Tag: World Health Organization

This is the final in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

“Opportunities to contain the virus were lost soon after, largely because of a lack of trust between local communities and the officials and medical professionals trying to nip the epidemic in the bud.” (Petherick 2015:591)

Online training of humanitarian professionals is one thing, but what about community participation? “Beneficiary communications” and “listening” approaches have emerged to encourage inclusive approaches to all aspects of humanitarian work.

Learning needs to include not just professionals but also volunteers and affected families, whether or not they are involved in social mobilization efforts. As the Red Cross Red Crescent Movement has taught us, volunteers are far more than part-time humanitarians. They are embedded in their communities and learn to use the cultural and tacit knowledge from belonging to empower themselves, their families, neighbors, and every member of the community – whatever their status, in a fully inclusive way. Making sense of what happens in a community (and what should be done there, as well as how to do it), more so than ever before, requires a fluid, reciprocal (two-way) connection between communities and global knowledge and practice.

Recognizing this, there are three practical questions:

1. what is the pedagogical model (and technology to deploy it) that can scaffold such an inclusive approach;
2. to what extent can we overcome limitations and barriers such as language or uneven access to the Internet, in the divide between the capital cities and the village; and
3. how can we capture and process learning during a crisis.

By opening up an inclusive “lessons learned” process to all involved in or affected by the Ebola crisis, a new learning system may:

1. provide a practical demonstration of the notion of “shared sovereignty” in the interest of protecting public health when health crises reach across borders;
2. contribute to mainstreaming community engagement as a core function when managing a health emergency.

Every organization has already engaged its own internal processes to monitor, evaluate, and review what went right, what went wrong, and what to do about it. Some organizations may feel that they have already completed the most thorough review and evaluation process (including public scrutiny) they have ever undertaken. Between organizations, dialog may be more difficult but is nevertheless occurring, at least between individuals who have learned to trust each other and are more keenly aware than ever that their effectiveness depends on the quality of collaboration and coordination. Lessons learned is already a major topic of scholarship referenced in the scientific literature since 2014 (2,690 articles found by Google Scholar for the search terms “Ebola” and “lessons learned”, with 70% of them published in 2015).

However, many if not most of these processes rely on small, closed feedback loops, inside expert circles or established organizational hierarchies, limiting the ability of such reviews to achieve double-loop learning in which the governing values as well as actions are questioned. Mainstreaming community engagement is unlikely to be taken seriously if the communities are kept outside of such efforts that declare their intention to be inclusive but lack mechanisms to do so effectively.

Resolving the technical barriers to access is necessary but insufficient to ensure community engagement in lessons learned. This is why we need an initiative that provides pedagogical affordances to facilitate the balance between central (global) and devolved (community) knowledge sources, key to recognition of the complementary value of both expert technical knowledge from the global perspective and the perspectives ‘from below’ of community health workers, volunteers, and others in the field.

The objective is to open access the lessons learned process, increasing the volume (scalable to accommodate hundreds or thousands of participants), diversity (any organization, country, role in the epidemic), and efficiency (faster knowledge production without sacrificing quality). Furthermore, knowledge sharing and peer review ensure that participants are learning from each other as they work, so that the lessons identified and reflect on have an immediate impact across the network of those taking part (and, by extension, their work contexts and organizations).

For participants in such a system, the process of community dialogue, knowledge sharing, peer review and revision will produce deep learning outcomes. The shared experience will also forge bonds of trust between individuals who otherwise might never meet, despite their common involvement in the crisis. Together, the learners will produce new knowledge that will be analyzed by the research project so that its output may inform the initiative’s organizational partners, and be available as a citable and extensible body of work going forward.

The author would like to acknowledge Bill Cope for his ceaseless guidance and boundless patience and Kátia Muck, whose research and insights nourished his own.

Reference

Petherick, Anna. “Ebola in West Africa: Learning the Lessons.” The Lancet 385, no. 9968 (February 2015): 591–92. doi:10.1016/S0140-6736(15)60075-7.

