Stories

Tag: equity

  • The business of artificial intelligence and the equity challenge

    The business of artificial intelligence and the equity challenge

    Since 2019, when The Geneva Learning Foundation (TGLF) launched its first AI pilot project, we have been exploring how the Second Machine Age is reshaping learning. Ahead of the release of the first framework for AI in global health, I had a chance to sit down with a group of Swiss business leaders at the PanoramAI conference in Lausanne on 5 June 2025 to share TGLF’s insights about the significance and potential of artificial intelligence for global health and humanitarian response. Here is the article posted by the conference to recap a few of the take-aways.

    The Global Equity Challenger

    At the Panoramai AI Summit, Reda Sadki, leader of The Geneva Learning Foundation, delivered provocative insights about AI’s impact on global equity and the future of human work. Drawing from humanitarian emergency response and global health networks, he challenged comfortable assumptions about AI’s societal implications.

    The job displacement reality

    Reda directly confronted panel optimism about job preservation: “One of the things I’ve heard from fellow panelists is this idea that we can tell employees AI is not coming for your job. And I struggle to see that as anything other than deceitful or misleading at best. ”

    Eliminating knowledge worker positions in education

    “In one of our programmes, after six months we were able to use AI to replace key functions initially performed by humans. Humans helped us figure out how to do it. We then refocused a smaller team on tasks that we cannot or do not want to automate. We tried to do this openly.”

    What’s left for humans to do?

    “These machines are already learning faster and better than us, and they are doing so exponentially. Right now, what’s left for humans currently is the facilitation, facilitating connections in a peer learning system. We do not yet have agents that can facilitate, that can read the room, that can help humans understand.”

    Global access inequities

    Reda highlighted three critical equity challenges: geographic access restrictions (‘geolocking’), transparency expectations around AI usage, and punitive accountability systems that discourage innovation in humanitarian contexts. “Somebody who uses AI in that context is more likely to be punished than rewarded, even if the outcomes are better and the costs are lower. ”

    Emerging markets disconnect

    “Even though that’s where the future markets are likely to be for AI, ” Reda observed limited engagement with Africa, Asia, and Latin America among attendees, highlighting a strategic blindness to global AI market evolution.

    Organizational evolution question

    Reda posed fundamental questions about future organizational structures, questioning whether traditional hierarchical models with management layers will remain dominant “two years or five years down the line. ”

    Network-based innovation vision

    “We’ve nurtured the emergence of a global network of health workers sharing their observations of climate change impacts on the health of communities they serve. This is already powerful for preparedness and response, but we’re trying to find ways to weave in and embed AI as co-workers and co-thinkers to help health workers harness messy, complex, large-volume climate data.”

    Exponential learning challenge

    “These machines are already learning faster and better than us and that, and they’re doing so exponentially better than us. It’s pretty clear what, you know, what keeps me awake at night is what what’s left for humans. ”

    Key Achievement: Reda demonstrated how honest assessment of AI’s transformative impact requires abandoning comfortable narratives about job preservation, positioning global leaders to address equity challenges while identifying uniquely human capabilities in an AI-augmented world.

    Reda Sadki serves as Executive Director of The Geneva Learning Foundation (TGLF), a Swiss non-profit. Concurrently, he maintains his position as Chief Learning Officer at Learning Strategies International (LSi) since 2013, where he helps international organizations improve their change execution capabilities. TGLF, under his guidance, catalyzes large-scale peer networks of frontline actors across 137 countries, developing learning experiences that transform local expertise into innovation and measurable results.

    Image: PanoramAI (Raphaël Briner).

  • Patterns of prejudice: Connecting the dots helps health workers combat bias worldwide

    Patterns of prejudice: Connecting the dots helps health workers combat bias worldwide

    English | Français

    “I noticed that every time he went to appointments or emergency services, he was often met with suspicion or treated as if he was exaggerating his symptoms,” shared a community support worker from Canada, describing how an Indigenous teenager waited three months for mental health services while non-Indigenous youth were seen within weeks.

    This testimony was just one of hundreds shared during an unusual global gathering where frontline health workers confronted an uncomfortable truth: healthcare systems worldwide are riddled with biases that determine who lives and who dies.

