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:
what we learned from the experiences themselves and how it can help practitioners; and
what we learned about the significance and potential of the peer learning process itself.
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.
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.
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.
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.
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
Watkins and Marsick describe learning culture as the capacity for change. They identify seven key action imperatives or “essential building blocks” that strengthen it: continuous learning opportunities, inquiry and dialogue, collaboration and team learning, systems to capture and share learning, people empowerment, connection to the environment, and strategic leadership for learning (Watkins & O’Neil, 2013).
Crucially, the instrument developed by Watkins and Marsick assesses learning culture by examining perceptions of norms and practices, not just individual behaviors (Watkins & O’Neil, 2013).
This aligns with Seye Abimbola’s assertion that learning in health systems should be “people-centred” and occurs at multiple interconnected levels.
Furthermore, this research demonstrates that certain dimensions of learning culture, like strategic leadership and systems to capture and share knowledge, are key mediators and drivers of performance outcomes (Yang et al., 2004).
This provides compelling evidence that investments in learning can yield tangible improvements in health delivery and population health.
Learn more: Jones, I., Watkins, K. E., Sadki, R., Brooks, A., Gasse, F., Yagnik, A., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., & Kovanovic, V. (2022). IA2030 Case Study 7. Motivation, learning culture and programme performance (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7004304
As Watkins and Marsick (1996) argue, to develop a strong learning culture, we need to “embed a learning infrastructure”, “cultivate a learning habit in people and the culture”, and “regularly audit the knowledge capital” in our organization or across a network of partners.
While investments in learning can be a challenging sell in resource-constrained global health settings, this evidence establishes that learning culture is in fact an indispensable driver of health system effectiveness, not just a “nice to have” attribute.
Subsequent studies have also linked learning culture to key performance indicators like care quality, patient satisfaction, and innovation.
To advance learning health systems, it is important to translate this research in terms that resonate with the worldview of global health practitioners like epidemiologists and to produce further empirical studies that speak to their evidentiary standards.
The learning culture framework offers an evidence-based approach to guide this transformation.
References
Abimbola, S. The uses of knowledge in global health. BMJ Glob Health 6, e005802 (2021).
Watkins, K. E. & O’Neil, J. The Dimensions of the Learning Organization Questionnaire (the DLOQ): A Nontechnical Manual. Advances in Developing Human Resources 15, 133–147 (2013).
Watkins, K., & Marsick, V. (1996). (Eds.). In action: Creating the learning organization (Vol. 1). Alexandria, VA: ASTD Press.
Yang, B., Watkins, K. E. & Marsick, V. J. The construct of the learning organization: Dimensions, measurement, and validation. Human Resource Development Quarterly 15, 31–55 (2004).
Argyris (1976) defines double-loop learning as occurring “when errors are corrected by changing the governing values and then the actions.” He contrasts this with single-loop learning, where “errors are corrected without altering the underlying governing values.”
Double-loop learning involves questioning “not only the objective facts but also the reasons and motives behind those facts”.
It requires becoming aware of one’s own “theories-in-use” – the often tacit beliefs and norms that shape behavior – and subjecting them to critical reflection and change.
This is challenging because it can threaten one’s sense of competence and self-image.
Checking for double-loop learning: ‘Are we doing things right?’ vs. ‘Are we doing the right things?’
In global health, double-loop learning means not just asking “Are we doing things right?” but also “Are we doing the right things?” It means being willing to challenge long-held assumptions about what works, for whom, and under what conditions.
Epistemological assumptions (“we already know the best way”), methodological orthodoxies (“this is not how we do things”), and apolitical stance (“I do health, not politics”) of epidemiology can predispose practitioners to be dismissive of a concept like double-loop learning.
Seye Abimbola is part of a growing community of researchers who argue that double-loop learning is critical for advancing equity and self-reliance in global health systems, because global health tends to overlook its own assumptions.