This is the fourth in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

“Continuous learning at the individual level is necessary but not sufficient to influence perceived changes in […] performance. It is argued that learning must be captured and embedded in ongoing systems, practices, and structures so that it can be shared and regularly used to intentionally improve changes in knowledge performance.” (Marsick and Watkins 2003:134)

Scholar is an online learning environment for collaborative learning developed through the education research and practice by Mary Kalantzis and Bill Cope of the University of Illinois College of Education. It is designed to produce (and not simply consume) knowledge, in order to develop higher-order thinking, analysis, reflection, evaluation, and application. It closely models forms of leadership and collaboration at the heart of how humanitarians learn and work together to solve problems.

In November 2013, the International Federation of Red Cross and Red Crescent Societies (IFRC) piloted the Scholar learning environment by offering a four-week course open to anyone with experience in at least one emergency operation. Funded by the American Red Cross, the course was supported by Emergency Response Unit (ERU) managers in National Societies and the FACT and ERU team in Geneva.

The call for participants was a single-page summary of the course, linked to a simple enrollment questionnaire. This call was publicized on the IFRC’s web site and circulated by National Societies, partners and supporters.

671 people enrolled in less than two weeks, half of them from the Red Cross Red Crescent Movement. Of those, 591 met the criteria for enrollment and 285 people (48%) fully engaged in the course work and community dialogue. Above all, the group was characterized by its diversity: over 100 countries (including 67 National Societies), hundreds of roles and missions were represented, with experience ranging from a single operation to over fifty.

The purpose of the course was to share and reflect on how we learn before, during, and after an emergency operation. There were no guidelines, reference materials, assigned readings, or expert lectures. Instead, learners were tasked with developing their own case study, guided by a structured evaluation rubric developed by global disaster management and learning experts. Engaged in this process, they found intrinsic motivation to contribute to the community dialogue, and soon began to share reference documents that they had found useful in their own work.

It was difficult in the beginning, but as I was writing and reading the different posts in the Scholar Community, information was coming back to me. Reading and writing [is] not what I love the most in my life, but I [discovered that] once you are reading or writing about something, you like, it [becomes] a passion. I am also getting better in ENGLISH [through] writing […] and reviewing others’ case study.

In addition, each week was punctuated by a “live learning moment”, a synchronous session using webinar technology. In Week 1, JP Taschereau, a seasoned humanitarian and head of operations from the IFRC, described how he learned to take on completely new responsibilities and solve complex problems (that included managing air operations!) in the early days following the December 2004 Tsunami. This inspired and encouraged the community, engaged in writing their first draft during that week. In the following weeks, these live sessions were used to share insights, questions, and breakthroughs by the participants, with strong facilitation but no expert intervention.

The participants engaged in the written activity (writing a case study) in three stages. First, they had to develop a short case study describing how they prepared for an operation they were in, what the gaps were in their knowledge, skills and competencies, and how they learned during the operation (Stage 1 – Writing). Second, they had to peer review the case studies of three other participants (Stage 2 – Review). Third, they had to revise their case study using the inputs and comments received from their peers (Stage 3 – Revision).

“I have been writing reports and case studies”, explained Sue, a learner in this course, “but this was one of its kind, as I had to assess myself and my work, my mistakes and my learning. In general […] we just pick a subject and start writing about that, but in this case study I was a subject […]. I discovered a lot of things which [I had not considered] before”.

In one month, 105 (37%) completed case studies, drafting, reviewing, and revising over 700 pages of new insights into the learning processes in emergency operations. Such a rapid pace (four weeks) and massive volume had never been achieved before.

The IFRC Scholar pilot was then researched by the University of Illinois team. Analysis of the knowledge produced, the learning processes, and evaluation feedback from participants demonstrated that:

1. open learning in the humanitarian context made productive use of diversity possible (across geographies, levels of experience, roles or position, organizations, etc.);
2. intrinsic motivation was nurtured and scaffolded by the Scholar learning process, leading to a high level of engagement and commitment from learners who forged bonds that, in some cases, outlasted the course;
3. the combination of sharing experience (community) and peer review (case study) led to collaboration and reflective learning outcomes; and
4. the knowledge produced was of surprisingly high quality (given the open enrollment and diversity).

Overall, the Scholar learning environment facilitated an economy of effort that made a strategic shift in how the pilot’s cohort learned more pragmatically realizable than in the past.

To learn more about the Learning in emergency operations pilot course, download Dr Katia Muck’s white paper or her paper The Role of Recursive Feedback: A Case Study of e-Learning in Emergency Operations published in the The International Journal of Adult, Community, and Professional Learning Volume 23, Issue 1.

