country borders and health system levels.

    A district-level Ministry of Health staff member from Ghana encapsulated the impact: “I have linked up with expert vaccinators worldwide through experience sharing and twinning. I have become more competent and knowledgeable in the area of immunization, and work confidently.”

    This sentiment was echoed by many participants who found value not only in acquiring new knowledge but also in expanding their professional networks and gaining confidence in their problem-solving abilities.

    The case study also reveals the adaptability of the approach in responding to unique contexts.

    This resilience underscores the potential of digital platforms to democratize access to expertise and foster global collaboration.

    However, the study also identifies areas for improvement.

    • Participants expressed a desire for more follow-up support and opportunities to continue their peer learning groups beyond the initial sessions.
    • Additionally, the need for better integration of community engagement strategies was identified as a key area for future development.

    To contextualize these findings, we can turn to a 2022 study by Watkins et al., which evaluated a prototype of these experience-sharing sessions known as Immunization Training Challenge Hackathons (ITCH), conducted in 2020.

    The ITCH methodology, developed by The Geneva Learning Foundation (TGLF), informed the design of the 2022 IA2030 Movement sessions.

    Watkins et al. found that the ITCH approach fostered four simultaneous types of learning: peer, remote, social, and networked.

    1. Peer Learning: This involves participants learning directly from each other’s experiences and knowledge. In the context of immunization, imagine a scenario where a vaccination program manager from rural India shares their successful strategy for improving vaccine cold chain management with a colleague facing similar challenges in sub-Saharan Africa. This direct exchange of practical, context-specific knowledge can complement more theoretical training, as it is based on real-world application.
    2. Remote Learning: This refers to the ability to learn and solve problems collaboratively across geographical distances. For an immunization specialist, this might seem counterintuitive, as many believe that hands-on, in-person training is essential. However, the ITCH sessions demonstrated that meaningful learning can occur remotely. For example, a team in Bangladesh could describe their approach to overcoming vaccine hesitancy, and a team in Nigeria could immediately adapt and apply those strategies to their local context, all without the need for costly and time-consuming travel.
    3. Social Learning: This concept emphasizes the importance of learning within a network. In the immunization field, professionals often work in isolation, especially at sub-national levels. The ITCH sessions created a sense of belonging to a global network, community, and platform of immunization practitioners. This social aspect can boost motivation, reduce feelings of isolation, and foster a collective approach to problem-solving that transcends individual or even national boundaries.
    4. Networked Learning: This type of learning emerges from connections made across different levels of health systems and across country borders. For an epidemiologist, this might be analogous to how disease surveillance networks function across borders. In the ITCH context, it means that a district-level immunization officer could learn from and share ideas with national-level policymakers from other countries, fostering a more holistic understanding of immunization challenges and solutions.

    These four types of learning operate simultaneously during ITCH sessions, creating a synergistic effect. 

    For instance, a participant might learn a new cold chain management technique (peer learning) from a colleague in another country (remote learning), feel supported by the global community in implementing this new technique (social learning), and then share their adaptation of this technique with others across various levels of the health system (networked learning).

    From an epidemiological perspective, this approach to learning could be compared to how we understand disease transmission and intervention effectiveness.

    Just as multiple factors contribute to disease spread and control, these multiple learning types contribute to knowledge dissemination and capacity building in the immunization field.

    The value of this approach lies in its potential to rapidly disseminate practical, context-specific knowledge and solutions across a global network of immunization professionals.

    This can lead to faster adoption of best practices, more innovative problem-solving, and ultimately, improvements in immunization program performance that could contribute to better disease control outcomes.

    While this approach may seem unconventional compared to traditional training methods in the immunization field, the evidence presented by Watkins et al. suggests that it can be a powerful complement to existing capacity-building efforts, particularly in resource-constrained settings where access to formal training opportunities may be limited.

    This multifaceted approach allowed participants to not only acquire new knowledge but also to expand their professional networks and gain confidence in their problem-solving abilities—findings that align closely with the outcomes observed in the 2022 IA2030 Movement sessions.

    The Watkins study emphasized the importance of building confidence and motivation through peer learning experiences, a theme strongly echoed in the Mbuh case study.

    Furthermore, Watkins et al. highlighted the potential of this approach to create a “space of possibility” for innovation and problem-solving, which is evident in the diverse and creative solutions shared during the 2022 sessions.

    Both studies underscore the significance of peer-led, digital learning experiences in accelerating progress towards global health goals.

    By fostering peer learning and digital collaboration, these approaches empower health workers to turn global strategies into effective local action.

