Stories

Tag: Human resources for health

  • Strengthening primary health care in a changing climate

    Strengthening primary health care in a changing climate

    A new article by Andy Haines, Elizabeth Wambui Kimani-Murage, and Anya Gopfert, “Strengthening primary health care in a changing climate,” outlines how climate change is already impacting health systems worldwide, with primary health care (PHC) workers bearing the immediate burden of response.

    Haines and colleagues make a compelling case for strengthening primary health care (PHC) as a cornerstone of climate-resilient health systems.

    First, they note that approximately 90% of essential universal health coverage interventions are delivered through PHC settings, making these facilities and workers the backbone of healthcare delivery.

    This is particularly significant because PHC systems address many of the health outcomes most affected by climate change, including non-communicable diseases, childhood undernutrition, and common infectious diseases like malaria, diarrheal diseases, and respiratory infections.

    Furthermore, PHC workers are often the first responders to extreme weather events such as floods, droughts, and heatwaves.

    They must manage both the immediate health impacts and the longer-term consequences of these events.

    This comprehensive view of PHC’s role in climate resilience represents a significant shift from viewing primary care merely as a service delivery mechanism to recognizing it as a crucial component of climate adaptation and health system strengthening.

    The authors argue that investing in PHC is not only essential for addressing immediate health needs but also for building long-term resilience to climate-related health threats.

    In examining workforce issues, Haines et al. specifically emphasize that “building the capacity of the PHC and public health workforce in emergency preparedness and response to climate-induced risks is crucial for enhancing the resilience of health systems.”

    They argue that “the health-care workforce, including multidisciplinary PHC teams, should be provided with training and education on the impacts of climate change on health and the implications for health-care delivery.”

    The article specifies that this training should focus on three key areas: “strengthening integrated disease surveillance and response systems,” “diagnosis and management of changing disease patterns (eg, outbreaks of vector-borne diseases in new locations),” and “interpretation and use of available climate, weather, and health data to support planning and management of adaptation and mitigation interventions.”

    They mention resources like those proposed by the “WONCA Global Family Doctor Planetary Health Working Party” as instructive for such training.

    Although the article emphasizes the role of PHC workers as being “often on the front line of responses to extreme events such as floods, droughts, and heatwaves,” it does not discuss mechanisms for capturing or leveraging their experiential knowledge.

    This is what they know because they are there every day.

    Recommendations follow a traditional institutional approach: strengthen health information systems, build workforce capacity, develop integrated service delivery models, increase funding, and enhance governance.

    While these recommendations are well-founded, they primarily envision a top-down flow of knowledge and resources, with health workers positioned as recipients of training and implementers of policies.

    The epistemological framework underlying their recommendations reflects what educational theorists would recognize as a transmission model of learning, where knowledge is conceived as flowing primarily from experts to practitioners in a hierarchical manner.

    This approach, while valuable for disseminating standardized protocols and evidence-based practices, implicitly positions health workers as passive recipients rather than active knowledge creators and agents of climate-health resilience.

    Such a framework potentially undervalues the situated knowledge and practical wisdom (what Aristotle called phronesis) that practitioners develop through direct experience with climate-health challenges in their communities.

    It also overlooks the potential for what complexity theorists describe as emergent learning – where new knowledge and practices arise from the dynamic interactions between practitioners facing similar challenges in different contexts.

    Our research has documented how health workers are already responding to climate-related health challenges.

    For example, observations from more than 1,200 health workers in 68 countries reveal a rich tapestry of local knowledge and insights that often go unrecognized in formal academic and policy discussions

    Health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.

    Where Haines sees health workers primarily as implementers of climate-resilient healthcare strategies, we view them as leaders and innovators in climate adaptation.

    However, these perspectives need not be mutually exclusive.

    TGLF’s model offers a bridge between formal institutional approaches and ground-level experiential knowledge.

    New peer learning platforms like Teach to Reach enable rapid sharing of solutions across geographical and institutional boundaries.

    This platform enables health workers to be both learners and teachers, sharing successful adaptations while learning from colleagues facing similar challenges in different contexts.

    Such participatory approaches also help local knowledge inform global understanding – if global research institutions and funders are willing to listen and learn.

    When TGLF gathered observations about climate change impacts on health, we received detailed accounts of everything from disease transmission to healthcare access.

    A health worker from Cameroon described how flooding from Mount Cameroon led to deaths in their community.