Is it reasonable to posit that some global health interventions have been driven by unchecked assumptions – assumptions about what communities need, what they value, and what will work in their context? How often have we relied on a one-size-fits-all approach, implementing ‘best practices’ from afar without fully understanding local realities? How do we know to what extent programs have thereby failed to meet their goals, wasted precious resources, and may have even caused unintended harm?
As Abimbola (2021) notes, “double-loop learning goes further to question and influence frameworks, models and assumptions around problems and their solutions, and can drive deeper shifts in objectives and policies.”
For example, affected communities hold vital expertise to mitigate health risks.
However, fully leveraging this potential requires global health professionals to fundamentally rethink their roles and assumptions.
For research to serve the needs of affected communities, it is likely to be useful to reframe these roles and assumptions to see themselves as “subsidiary” partners in service of “primary” community actors (Abimbola, 2021).
Institutionalizing double-loop learning requires enabling critical reflection and co-production between health workers, managers and citizens (Sheikh & Abimbola, 2021).
It also depends on developing the learning capacities of communities and health workers in areas like participatory governance, team-based learning and innovation management.
The next logical question is ‘how’ to implement double-loop learning.
Learning culture is a critical concept missing from health systems research.
It provides a practical and actionable framework to operationalize the double-loop learning notion of ‘learning health systems’ and drive transformative change.
Argyris, C. Single-loop and double-loop models in research on decision making. Administrative science quarterly 363–375 (1976). https://doi.org/10.2307/2391848
Argyris, C. Double-loop learning, teaching, and research. Academy of Management Learning & Education 1, 206–218 (2002). https://www.jstor.org/stable/40214154
Kabir Sheikh & Seye Abimbola. Learning Health Systems: Pathways to Progress. (Alliance for Health Policy and Systems Research, 2021).
The finding is based on analysis large-scale learning culture measurements conducted by the Geneva Learning Foundation in 2020 and 2022, with more than 10,000 immunization staff from all levels of the health system, job categories, and contexts, responding from over 90 countries.
Year
n
Continuous learning
Dialogue & Inquiry
Team learning
Embedded Systems
Empowered People
System Connection
Strategic Leadership
2020
3830
3.61
4.68
–
4.81
4.68
5.10
4.83
2022
6185
3.76
4.71
4.86
4.93
4.72
5.23
4.93
TGLF global measurements (2020 and 2022) of learning culture in immunization, using the Dimensions of Learning Organization Questionnaire (DLOQ)
What does this finding about continuous learning actually mean?
In immunization, the following gaps in continuous learning are likely to be hindering performance.
Relatively few learning opportunities for immunization staff
Limitations on the ability for staff to experiment and take risks
Low tolerance for failure when trying something new
A focus on completing immunization tasks rather than developing skills and future capacity
Lack of encouragement for on-the-job learning
This gap hurts more than ever when adapting strategies to reach “zero-dose” children.
These are children who have not been reached when immunization staff carry out what they usually do.
The traditional learning model is one in which knowledge is codified into lengthy guidelines that are then expected to trickle down from the national team to the local levels, with local staff competencies focused on following instructions, not learning, experimenting, or preparing for the future.
For many immunization staff, this is the reference model that has helped eradicate polio, for example, and to achieve impressive gains that have saved millions of children’s lives.
It can therefore be difficult to understand why closing persistent equity gaps and getting life-saving vaccines to every child would now require transforming this model.
Yet, there is growing evidence that peer learning and experience sharing between health workers does help surface creative, context-specific solutions tailored to the barriers faced by under-immunized communities.
Such learning can be embedded into work, unlike formal training that requires staff to stop work (reducing performance to zero) in order to learn.
Yet the predominant culture does little to motivate or empower these workers to recognize or reward such work-based learning.
Furthermore, without opportunities to develop skills, try new approaches, and learn from both successes and failures, staff may become demotivated and ineffective.
This is not an argument to invest in formal training.
Investment in formal training has failed to measurably translate into improved immunization performance.