    References

    Mbuh, C., Gasse, F., Jones, I., Sadki, R., Brooks, A., Zha, M., Steed, I., Sequeira, J., Churchill, S., Kovanovic, V., 2022. IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7014392

    Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4

    Image: The Geneva Learning Foundation Collection © 2024

  • What learning science underpins peer learning for Global Health?

    What learning science underpins peer learning for Global Health?

    Watch Reda Sadki’s presentation about peer learning for global health at the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH) Symposium on 19 October 2023

    Most significant learning that contributes to improved performance takes place outside of formal training.

    It occurs through informal and incidental forms of learning between peers.

    This is called peer learning or peer-to-peer learning.

    Effective use of peer learning requires realizing how much we can learn from each other (peer learning), experiencing the power of defying distance to solve problems together (remote learning), and feeling a growing sense of belonging to a community (social learning), emergent across country borders and health system levels (networked learning).

    At the ASTMH annual meeting Symposium organized by Julie Jacobson, two TGLF Alumnae, María Monzón from Argentina and Ruth Allotey from Ghana, will be sharing their analyses and reflections of how they turned peer learning into action, results, and impact.

    In his presentation, Reda Sadki, president of The Geneva Learning Foundation (TGLF), will explore:

    1. What do we need to understand about digital learning?
    2. Networked learning: rethinking learning architecture in the Digital Age
    3. Social learning: peer learning is about making human connections
    4. Practical examples of TGLF peer learning systems for WHO, Wellcome, UNICEF, and Bridges to Development that connect learning to change, results, and impact.
    5. Emergent peer learning systems driven by local practitioner and community needs and priorities.

    Join this #TropMed23 Peer Learning symposium on Day 2 of the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH).

  • Community health into the scalable, networked future of learning

    Community health into the scalable, networked future of learning

    Preface to the IFRC Global Health Team’s Training Guidelines (2013) by Reda Sadki

    “At the heart of a strong National Society” explains Strategy 2020, “is its nationwide network of locally organized branches or units with members and volunteers who have agreed to abide by the Fundamental Principles and the statutes of their National Society.” To achieve this aim, National Societies share a deeply-rooted culture of face-to-face (FTF) learning through training. This local, community-based Red Cross Red Crescent culture of learning is profoundly social: by attending a “training” at their local branch, a newcomer meets other like-minded people who share their thirst for learning to make a better future. It is also peer education: trainers and other educators are often volunteers themselves, living in the same communities as their trainees.

    Although some National Societies have been early adopters of educational technology to deliver distance learning since the early 1990s – and IFRC’s Learning network has scaled up global educational opportunities since 2009 –, such initiatives do not appear to have changed the local, community-based, face-to-face training processes that start in the branch-as-classroom.

    Quality in the history of Red Cross Red Crescent learning, education and training (LET) has been based on this combination of practical knowledge you can use, building social ties through face-to-face contact, and leveraging the power of peer education to learn by doing. No other humanitarian organization has ‘brick-and-mortar’ structures on a massive scale to embed public health education in each and every community.

    The global volume of health training delivered by the Red Cross Red Crescent is indeed massive. For example, every year, 17 million trainees learn first aid skills face-to-face programs run by National Societies. These trainees then use their first aid skills to provide assistance to 46 million people.

    In 2011, IFRC’s research into the social and economic value of its more than 13 million global volunteer workforce concluded that, while many volunteers work across multiple fields, the most volunteers – and the greatest proportion of value – are related to health promotion (IFRC 2011:7). Although the Red Cross and Red Crescent is “known mostly for its role in disasters”, this study highlighted that “the area in which most volunteers are engaged is health.” (IFRC 2011:8)

    The social value of the health services delivered by Red Cross Red Crescent volunteers is particularly poignant in the context of a global, critical health workforce shortage. However, the recognition of our unique volunteer workforce is premised on our continued ability to ensure that they continually improve skills, knowledge and competencies to contribute to strengthening health systems.

    In 2012, IFRC’s secretariat spent 18,485,821 CHF on a budget line titled “workshops and training”, roughly equivalent to 360,000 hours of in-person training – nearly a thousand hours per day. Every subject matter expert in IFRC’s Global Health Team includes the delivery of face-to-face training in his or her work plan, and many also develop training materials in the form of printed manuals or, more recently, online courses for IFRC’s Learning platform.

    With the publication of these guidelines, the Global Health Team aims to recognize the significance of the pedagogical dimension of these training activities as the key determinant of quality in training. Indeed, it is only with a clear framework for how we teach and how we learn that we may know how to measure the learning outcomes, impact and effectiveness of such activities.

    These Guidelines for face-to-face training provide detailed instructions first in how to assess learning needs to determine whether these can be addressed by face-to-face training. Only once this is established should training be developed using a rigorous methodology based on available evidence of how adult volunteers learn in Red Cross Red Crescent contexts. Last but not least, training activities should be evaluated not only with respect to improved knowledge and skills, but also improved performance for both the individual and the organization.