    Another from Kenya shared how changing agricultural patterns forced them to develop new strategies for ensuring safe food access.

    Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660

    These granular insights complement the broader statistical evidence presented in academic literature, providing crucial context for how climate changes manifest in specific communities.

    TGLF’s model demonstrates how digital technologies can democratize knowledge sharing to strengthen scientific evidence and drive locally-led action.

    This creates a dynamic knowledge ecosystem that can respond more quickly to emerging challenges than traditional top-down approaches.

    Importantly, this model addresses a key gap in Haines’ recommendations: the need for rapid, scalable knowledge sharing among frontline workers.

    While formal research and policy development necessarily take time, climate impacts are already affecting communities.

    TGLF’s approach enables immediate peer learning while building an evidence base for longer-term policy development.

    The model also addresses the issue of trust.

    Health workers, as trusted community members, play a crucial role in helping communities make sense of and navigate the changes they are facing.

    Their understanding of local contexts and constraints are critical to develop strategies that can actually be implemented.

    By combining institutional support with health worker-led local action, we can strengthen health systems to be both technically robust and locally responsive.

    Our experience at the Geneva Learning Foundation suggests that new learning and leadership are needed to bridge these approaches, enabling the rapid sharing of both formal and experiential knowledge while building the collective capacity needed to survive the impacts of climate change on our health.

    References

    Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7

    Image: The Geneva Learning Foundation Collection © 2024

  • Integrating community-based monitoring (CBM) into a comprehensive learning-to-action model

    Integrating community-based monitoring (CBM) into a comprehensive learning-to-action model

    According to Gavi, “community-based monitoring” or “CBM” is a process where service users collect data on various aspects of health service provision to monitor program implementation, identify gaps, and collaboratively develop solutions with providers.

    • Community-based monitoring (CBM) has emerged as a promising strategy for enhancing immunization program performance and equity.
    • CBM interventions have been implemented across different settings and populations, including remote rural areas, urban poor, fragile/conflict-affected regions, and marginalized groups such as indigenous populations and people living with HIV.

    By engaging service users, CBM aims to foster greater accountability and responsiveness to local needs.

    • However, realizing CBM’s potential in practice has proven challenging.
    • Without a coherent approach, CBM risks becoming just another disconnected tool.

    The Geneva Learning Foundation’s innovative learning-to-action model offers a compelling framework within which CBM could be applied to immunization challenges.

    The model’s comprehensive design creates an enabling environment for effectively integrating diverse monitoring data sources – and this could include community perspectives.

    Health workers as trusted community advisers… and members of the community

    A distinctive feature of TGLF’s model is its emphasis on health workers’ role as trusted advisors to the communities they serve.

    The model recognizes that local health staff are not merely service providers, but often deeply embedded community members with intimate knowledge of local realities.

    For example, in TGLF’s immunization learning initiatives, participating health workers frequently share insights into the social, cultural, and economic factors shaping vaccine hesitancy and uptake in their communities.

    • They discuss the everyday barriers families face, from misinformation to transportation challenges, and strategize context-specific outreach approaches.
    • This grounding in community realities positions health workers as vital bridges for facilitating community engagement in monitoring.

    When local staff are empowered as active agents of learning and change, they can more effectively champion community participation, translating insights into tangible improvements.

    Could CBM fit into a more comprehensive system from local monitoring to action?

    TGLF’s model supports health workers in this bridging role by providing a comprehensive framework for local monitoring and action.

    Through peer learning networks and problem-solving cycles, the model equips health staff to collect, interpret, and act on unconventional monitoring data from their communities.

    For instance, in TGLF’s 2022 “Full Learning Cycle” initiative, 6,185 local health workers from 99 countries examined key immunization indicators to inform their analyses of root causes and then map out corrective actions.

    • Participants began monitoring their own local health indicators, such as vaccination coverage rates.
    • For many, this was the first time they had been prompted to use this data for problem-solving a real-world challenge they face, rather than just reporting up the next level of the health system.

    They discussed many factors critical for tailoring immunization strategies.

    This transition – from being passive data collectors to active data users – has proven transformative.

    It positions health workers not as cogs in a reporting machine, but as empowered analysts and strategists.

    By discussing real metrics with peers, participants make data actionable and contextually meaningful.

    Guided by expert-designed rubrics and facilitated discussions, health workers translated this localized monitoring data into practical improvement plans.