Worse, the per diem economy of extrinsic incentives for formal training has, in some places, led to absurdity: some health workers may earn more by sitting in classrooms than from doing their work.
With a weak culture of learning, the system likely misses out on practices that make a difference.
This is the “how” that bridges the gap between best practice and what it takes to apply it in a specific context.
The same evidence also demonstrates a consistently-strong correlation between strengthened continuous learning and performance.
Investment in continuous learning is simple, costs surprisingly little given its scalability and effectiveness.
The Geneva Learning Foundation. From exchange to action: Summary report of Gavi Zero-Dose Learning Hub inter-country exchanges. Geneva: The Geneva Learning Foundation, 2023. https://doi.org/10.5281/zenodo.10132961
The Geneva Learning Foundation. Motivation, Learning Culture and Immunization Programme Performance: Practitioner Perspectives (IA2030 Case Study 7) (1.0); Geneva: The Geneva Learning Foundation, 2022. https://doi.org/10.5281/zenodo.7004304
The following is excerpted from Watkins, K.E. and Marsick, V.J., 2023. Chapter 4. Learning informally at work: Reframing learning and development. In Rethinking Workplace Learning and Development. Edward Elgar Publishing.
This chapter’s final example illustrates the way in which organically arising IIL (informal and incidental learning) is paired with opportunities to build knowledge through a combination of structured education and informal learning by peers working in frequently complex circumstances.
Reda Sadki, president of The Geneva Learning Foundation (TGLF), rethought learning and development (L&D) for immunization workers in many roles in low- and middle-income countries (LMICs).
Adapting to technology available to participants from the countries that joined this effort, Sadki designed a mix of experiences that broke out of the limits of “training” as it was often designed by conventional learning and development practitioners.
He addressed, the inability to scale up to reach large audiences; difficulty to transfer what is learned; inability to accommodate different learners’ starting places; the need to teach learners to solve complex problems; and the inability to develop sufficient expertise in a timely way. (Marsick et al., 2021, p. 15)
This led his organization, to invite front-line staff from all levels of immunization systems in low- and middle-income countries (LMICs) to create and share new learning in response to the social and behavioral challenges they faced.
Sadki designed learning and development for “in-depth engagement on priority topics,” insights into “the raw, unfiltered perspectives of frontline staff,” and peer dialogue that “gives a voice to front-line workers” (The Geneva Learning Foundation, 2022).
Reda started with an e-learning course, which he supplemented by interactive, community building, and knowledge creation features offered by Scholar, a learning platform developed by Bill Cope and Mary Kalantzis (Marsick et al., 2021, pp. 185-186).
Scholar’s learning analytics enabled him to tailor learning to learner preferences and to continually check outcomes and adjust next steps.
See Figure 4.3, which lays out the full learning cycle, a combination of interventions that Reda assembled over time to support peer learning-based work—“work that privileges learning in order to build individual and organizational capacity to better address emergent challenges or opportunities” (Marsick et al., 2021, p.177).
In his initiative, over a period of 12-18 months, participants develop and implement projects related to local immunization initiatives.
To date, participants have come from 120 countries.
In this vignette, Reda Sadki reflects on how this new model for learning and development evolved over time, and how L&D is transformed in a connected, networked learning environment.
My reframe of learning and development started when I wrote to Bill Cope and Mary Kalantzis, respectively professor and dean of the University of Illinois College of Education, after I was appointed Senior Officer for Learning Systems at the International Federation of Red Cross and Red Crescent Societies (IFRC). I shared my strategy for the organization of facilitation, learning, and sharing of knowledge. I thought my strategy was brilliant. (At the time, I was already thinking that this was about more than learning and development…)
They replied that these were interesting ideas, but I was missing the point because this is not learning. What I shared focused on publishing knowledge in different ways, but not on creation of knowledge as key to the learning process.
That was a shock to me.
So, the first realization about the limits of current thinking about learning and development came from Bill and Mary challenging me by saying: “What are people actually getting to do? You know, that’s where the learning is likely to happen.”