In Friday’s final blog post in this series, we’ll try to determine how close to the ground a global and digital educational initiative can get.

References

Cope, Bill, and Mary Kalantzis. “Towards a New Learning: The Scholar Social Knowledge Workspace, in Theory and Practice.” E-Learning and Digital Media 10, no. 4 (2013): 332. doi:10.2304/elea.2013.10.4.332.

Kalantzis, Mary, and Bill Cope. New Learning: Elements of a Science of Education. Second edition. Cambridge University Press, 2012.

Marsick, Victoria J., and Karen E. Watkins. “Demonstrating the Value of an Organization’s Learning Culture: The Dimensions of the Learning Organization Questionnaire.” Advances in Developing Human Resources 5, no. 2 (May 1, 2003): 132–51. https://doi.org/10.1177/1523422303005002002

Magnifico, Alecia Marie, and Bill Cope. “New Pedagogies of Motivation: Reconstructing and Repositioning Motivational Constructs in the Design of Learning Technologies.” E-Learning and Digital Media 10, no. 4 (2013): 483. https://doi.org/10.2304/elea.2013.10.4.483

This is the third in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

“The responsible use of technology in humanitarian action offers concrete ways to make assistance more effective and accountable, and to reduce vulnerability and strengthen resilience. Distance learning and online education are good examples of technology supporting these goals” (World Disasters Report 2013:10).

There have been a number of online courses organized by humanitarian organizations as well as by higher education institutions. International organizations have developed e-learning courses such as MSF’s Ebola ebriefing and WHO’s Health Security Learning Platform, or leveraged existing online training packages such as IFRC’s scenario-based simulation modules on public health in emergencies.

American, British, Dutch, and Swiss universities are amongst those who have produced open online courses distributed on MOOC (Massive Open Online Course) platforms such as Coursera (Ebola Virus Disease: An Evolving Epidemic), Futurelearn (Ebola: Essential Knowledge for Health Professionals), and France Université Numérique (Ebola: Vaincre Ensemble!). All of these have focused on the transmission of information about the Ebola virus disease for general and/or specialist audiences, including those based in the field and in affected communities.

MSF’s Keri Cohn, writing from the Bo-Ebola Treatment Center in Sierra Leone, provided an account of the challenges she faced in using one such course due to access difficulties.

As an expat doctor, I have found your course […] to be excellent. Our national staff, who are local Sierra Leone nurses and clinical officers, have enrolled in the course on their mobile phone. However, because Internet is poor or not available, they have been unable to attend the course or [view videos]. In turn, with the help of MSF, I have been able to download [the content] and, together, in a group of around forty people, we have completed your course.

This is remarkable testimony with respect to the potential (as well as technical limitations) of online learning to disseminate reliable information to health workers, the ability of organizations to overcome technological barriers in the face of urgent need for information, and the high level of motivation of field-based health workers to acquire new knowledge.

But why should learning be a one-way street? What of the knowledge developed by Sierra Leone nurses and clinical officers through collaboration and engagement with people from the affected communities, peers from neighboring countries, and international staff? There is undoubtedly a massive amount of deep, continual learning happening in such a group through practice and experience, not to mention human bonds of friendship and solidarity, forged in the face of adversity. Learning – whatever the medium – cannot be reduced to the one-way transmission of information.

Many of the online learning technologies of the recent past have been modeled after top-down, legacy training systems. In their basic approach and use in practice, these are heavily weighted to the transmission of centralized knowledge from the center (headquarters, the capital city) to the periphery (the community, village, or clinic). They are frequently ineffective, as the transmitted knowledge is often abstract and decontextualized, while the value of existing local knowledge, practices and understanding is not recognized or incorporated into the learning experience.

Transmissive learning remains the dominant mode of formal learning in the humanitarian context, even though everyone knows that such an approach is ineffective when it comes to teaching and learning the critical thinking skills that are needed to deliver results and, even more crucially, to see around the corner of the next challenge. The moral economy of such transmissive education and training demands unquestioning compliance in the face of authority, lack of critical autonomy, and an absence of responsibility. Learners are treated as passive knowledge consumers rather than active knowledge producers, clearly out of alignment with both the spirit and practical needs of a humanitarian health crisis and processes of human capacity building in local communities and institutions. Such approaches are unlikely to foster collaborative leadership and team work, provide experience, or confront the learner with holistic complexity of specific sites and cases. In other words, they fail the crucial test of grounded relevance to improved preparedness and performance.