    For an epidemiologist, this represents a significant shift from traditional top-down monitoring paradigms.

    By valuing and actioning local knowledge, TGLF’s model demonstrates how community insights can be systematically integrated into immunization decision-making.

    However, until now, its actors have been health workers, many of them members of the communities they serve, not service users themselves.

    CBM’s focus on monitoring is important – but leaves out key issues around community participation, decision-making autonomy, and strategy.

    How could we integrate CBM into a transformative approach?

    TGLF’s experiences suggest that CBM could be embedded within comprehensive learning-to-action systems focused on locally-led change.

    TGLF’s model is more than a monitoring intervention.

    • It combines structured learning, rapid solution sharing, root cause analysis, action planning, and peer accountability to drive measurable improvements.
    • These mutually reinforcing components create an enabling environment for health workers to translate insights into impact.

    In this framing, community monitoring becomes one critical input within a continuous, collaborative process of problem-solving and adaptation.

    Several features of TGLF’s model illustrate how this integration could work in practice:

    1. Peer accountability structures, where health workers regularly convene to review progress, share challenges, and iterate solutions, create natural entry points for discussing and actioning community feedback.
    2. Rapid dissemination channels, like TGLF’s “Ideas Engine” for spreading promising practices across contexts, enable local innovations in response to community-identified gaps to be efficiently scaled.
    3. Emphasis on root cause analysis and systemic thinking equips health workers to interpret community insights within a broader ecosystem lens, connecting localized issues to upstream determinants.
    4. Cultivation of connected leadership empowers local actors to champion community priorities and navigate complex change processes.

    TGLF’s extensive digital network connects health workers across system levels and contexts, enabling them to learn from each other’s experiences with no upper limit to the number of participants.

    By contrast, CBM seems to assume that a community is limited to a physical area, which fails to recognize that problem-solving complex challenges requires expanding the range of inputs used.

    Within a networked approach that connects both community members and health workers across boundaries of geography, health system level, and roles, CBM could become an integral component of a transformative approach to health system improvement – one that recognizes communities and local health workers as capable architects of context-responsive solutions.

    Fundamentally, the TGLF model invites a shift in mindset about whose expertise counts in monitoring and driving system change.

    CBM could provide the ‘connective tissue’ for health workers to revise how they listen and learn with the communities they serve.

    For immunization programs grappling with persistent inequities, this shift from passive compliance to proactive local problem-solving is critical.

    As the COVID-19 crisis has underscored, rapidly evolving public health challenges demand localized action that harnesses the full range of community expertise.

    TGLF’s model offers a tested framework for actualizing this vision at scale.

    By investing in local health workers’ capacity to learn, adapt, and lead change in partnership with the communities they serve, the model illuminates a promising pathway for integrating CBM into immunization monitoring and beyond.

    For epidemiologists and global health practitioners, TGLF’s approach invites a reframing of how we conceptualize and operationalize community engagement in health system monitoring.

    It challenges us to move beyond tokenistic participation towards genuine co-design and co-ownership of monitoring processes with local actors.

    Realizing this vision will require significant shifts in mindsets, power dynamics, and resource flows.

    But as TGLF’s initiatives demonstrate, when we invest in the leadership of those closest to the challenges we seek to solve, transformative possibilities emerge.

    Further rigorous research comparing the impacts of different CBM integration models could help accelerate this paradigm shift, surfacing critical lessons for the immunization field and global health more broadly.

    TGLF’s model not only offers compelling lessons for reimagining monitoring and improvement in immunization programs, it also provides a pathway for integrating CBM into a system that supports actual change.

    CBM practitioners are likely to struggle with how to incorporate it into existing practices.

    By investing in frontline health workers as change agents, and surrounding them with an empowering learning ecosystem, the model offers a path to then bring in community monitoring.

    Without such leadership from health workers, it is unlikely that communities are able to participate.

    The journey to authentic community engagement in health system monitoring is undoubtedly complex.

    But if we are to deliver on the promise of equitable immunization for all, it is a journey we must undertake.

    TGLF’s model lights one promising path forward – one that positions communities and local health workers as the beating heart of a learning health system.

    While Gavi’s evidence brief affirms the promise of CBM for immunization, TGLF’s experience with its own model suggests the full potential of CBM may be realized by embedding it within more comprehensive, digitally-enabled learning systems that activate health workers as agents of change – and do so with both physical and digital communities implementing new forms of peer and community accountability that complement conventional kinds (supervision, administration, donor, etc.).