I could see they had a point, but I didn’t know what it meant.
I reflected on recent work I had done for the IFRC, where I was responsible for a pipeline of 80 or so e-learning modules.
These information transmission modules were extremely limited, had very little impact.
But there is a paradox, which is that people across the Red Cross who we were trying to reach were really excited and enthusiastic about them.
I had not designed these modules.
It was 500 screens of information with quizzes at the end.
It violated every principle of learning design.
And yet people loved it and were really proud to have completed it.
The second realization was that what made people excited using the most boring format and medium was that this was the first time in their life that they were connecting in a digital space with something that spoke to their IFRC experience.
So, the driver was learning.
People come to the Red Cross and Red Crescent because they want to learn first aid skills, to prepare for a disaster, or to recover from one.
Previously, that was an entirely brick-and-mortar experience.
You have Red Cross branches pretty much everywhere in the world.
It’s a very powerful social peer learning experience.
The trainer teaching you is likely to be someone like you from your community.
You meet people with like-minded values.
And so, however inadequate, the digital parallel to that existed, and it helped people connect with their Red Cross culture, but in a digital space.
With that insight, the learning platform became the fastest-growing digital system in the entire Red Cross Red Crescent Movement.
That was the connection of learning and development to complexity and networks.
I read Marsick and Watkins in the ’80s and ’90s. Informal and incidental learning mattered then. Its significance would explode with the digital transformation.
In my mind , that is what Siemens tapped into in the 2000s, through the lenses of digital network, complexity, and systems theory.
The Internet leads to a different kind of thinking and doing.
His theory of learning, connectivism, grew out of that difference.
January of 2011, Ivy League universities began to publish massive open online courses (MOOCs), three years after George Siemens and his Canadian colleagues had coined the term while implementing connectivism.
Stanford professors had 150,000 people in their artificial intelligence MOOC, alongside 400 people who took the same course on the Stanford campus.
Learning at scale is an important part of problem-solving complex challenges.
It is also important for peer learning and innovation: the greater the scale, the greater the diversity of inputs that we can use to support each other’s learning.
Nine years later, at the Geneva Learning Foundation, we had digital scaffolding or learning infrastructure already in place.
I had been working, since 2016, with the World Health Organization, to help country-based immunization staff translate global guidelines, norms, and standards into practice.
The COVID-19 Scholar Peer Hub became a digital network hosted by The Geneva Learning Foundation (TGLF) and developed with over 600 health worker alumni from all over the world.
We began to understand not only learningat scale, but also design at scale.
The Peer Hub launched in July 2020 and connected over 6,000 health professionals from 86 countries to contribute to strengthening skills and supporting implementation of country COVID-19 plans of action for vaccination, and to recover from the damage wrought by the pandemic.
Our network, platform, and community tripled in size, in less than six months.
Using social network analysis (SNA), Sasha Poquet explored the value of such a learning environment, one that builds a community of learning professionals, and that has ongoing activities to maintain the community both short- and long term, where you educate through various initiatives rather than create individual communities for each independent offering.
It’s a holistic system of systems, in which everything is connected to everything, and every component is like a fractal embedded in the other components.
This is not an abstract concept. We have found ways to actually implement this, in practical ways, with startling outcomes.
That’s where we have moved in rethinking learning and development.
You help people learn by connecting to each other, and by understanding the informal, incidental nature of learning.
Yet these are two competing frameworks that collide, contradict, and are superimposed on top of each other.
Both are helpful at specific times.
In general, you can recognize the tensions and say: “Well, let’s put each one in front of the problem. Let’s see what we gain by applying each. Let’s reconcile in situ what the contradictory things are that we learn through these different lenses and then make decisions and figure out what the design elements look like.”
What does it give to hold these notions of community and network in creative tension with one another?
It’s kind of like a fruit salad where you mix all these fruits together and the juice you get at the bottom of the bowl tends to be really delicious. That’s the best case.