    By adopting an approach based on needs analysis, these guidelines also highlight the potential for innovative approaches to training that leverage the amazing economy of effort achieved by appropriate use of educational technology and broadened approaches that synergize learning and education with training. A paradigm change is needed for training if it is to remain relevant to delivery science, primarily because of the changing nature of knowledge in an increasingly volatile, uncertain, complex and ambiguous world.

    In 1986, according to research by Robert Kelly of Carnegie-Mellon University, 75% of the knowledge needed to do your job was stored in your brain. By 2006, Kelly’s research found that this percentage had dropped to 10%. 90% of the knowledge we use depends on our connections with others. This is in part why, more than ever before, most of what people do in their jobs is currently acquired through experience, regardless of the amount of formal training received. If learning is less and less about recalling information, what then should training focus on?

    This dilemma is compounded by the diminishing half-life of knowledge. As learning theorist George Siemens explains, “courses are fairly static, container-views of knowledge. Knowledge is dynamic—changing hourly, daily. [This] requires an understanding of the nature of the half-life of knowledge in [a field, to select] the right tools to keep content current for the learners.” (Siemens 2006:55). How do we train when knowledge flows too fast for processing or interpreting?

    If improving performance of health workers in a rapidly-changing world rested solely on more structured, better-designed curricula, this would primarily reveal the underlying assumption or notion that the world has not really changed. Attempting to do more of what has been done in the past is not the answer. We need to do new things in new ways.

    As acknowledged in IFRC’s Framework for building strong National Societies (2011), “in a world of changing needs, expectations and opportunities, our knowledge, skills, and competences must keep up to date to meet new demands. We need to address familiar problems by being more proficient in applying what works as well as by using the innovations and insights from new research and technologies that have the potential to bring better results.”

    Traditional approaches are unlikely to be scalable. With 13.6 million Red Cross Red Crescent volunteers, no classroom is large enough. No individual is smart enough to tame the knowledge flows, no intervention is complete enough, no training program lasts long enough, and no solution is global enough.

    The skills and processes that will make us health workers of tomorrow are not yet embedded in our educational structures. We do know, however, much of what is needed: The capacity to know more is more critical than what is currently known. The ability to see connections between fields, ideas, and concepts is a core skill.

    These guidelines recognize the value of existing local knowledge, practices and understanding, and that incorporating them into the learning experience is a key challenge. Our local branches form a vast, global network of brick-and-mortar structures which can be used to anchor public health activities, but they currently reside at the bottom of each National Society’s top-down vertical pyramid. They are rarely linked to each other.

    Strategy 2020 calls for IFRC to “draw inspiration from our shared history and tradition” while committing to finding creative, sustainable solutions to a changing world. Meeting the challenge in the future – to reinvent Red Cross Red Crescent health education in order to strengthen National Societies – may well depend on connecting branches to each other to extend our learning culture’s social, peer-based learning to form a vast, global knowledge community. In the 21st Century, such connections may no longer be a ‘nice-to-have’, and may well prove indispensable for anyone working for change at the community level, most obviously on global public health issues with local impact and consequences.

    Branches connected to each other could support new forms of community-based public health practice in which local volunteers are linked to international delegates and public health and medical expertise in fluid, real-time, two-way knowledge conversations. Such networks will open new possibilities for a new learning system where community and global health workers create together, giving each other feedback (and even feedback on feedback), sharing their inspirations and discoveries. Within their knowledge communities, they will work at their own pace, according to their own interests and capabilities. They will use digital storytelling to explore and implement solutions, embracing complexity and adapting to volatility and uncertainty in ways that rapid health assessments, operational plans, and other current tools simply cannot. We will be lifelong learners, teaching each other practical skills and refining not only the methods but also the conduits for teaching and learning through constant practice.

    These collaborative, flexible, motivating, participatory and supportive approaches are neither wishful thinking nor simply a nicer, kinder and gentler form of learning. Their pedagogical patterns closely emulate core competencies of twenty-first century humanitarian workers, who are expected to be able to manage complex crisscrossing knowledge flows, to work in networked configurations (rather than command-and-control structures), and to use participatory methodologies to partner with beneficiaries.

    By asking questions about why we do training, by exploring why and how training can improve performance, these Guidelines represent a milestone on the road to the reinvention of the Red Cross Red Crescent delivery science that underpins how we service the health needs of vulnerable people.

    Preface to the IFRC Global Health Team’s Training Guidelines (2013) by Reda Sadki

    Image: Ancient Mayan port city of Tulum, Yucatán Peninsula. Personal collection.