  • Learn health, but beware of the behaviorist trap

    Learn health, but beware of the behaviorist trap

    The global health community has long grappled with the challenge of providing effective, scalable training to health workers, particularly in resource-constrained settings.

    In recent years, digital learning platforms have emerged as a potential solution, promising to deliver accessible, engaging, and impactful training at scale.

    Imagine a digital platform intended to train health workers at scale.

    Their theory of change rests on a few key assumptions:

    1. Offering simplified, mobile-friendly courses will make training more accessible to health workers.
    2. Incorporating videos and case studies will keep learners engaged.
    3. Quizzes and knowledge checks will ensure learning happens.
    4. Certificates, continuing education credits, and small incentives will motivate course completion.
    5. Growing the user base through marketing and partnerships is the path to impact.

    On the surface, this seems sensible.

    Mobile optimization recognizes health workers’ technological realities.

    Multimedia content seems more engaging than pure text.

    Assessments appear to verify learning.

    Incentives promise to drive uptake.

    Scale feels synonymous with success.

    While well-intentioned, such a platform risks falling into the trap of a behaviorist learning agenda.

    This is an approach that, despite its prevalence, is a pedagogical dead-end with limited potential for driving meaningful, sustained improvements in health worker performance and health outcomes.

    It is a paradigm that views learners as passive recipients of information, where exposure equals knowledge acquisition.

    It is a model that privileges standardization over personalization, content consumption over knowledge creation, and extrinsic rewards over intrinsic motivation.

    It fails to account for the rich diversity of prior experiences, contexts, and challenges that health workers bring to their learning.

    Most critically, it neglects the higher-order skills – the critical thinking, the adaptive expertise, the self-directed learning capacity – that are most predictive of real-world performance.

    Clicking through screens of information about neonatal care, for example, is not the same as developing the situational judgment to adapt guidelines to a complex clinical scenario, nor the reflective practice to continuously improve.

    Moreover, the metrics typically prioritized by behaviorist platforms – user registrations, course completions, assessment scores – are often vanity metrics.

    They create an illusion of progress while obscuring the metrics that truly matter: behavior change, performance improvement, and health outcomes.

    A health worker may complete a generic course on neonatal care, for example, but this does not necessarily translate into the situational judgment to adapt guidelines to complex clinical scenarios, nor the reflective practice to continuously improve.

    The behaviorist paradigm’s emphasis on information transmission and standardized content may stem from an implicit assumption that health workers at the community level do not require higher-order critical thinking skills – that they simply need a predetermined set of knowledge and procedures.

    This view is not only paternalistic and insulting, but it is also fundamentally misguided.

    A robust body of scientific evidence on learning culture and performance demonstrates that the most effective organizations are those that foster continuous learning, critical reflection, and adaptive problem-solving at all levels.

    Health workers at the frontlines face complex, unpredictable challenges that demand situational judgment, creative thinking, and the ability to learn from experience.

    Failing to cultivate these capacities not only underestimates the potential of these health workers, but it also constrains the performance and resilience of health systems as a whole.

    Even if such a platform achieves its growth targets, it is unlikely to realize its impact goals.

    Health workers may dutifully click through courses, but genuine transformative learning remains elusive.

    The alternative lies in a learning agenda grounded in advances of the last three decades learning science.

    These advances remain largely unknown or ignored in global health.

    This approach positions health workers as active, knowledgeable agents, rich in experience and expertise.

    It designs learning experiences not merely to transmit information, but to foster critical reflection, dialogue, and problem-solving.

    It replaces generic content with authentic, context-specific challenges, and isolated study with collaborative sense-making in peer networks.

    It recognizes intrinsic motivation – the desire to grow, to serve, to make a difference – as the most potent driver of learning.

    Here, success is measured not in superficial metrics, but in meaningful outcomes: capacity to lead change in facilities and communities that leads to tangible improvements in the quality of care.

    Global health leaders faces a choice: to settle for the illusion of progress, or to invest in the deep, difficult work of authentic learning and systemic change, commensurate with the complexity and urgency of the task at hand.

    Image: The Geneva Learning Foundation Collection © 2024

  • Climate change and health: Health workers on climate, community, and the urgent need for action

    Climate change and health: Health workers on climate, community, and the urgent need for action

    As world leaders gathered for the COP28 climate conference, the Geneva Learning Foundation called for the insights of health workers on the frontlines of climate and health to be heard amidst the global dialogue.