The flip side can be confusion.
Some categories of learners just feel completely overwhelmed by being presented with multiple ways of doing something, having to make their own decisions in ways they’re simply not used to, being given too many choices or being put in contexts that are too ambiguous for there to be an easy resolution.
But if you think about the skills we need in a digital age—for navigating the unknown, accepting uncertainty, making decisions, that ability to look around the corner—we try to convey the message to people who are uncomfortable that if they don’t figure out how to overcome their discomfort, they’re probably going to struggle and not be ready to function in the age in which we live.
Evolution of a new model for learning and development
Looking back to early 2020, Reda described important insights from an early pre-course symposium offering lived experiences shared by course applicants combined with video archives drawn from prior conferences sponsored by the Bill & Melinda Gates Foundation.
Reda packaged selected recorded talks in a daily sequence, and interspersed it with networking discussions and sharing of experiences of immunization training by field-based practitioners.
For many, it was the first time they could go online and discover the experience of a peer, who could be from anywhere in the world.
It was a process of discovery – realizing you can literally and figuratively connect across distance with people who are like yourself.
We were able to create a conference-like experience, a metaphor that’s familiar to many—the combination of presentation and conversation and shared experience – by basically Scotch-taping together some older videos and editing a few stories from the real world.
Now, it was part of an overall process over several years that got us to that point—where we had formed a community, a digital community that was mature enough, that was sophisticated enough, to overcome the barriers they were facing and participate.
But still, it showed it could be done.
We began to try out our new ideas and practices.
In the first Teach to Reach Conference in January 2021, we designed with an organizing committee composed of over 500 alumni, we set up opportunities for people to pair of and talk to one another about their field experiences with vaccination.
Peer learning mattered more than ever, because participants were immunization staff getting ready to introduce new COVID-19 vaccines in developing countries.
There were no established norms and standards for how to do this.
The conference offered some 56 workshops and other formal sessions, plenaries, and interviews.
However, we discovered that the most meaningful learning was through some 14,000 networking meetings, where you pressed a button and you were randomly matched with someone else at the conference.
People now join group sessions where you listen to peers sharing their insights and experiences of vaccine hesitancy or other topics, and then you go off and network in one-to-one, private meetings and share your own experience, nourished by what happened in that group session; and also continue your learning in that very intimate way that you get through individual conversation that you don’t get in the anonymization of the Zoom rectangles.
Dialogue is great, but we are most interested in action that leads to results.
In every formal course, learners design a project around a real problem that they face, and use multiple learning resources to support learning in the context of that project.
An evaluation showed that people were already implementing projects and doing things with what they had learned.
How could we scaffold not just learning but actual project implementation?
In order to catalyze action, we added a number of components in a sequence, a deliberate pedagogical pattern designed on the basis of evidence from learning science combined with empirical evidence from our practice.
First, the Ideas Engine, where people share ideas and practices, and give and receive feedback on them.
That’s followed by situation analysis really getting to the root cause of the problem they’re facing. We just ask learners to ask “why” fives times. Half of learners found a root cause different from the one they had initially diagnosed.
And third, then, is action planning to clarify: What’s your goal? What are three corrective actions you’re going to take? How will you know that you have achieved your goal?
These are classic, conventional action planning questions.
The difference is the networked, peer learning model. It’s described by some learners as a “superpower”. Defying distance and many other boundaries, each person can tap into collective intelligence to accelerate their progress.
It has taken years to bring together the right components, in the right sequence, to encourage reflective practice, develop analytical competencies, higher-order learning… but in ways that link every step of thinking to doing, and where the end game is about improved health outcomes, not just learning outcomes.
That led us ultimately to the Impact Accelerator—that doesn’t have an end point.
It starts with four weeks of goal setting, focused on continuous quality improvement.
People initially declare very ambitious goals like, “By the end of the month I will have improved immunization coverage.” This is too broad to be useful, and seldom can be achieved within a month.