What can education contribute?

What can education contribute to the shape of future global health crisis response? What is the role of technology, beyond improving the efficiency of the transmission of information? Education research in many fields, including humanitarian work, has shown that significant learning, even transformative learning, is usually grounded in and builds upon experience. The educator’s role is to scaffold self-understanding, and to facilitate expansion of that self-understanding.

In our volatile working environment, what we know (usually thought of as content-based knowledge) is replaced with how we are connected to others. That is how we stay current and informed. Learning nowadays is about navigation, discernment, induction and synthesis, more than memory and deduction. Memory has become less relevant in a world where so much knowledge is within reach within seconds. Networks are a powerful problem-solving resource that people naturally turn to when they need help. We rely on small, trusted networks to accelerate problem-solving (learning).

Many new learning practices – through both formal and informal networks – develop organically, in the face of sometimes extreme circumstances. Often, it is exceptional leadership qualities in individuals (and sometimes their organizations) that make up for gaps and limitations of existing learning methods. Nevertheless, although humanitarians may initiate and lead change through their own learning, organizations must create facilitative structures to support and capture learning in order to move toward their missions (Yang 2003:154).

In Thursday’s blog post, I’ll share the experience of a pilot course that sought to overcome the limitations of transmissive learning to support knowledge co-construction by people with experience in humanitarian operations.  

References

Stocking, Barbara. “Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, July 2015. http://www.who.int/csr/resources/publications/ebola/ebola-panel-report/en/.

Sharples, Mike. “FutureLearn: Social Learning at Massive Scale.” presented at the Learning With MOOCs II (LWMOOCS), Columbia Teacher’s College, October 3, 2015. http://www.slideshare.net/sharplem/social-learning-at-massive-scale-lwmoocs-2015-slideshare.

Vinck, Patrick (Ed.). World Disasters Report: Focus on Technology and the Future of Humanitarian Action. Geneva, Switzerland: International Federation of Red Cross and Red Crescent Societies, 2013.

Yang, Baiyin. “Identifying Valid and Reliable Measures for Dimensions of a Learning Culture.” Advances in Developing Human Resources 5, no. 2 (May 1, 2003): 152–62. doi:10.1177/1523422303005002003.

This is the second in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

“Whereas health is considered the sovereign responsibility of countries, the means to fulfill this responsibility are increasingly global, and require international collective action and effective and efficient governance of the global health system.” (Stocking 2015:10)

“Effective crisis management for health”, writes the World Health Organization in its management response to the Stocking report, “requires a series of strategic shifts” (Chan 2015:5). Calls for substantial modernization of emergency management capacity and preparedness have focused on resources to ensure rapid mobilization for the provision of logistics, operational support, and community mobilization. Yet, “the primary lesson so far has not been about the need for new response methods, but about human resources and coordination”, wrote Anna Petherick in The Lancet in February 2015. “Building new treatment centres,” she concludes, “was an easy task [sic] next to training and supervising people to staff them” (Petherick 2015:592). In other words, how we learn is key to the strategic shift in how the world manages health crises.

Learning is the implicit process required to achieve the capacities sought. In-service training, the most prevalent form of formal learning, is only the tip of the iceberg. Every time we ask “how do we change the capacity of individuals and systems?”, we are asking about how we learn (pedagogy) and how we know what we know (epistemology). For example, learning, education and training (LET) are not mentioned at all in the 2005 International Health Regulations (IHR). Learning is the implicit process required to achieve the capacities described by the Regulations. And yet, we leave tacit the processes (the “how”) which enable the acquisition and sharing of knowledge, skills and behaviors (competencies) needed in order for the health workforce and affected communities to face a health crisis.

In Wednesday’s blog post, we’ll review online learning around Ebola so far – and examine whether such initiatives can contribute to the strategic shift in human resources and coordination.  

References

Chan, Margaret. “WHO Secretariat Response to the Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, August 2015.
 
Stocking, Barbara. “Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, July 2015.
 
Petherick, Anna. “Ebola in West Africa: Learning the Lessons.” The Lancet 385, no. 9968 (February 2015): 591–92. https://doi.org/10.1016/S0140-6736(15)60075-7