    Ahead of Teach to Reach 10, a new eyewitness report analyses 219 new insights shared by 122 health professionals – primarily those working in local communities across Africa, Asia and Latin America – to two critical questions: How is climate change affecting the health of the communities you serve right now? And what actions must world leaders take to help you protect the people in your care?

    (Teach to Reach is a regular peer learning event. The tenth edition on 20-21 June 2024 is expected to gather over 20,000 community-based health workers to share experience of climate change impacts on health. Request your invitation here.)

    Their answers paint a picture of the accelerating health crisis unfolding in the world’s most climate-vulnerable regions. Community nurses, doctors, midwives and public health officers detail how volatile weather patterns are driving up malnutrition, infectious disease, mental illness, and more – while simultaneously battering health systems and blocking patient access to care.

    Yet woven throughout are also threads of resilience, ingenuity and hope. Health advocates are not just passively observing the impacts of climate change, but actively responding – often with scarce resources. From spearheading tree-planting initiatives to strengthening infectious disease surveillance to promoting climate literacy, they are innovating locally-tailored solutions.

    Importantly, respondents emphasize that climate impacts cannot be viewed in isolation, but rather as one facet of the interlocking crises of environmental destruction, poverty, and health inequity. Their insights make clear that climate action and community health are two sides of the same coin – and that neither will be achieved without deep investment in local health workforces and systems.

    Rooted in direct lived experience and charged with moral urgency, these frontline voices offer a stirring reminder that climate change is not some distant specter, but a life-and-death challenge already at the doorsteps of the global poor. As this new collection of insights implores, it’s high time their perspectives moved from the margins to the center of the climate debate.

    As Charlotte Mbuh of The Geneva Learning Foundation explains: “We hope that the chorus of voices will grow to strengthen the case for  why and how investment in human resources for health is likely to be a ‘best buy’ for community-focused efforts to build the climate resilience of public health systems.”

    Jones, I., Mbuh, C., Sadki, R., & Steed, I. (2024). Climate change and health: Health workers on climate, community, and the urgent need for action (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918

  • Journée mondiale contre le paludisme: nous avons besoin de nouvelles façons de mener le changement

    Journée mondiale contre le paludisme: nous avons besoin de nouvelles façons de mener le changement

    English version | Version française

    Aujourd’hui, à l’occasion de la Journée mondiale contre le paludisme, la Fondation Apprendre Genève est fière de se tenir aux côtés des travailleurs de la santé en première ligne dans la lutte contre cette maladie.

    Le paludisme reste un problème de santé majeure, affectant de manière disproportionnée les communautés d’Afrique et d’Asie.

    C’est pourquoi la lutte contre le paludisme sera au cœur de Teach to Reach 10, un événement phare qui permet à des milliers de professionnels de santé du monde entier de partager leurs expériences, leurs réussites et leurs défis.

    Teach to Reach est une plateforme qui facilite l’apprentissage par les pairs afin de mener des actions locales sur des questions de santé urgentes.

    Lors de Teach to Reach 10 le 21 juin 2024, nous nous concentrerons sur la menace urgente que représente le changement climatique pour la santé, en mettant particulièrement l’accent sur la façon dont l’évolution des conditions environnementales modifie le paysage du risque de paludisme et de la riposte à ce fléau.

    Le leadership des professionnels de la santé est essentiel pour une vision intégrée de la lutte contre le paludisme par et pour les communautés locales

    Comme le montre notre récent rapport « De la communauté à la planète: Professionnels de la santé sur le front du climat», les agents de santé du niveau périphérique sont déjà les témoins directs de la manière dont les changements climatiques affectent les schémas pathologiques et pèsent sur les systèmes de santé.

    La hausse des températures, les phénomènes météorologiques extrêmes et l’évolution des précipitations créent des conditions idéales pour la prolifération des moustiques vecteurs du paludisme, exposant ainsi les communautés à des risques accrus.

    Des acteurs comme Yapoulouce Bamba, de Guinée, ont observé cette tendance inquiétante : «La dégradation de l’environnement a créé davantage de lieux de reproduction pour les moustiques. Pendant la saison des pluies, on observe une augmentation exponentielle des populations de moustiques, ce qui accroît le nombre de cas de paludisme.»