We help them set specific goals. For example: “By the end of the month, I will have presented the project to my boss and secured some funding”— and even that may be quite ambitious.
We help people figure out for themselves what they can actually do within the constraints they have.
Unlike “Grand Challenges” or other innovation tournaments, you don’t have a competitive element, you don’t have a financial incentive, and it still works.
The heart and soul of it is intrinsic motivation.
After these steps there’s ongoing longitudinal reporting.
Peer learning provides a new kind of accountability, as colleagues challenge each other to do better – and also to present credible results.
Basically, we’ll call you back and ask, what happened to that project you were doing? Did you finish it? Did you get stuck? if so, why? What evidence do you have that it’s made a difference? You share that with us and if you have good news to share, we’ll probably invite you to an inspirational event for the next cycle.
Challenges in inventing a new learning model
If you look at this from the point of view of the learner, the first point of contact is social.
It’s somebody they know who’s going to share with them on WhatsApp the invitation to join the program.
Second are steps that test motivation and commitment because they could be seen as barriers to entry, for example, a long questionnaire for the current full learning cycle.
To join the cycle, 6,185 people in the first two weeks took the time to answer 95 questions, generating over half a million data points and insights.
About 40% of people who start the questionnaire finish it, and then start receiving instructions in a flow of emails, to prepare for the next steps.
We could have reduced the number of questions, lowering the barrier to entry.
We start with didactic steps, combined with some inspirational messages, e.g., asking them to reflect on why they are committed to the program, or how they are going to organize their time.
We don’t know what the program design will look like until we’ve collected the applications and analyzed what people share about their biggest challenges because it’s all challenge-based.
For example, we may think there is a problem due to vaccine hesitancy. We may be right: vaccine hesitancy is frequently given as a significant challenge. But there may be some things that surprise us.
And so, we adapt every part of the design, and we keep doing that every day throughout the program, so there’s no disconnect between the design and the implementation.
The design is the content.
The first thing may be an inspirational event to connect with their intrinsic motivation, which we then tap into throughout the cycle.
In June 2022, for example, we had an event for the network that completed the first part of the full learning cycle.
We challenged people to share photos, showing them in the field, doing their daily work during World Immunization Week.
We received over 1,000 photos in about two weeks.
We organized a community event. It was a slide show: showing photos with music, reading the names of those who had contributed, inviting them to comment each other’s photos.
A big chunk of what we do addresses the affective domain of learning that is critical to complex problem-solving and usually incredibly hard to get to.
And what we saw were people in the room having those moments of coming to consciousness, realizing their problems are shared, and feeling stronger because of it.
It was online, but you could feel the emotion. Something very powerful that we do not quite know how to describe, measure, or evaluate.
People love peer learning in principle but still are wary.
They might wonder how they can trust what their peer says: What’s the proof I can rely on them? What happens if they let me down? How do I feel if I don’t own up to the expectations? What if I’m peer-reviewing the work of somebody who’s far more experienced than I am, or conversely, if I read somebody’s work and judge they didn’t have the time or make the effort to do something good?
We use didactic constraints to scaffold spaces of possibility: If your project is due by Friday, we announce that there will be no extension. By contrast, the choice of project is yours.
We’re not going to tell you what your challenge is in your remote village, so you define it. We will challenge you to put yourself to the test, to demonstrate that this is actually your toughest challenge.
Or to demonstrate that what you think is the cause is the actual root cause.
And then we’ll have a support system that has about 20 different ways in which people can not only receive support, but also give it to others.
For the technical support sessions, for example, we’ll say there are two reasons for joining. Either you have a technical issue you want to solve; or you’re doing so well, you have a little bit of time to give to help your colleagues.
This is just one example of how we encourage connections between peers.
It took us years to find the right way to formulate the dialectic between those who are doing well, and those who are not. Are they really peers?
Over time, we gained confidence in peer learning after we adopted it.
We had prior experiences with learners who wanted an expert to tell them if their assignment was good or not.
Getting people to trust peer learning forced us to think through how we articulate the value of peer learning.
How do we help people understand that the limitations are there, but that they do not limit the learning?
An assumption in global health is that, in order to teach, you need technical expertise.
So if you are a technical expert, it is assumed that you can teach what you know.
We consider subject matter expertise, but if you are an expert and come to our event, you’re actually asked to listen, as a guide on the side rather than a sage on the stage.
You do not get to make a presentation, at least not until learners have experienced the power of peer leraning.
You listen to what people are sharing about their experiences.
Then, you have a really important role, that is to respond to what you’ve heard and demonstrate that your expertise is relevant and helpful to people who are facing these challenges.
That has sometimes led to opposition when experts realize to what extent we flipped the prevailing model around.
Some people really embrace it.
Others get really scared.
One of the most recent shifts we have made is that we stopped talking about courses.
Courses are a very useful metaphor, but we are now talking about a movement for immunization.
In the past, we observed that people who dropped out felt shame and stopped participating.
Even if you are not actively participating, you’re still a member of the immunization movement.
People have participated as health professionals, as government workers, as members of civil society, in various kinds of movements since decolonization.
So the “movement” metaphor has a different resonance than that of “courses”.
We used to call the Monday weekly meeting a discussion group.
We’re now calling it a weekly assembly.
It is a term that speaks to the religiosity of many learners, as well as to those with social commitments in their local communities.
About ten years ago, I began to think of my goal for these discussion groups like the musician, the artist that you most appreciate, who really moves your soul, moves you, your every fiber and your body and your soul and your mind.
I remember in 1989 I went to a Pink Floyd concert.
When we left the concert, we were drenched in sweat.
I was exhausted and just had an exhilarating experience.
That’s what I would like people who participate in our events to feel.
I believe that’s key to fostering the dynamics that will lead to effective teaching and learning and change as an outcome.
We’re still light years away from that.
A global health researcher told me that when she joins our events, she feels like she is in church in her home country of Nigeria.
The Geneva Learning foundation’s Dialogue connects a diverse group of learning leaders from all over the world who are tackling complex learning, leadership, and impact challenges. We explore the significance of leadership for the future of our societies, explore lessons learned and successes, and problem-solve real-world challenges and dilemmas submitted by Contributors of the Dialogue.
In the Geneva Learning Foundation’s Ninth Dialogue for Learning & Leadership, we start with Dr. Mai Abdalla. After studying global health security in at Yosei University South Korea and both public health and pharmaceutical science in her own country, Egypt. By the time she turned 30, Dr Abdalla had already worked with the Ministry of Health, UN agencies, and the African Union Commission. The accomplishments of her professional life are just the starting point, as we want to explore where and how did she learn to do what she does now? What has shaped her practice of leadership?
We are privileged to have Key Contributors Laura Bierema and Bill Gardner, together with Karen Watkins, three Scholars who have dedicated their life’s work to the study of leadership and learning. As we learn about Mai Abdalla’s leadership journey, they share their insights and reflections.
Here are a few of the questions we have explored in previous episodes of the Dialogue:
How do you define your leadership in relationship to learning?
Do you see yourself as a leader? Why or why not? If you do, who are your ‘followers’? Are you a ‘learning leader’ and, if so, what does that mean?
How do you define leadership in this Digital Age? How is it different from leadership in the past?
When and how did you realize the significance of the leadership question in your work and life? Who or what helped you come to consciousness? What difference did it make to have this new consciousness about the importance of leadership?
What is your own leadership practice now? Can you tell us about a time when you exercised ‘leadership’. What were the lessons learned? What would you do the same or differently if confronted with the same situation in the future?
In the second half of the Dialogue, we explored the leadership challenges of other other invited Contributors, including:
Sanusi Getso on leadership to establish antenatal care services for a neglected community.
Alève Mine shares her quandary about how to understand something for which no scaffold exists in one’s current view of the world.