    De la gouvernance internationale à l’action locale : comment Teach to Reach peut contribuer à transformer la déclaration de Yaoundé en action locale

    Lors de la conférence Teach to Reach 10, nous discuterons de la manière de transformer l’engagement des dirigeants africains dans la déclaration de Yaoundé en actions concrètes, menées localement pour accélérer la lutte contre le paludisme.

    En rassemblant les acteurs de la santé pour partager des solutions locales et renforcer la résilience, nous soutenons l’appel de la déclaration en faveur de l’investissement dans la recherche et l’innovation, de la collaboration transfrontalière et de l’engagement des communautés en tant que partenaires dans la lutte contre le paludisme.

    Teach to Reach incarne ainsi la vision de cette Déclaration, qui consiste à soutenir ceux qui sont en première ligne de la lutte contre le paludisme en leur apportant les connaissances, les outils et la solidarité dont ils ont besoin pour avoir un impact transformateur dans leurs communautés.

    Nous avons besoin d’inventer de nouvelles façons de mener le changement

    En cette Journée mondiale contre le paludisme, nous invitons tous ceux qui se sont engagés à mettre fin à cette maladie à se joindre à nous pour apprendre et écouter auprès des agents de santé de première ligne.

    Leurs voix, leurs expériences et leur leadership sont essentiels pour stimuler l’action locale et la collaboration internationale nécessaires pour vaincre cette menace persistante dans un climat changeant.

    Ensemble, nous pouvons trouver de nouvelles façons de mener le changement pour construire un avenir sans paludisme, pour tous.

    Image: Collection de la Fondation Apprendre Genève © 2024

  • World Malaria Day 2024: We need new ways to support health workers leading change with local communities

    World Malaria Day 2024: We need new ways to support health workers leading change with local communities

    English version | Version française

    Today, on World Malaria Day, the Geneva Learning Foundation is proud to stand with health workers on the frontlines of the fight against this deadly disease.

    Malaria remains a critical global health challenge, disproportionately affecting communities in Africa and Asia.

    That’s why we’re putting malaria at the heart of the agenda for Teach to Reach 10, our landmark event connecting tens of thousands of health workers worldwide to share their experiences, successes, and challenges.

    Teach to Reach is a unique platform that enables health workers to learn from each other, contribute to global knowledge, and drive local action on pressing health issues.

    At Teach to Reach 10 this June, we will be focusing on the urgent threat of climate change to health, with a special emphasis on how changing environmental conditions are altering the landscape of malaria risk and response.

    Read Gavi’s article about our work: Global problems, local solutions: the health workers helping communities brace for climate change

    World Malaria Day: Health worker leadership is critical to an integrated view of malaria response by and for local communities

    As our recent report “On the frontline of climate change and health: A health worker eyewitness report” highlighted, health workers are already witnessing firsthand how climate shifts are affecting disease patterns and burdening health systems.

    Rising temperatures, extreme weather events, and changing rainfall patterns are creating ideal conditions for malaria-carrying mosquitoes to thrive, putting communities at greater risk.

    Health workers like Yapoulouce Bamba from Guinea have observed this worrying trend: “The degradation of the environment has created more breeding grounds for mosquitoes. During the rainy season, there is a noticeable exponential increase in mosquito populations, which in turn raises the number of malaria cases.”

    World Malaria Day: From global governance to local action: how Teach to Reach can contribute to turning the Yaoundé Declaration into local action

    At Teach to Reach 10, we’ll be discussing how to turn the commitment of African leaders in the Yaoundé Declaration into locally-led action to accelerate action against malaria.

    By bringing together health workers to share local solutions and build resilience, we are supporting the Declaration’s call for investment in research and innovation, cross-border collaboration, and engagement of communities as partners in the malaria fight.

    Teach to Reach embodies the Declaration’s vision of supporting those at the forefront of the malaria fight with the knowledge, tools, and solidarity they need to drive transformative impact in their communities.

    We need new ways to learn and lead

    On this World Malaria Day, we invite all those committed to ending malaria to join us in listening to and learning from frontline health workers.

    Their voices, experiences, and leadership are key to driving the local action and global collaboration needed to overcome this persistent threat in a changing climate.

    New ways to learn and lead are vital so that we can build a healthier, malaria-free future for all.

    Image: The Geneva Learning Foundation Collection © 2024

  • Protect, invest, together: strengthening health workforce through new learning models

    Protect, invest, together: strengthening health workforce through new learning models

    In “Prioritising the health and care workforce shortage: protect, invest, together,” Agyeman-Manu et al. assert that the COVID-19 pandemic aggravated longstanding health workforce deficiencies globally, especially in under-resourced nations. 

    With projected shortages of 10 million health workers concentrated in Africa and the Middle East by 2030, the authors urgently call for policymakers to commit to retaining and expanding national health workforces. 

    They propose common-sense solutions: increased, coordinated financing and collaboration across government agencies managing health, finance, economic development, education and labor portfolios.

    But how can such interconnected, long-term investments be designed for maximum sustainable impact?

    And what is the role of education?

    Rethinking health worker learning

    In a 2021 WHO survey across 159 countries, most health workers reported lacking adequate training to respond effectively to pandemic demands. This exposed systemic weaknesses in how health workforces develop skills at scale. Long before the COVID-19 pandemic, limitations of traditional learning approaches were already obvious.

    Prevailing modalities overly rely on passive knowledge transfer rather than active learner empowerment and engagement with real-world complexities. While assessment and credentialing are important, ultimately learning must be judged by its relevance, application and impact on people’s lives and health systems.

    Between April and June 2020, I had the privilege of working with a group of 600 of Scholars of The Geneva Learning Foundation (TGLF) from 86 countries. Together, we designed an immersive learning cycle integrating skill-building and peer exchange for those on the frontlines of the epidemic. We called it the “COVID-19 Peer Hub”. 

    It grew into an ecosystem that connected over 6,000 health professionals across 86 countries to share unfiltered insights, give voice to on-the-ground needs, and turn shared experience into action.

    Within three months, a third of participants had already implemented COVID-19 recovery plans, citing peer support as the main driver for turning their commitment into results.

    By the end of 2020, TGLF’s immunization platform, network, and community had tripled in size.

    In 2022, this network transformed into a Movement for Immunization Agenda 2030 (IA2030).

    Informing health workforce decisions

    What insights can health workforce policymakers draw from the Geneva Learning Foundation’s unique work to achieve the ambitious growth and support targets outlined by Agyeman-Manu et al.?

    First, expert-driven, top-down  approaches alone cannot handle emergent real-world complexities. In TGLF’s learning cycles, the most significant learning often occurs in lateral, one-to-one networking meetings between peers. These defy boundaries of geography, gender, ethnicity, religion, and job roles.

    Second, thoughtfully-applied technology can exponentially accelerate learning’s reach, access and connections following learner needs. New digital modalities opened by pandemic disruptions must be sustained and optimized post-crisis, despite the tendency to revert back to previous norms of learning through high-cost, low-volume formal trainings and workshop.

    Third, relevance heightens learning and application. Learning and teaching should not just be centered on learners’ needs and problems to boost motivation and effectiveness. Learning cannot be detached from its context.

    Finally, nurturing cultures that support effective learning matters for performance and human achievement. Systems enabling peer reward and accountability build resilience.

    Protect, invest, together in a learning workforce

    Health policymakers are manifesting intent to act on the health workforce crisis.

    Alongside urgent investments, applying systemic perspectives from learning innovations like those The Geneva Learning Foundation has pioneered presents a path to growing motivated, capable workforces ready for the challenges ahead.

    Rethinking assumptions opens eyes – when we commit to support health workers holistically, the rewards radiate across health ecosystems.

    Reference: Agyeman-Manu et al. Prioritising the health and care workforce shortage: protect, invest, together. The Lancet Global Health (2023). https://doi.org/10.1016/S2214-109X(23)00224-3

  • Prioritizing the health and care workforce shortage: protect, invest, together

    Prioritizing the health and care workforce shortage: protect, invest, together

    The severe global shortage of health and care workers poses a dangerous threat to health systems, especially in low- and middle-income countries (LMICs). The authors of the article “Prioritising the health and care workforce shortage: protect, invest, together”, including six health ministers and the WHO Director-General, assert that this workforce crisis requires urgent action and propose “protect, invest, together” to tackle it.

    Deep protection of the existing workforce, they assert, is needed through improved working conditions, fair compensation, upholding rights, addressing discrimination and violence, closing gender inequities, and implementing the WHO Global Health and Care Worker Compact to ensure dignified working environments. All countries must prioritize retaining workers to build resilient health systems.

    Significantly increased and strategic long-term investments are imperative in both training new health workers through educational channels and sustaining their employment. Countries should designate workforce development, especially at the primary care level, as crucial human capital investments impacting population health outcomes. Intersectoral financing is key, bringing together domestic funds, grants, concessional sources, and private sector partners into coordinated national plans. Global solidarity is required to resource-constrained LMIC health workforces.

    Intersectoral collaboration between ministries of health, finance, economic development, education and employment can develop integrated health workforce strategies. South-South partnerships offer pathways for health worker training and mobility to address regional shortages. Small island nations confront severe but overlooked workforce obstacles requiring specially tailored policy approaches.

    The severe projected health workforce shortfall urgently necessitates that actors globally protect existing health workers, strategically invest in growing national workforces, and unite intersectorally behind robust health employment systems, especially in lower resourced contexts. As the authors emphasize, “there can be no health, health systems, or emergency response without the health and care workforce.”

    What about the role of education?

    This article does not provide much direct discussion of health education systems related to the global health workforce shortage. However, it makes the following relevant points:

    1. Chronic underinvestment in the health and care workforce, including in education and training, has contributed to long-standing shortages.
    2. There is a need for strategic investments in health and care worker education and lifelong learning, with a focus on primary health care, to help address shortages.
    3. Investments in standalone health infrastructure will have little effect unless matched by investments in developing the health workforce through education and training.
    4. Increasing, smarter and sustained long-term financing is crucial for health and care worker education and employment.
    5. Regional and subregional collaboration should be explored to bring together resources and capacities for health workforce education and training.
    6. Intersectoral collaboration between health, education, finance and other sectors is important for developing policies and making investments in health workforce education.

    Read more to understand what this means for health education: Protect, invest, together: strengthening health workforce through new learning models

    Reference: Agyeman-Manu et al. Prioritising the health and care workforce shortage: protect, invest, together. The Lancet Global Health (2023). https://doi.org/10.1016/S2214-109X(23)00224-3

    Illustration: The Geneva Learning Foundation Collection © 2024

  • How do we reframe health performance management within complex adaptive systems?

    How do we reframe health performance management within complex adaptive systems?

    We need a conceptual framework that situates health performance management within complex adaptive systems.

    This is a summary of an important paper by Tom Newton-Lewis et al. It describes such a conceptual framework that identifies the factors that determine the appropriate balance between directive and enabling approaches to health performance management in complex systems.

    Existing health performance management approaches in many low- and middle-income country health systems are largely directive, aiming to control behaviour using targets, performance monitoring, incentives, and answerability to hierarchies.

    Health systems are complex and adaptive: performance outcomes arise from interactions between many interconnected system actors and their ability to adapt to pressures for change.

    In my view, this paper mends an important broken link in theories of change that try to consider learning beyond training.

    The complex, dynamic, multilevel nature of health systems makes outcomes difficult to control, so directive approaches to performance management need to be balanced with enabling approaches that foster collective responsibility and empower teams to self-organise and use data for shared sensemaking and decision-making.

    Directive approaches may be more effective where workers are primarily extrinsically motivated, in less complex systems where there is higher certainty over how outcomes should be achieved, where there are sufficient resources and decision space, and where informal relationships do not subvert formal management levers.

    Enabling approaches may be more effective in contexts of higher complexity and uncertainty and where there are higher levels of trust, teamwork, and intrinsic motivation, as well as appropriate leadership.

    Directive and enabling approaches are not ‘either-or’: designers of health performance management systems must strive for an appropriate balance between them.

    The greater the dissonance between designing a health performance management system and the real context in which it is implemented, the more likely it is to trigger perverse, unintended consequences.

    Interventions must be carefully calibrated to the context of the health system, the culture of its organisations, and the motivations of its individuals.

    By considering each factor and their interdependencies, actors can minimise perverse unintended consequences while attaining a contextually appropriate balance between directive or enabling approaches in complex adaptive systems.

    The complexity of the framework and the interdependencies it describes reinforce that there is no ‘one-size-fits-all’ blueprint for health performance management.

    For higher-order learning and whole-system improvement to occur, practical and tacit knowledge needs to flow among complex adaptive systems’ actors and organisations, thus leveraging the power of networks and social connections (eg, learning exchanges and communities of practice).

    Reference

    Newton-Lewis, T., Munar, W., Chanturidze, T., 2021. Performance management in complex adaptive systems: a conceptual framework for health systems. BMJ Glob Health 6, e005582. https://doi.org/10.1136/bmjgh-2021-005582l