    “Equity Matters: A Practical Approach to Identify and Eliminate Biases,” a special event hosted by the Geneva Learning Foundation (TGLF) on 10-11 April 2025, drew nearly 5,000 health professionals from 72 countries. What made the event distinctive wasn’t just its scope, but its approach: creating a forum where community health workers from rural Nigeria could share insights alongside WHO officials from Switzerland, where district nurses from South Sudan could analyze cases with medical college professors from India.

    When healthcare isn’t equal: Global patterns emerge

    Despite working in vastly different contexts, participants described remarkably similar patterns of bias.

    “A pregnant woman was about to deliver in the hospital, but the doctor said they need to deposit 500,000 naira before she can touch the woman,” recounted Onosi Chikaodiri Peter, a community health worker with Light Bringer’s Outreach in Nigeria. “The husband was begging, pleading, with 100,000 naira, telling the doctor that he could sell all his livestock to make sure that the wife was okay. But the doctor wouldn’t attend to the woman. Along the line, the woman gave up. The child died.”

    Dr. Tusiime Ramadhan, who works with Humanitarian Volunteers International in Uganda, observed the same pattern: “People with money are referred to private clinics and hospitals for better health services often owned by the same government workers who sent them there.”

    Some biases manifest in subtler ways. Hussainah Abba Ali, who works with Impact Santé Afrique in Cameroon, described seeking treatment for malaria during her university years: “Because I was a young woman, the nurse assumed I was just exaggerating. She barely examined me, gave me paracetamol and told me to rest. I later found out that several men who came in after me with similar symptoms were tested immediately for malaria.”

    The stories came from everywhere—a physiotherapist in Nigeria whose expertise was ignored in favor of a male colleague; a nutritionist in DR Congo whose albino neighbor avoided vaccination clinics because of stigma; a public health specialist in Ethiopia’s Somali Region who explained how healthcare systems are designed for settled communities, leaving pastoralist populations behind.

    Alina Onica, a psychologist with Romania’s Icar Foundation working with domestic violence survivors, noted: “Victims are often judged for ‘not leaving’ the abuser, as if staying means it’s not serious. This bias ignores the complex trauma and fear they live with every day.”

    A framework for sense-making beyond single-issue analysis

    What united these diverse testimonies was the application of the BIAS FREE Framework, a practical tool that helps identify and eliminate discriminatory patterns in health systems.

    “Margaret Eichler and I started this work back in 1995 after developing some gender-based analysis tools,” explained Mary Anne Burke, the framework’s co-author. “We realized we had created something that could be applied to all social hierarchies. We’ve workshopped it on every continent but Antarctica and found it applicable everywhere.”

    Unlike approaches that focus exclusively on gender, ethnicity, or disability, the BIAS FREE Framework examines how these factors intersect. Brigid Burke, a researcher who’s used and taught the framework for 15 years, explained how to identify three distinct problem types:

    • H problems: Where existing hierarchies are maintained
    • F problems: Where relevant differences between groups are ignored
    • D problems: Where different standards are applied to different groups

    “It is easier to understand a hierarchy when you’re experiencing the oppression,” Burke told participants. “You can feel that you’re being treated in a way that takes away your dignity. It’s harder when you might be the one who is either consciously or unconsciously oppressing other people.”

    During the event, participants first shared their own experiences, then began to analyze them using the framework. Abdoulie Bah, a regional Red Cross officer from The Gambia, offered his analysis: “Oppressive hierarchies suggest that certain groups experience more oppression than others, often leading to a competitive dynamic among marginalized groups.”

    Solutions from the ground up

    What distinguished this event from typical global health conferences was its emphasis on solutions developed by frontline workers themselves.

    Dr. Orimbato Raharijaona, a medical doctor from Madagascar, described his team’s efforts to reach children in remote areas: “We prioritized areas with low vaccination coverage and strengthened birth follow-up to target zero-doses. Community dialogue helped raise awareness of the need for vaccination.”

    In Mali, Bouréma Mounkoro, a public health medical assistant, discovered that simply rescheduling vaccination days to align with community availability dramatically improved coverage rates and reduced dropouts.

    Dayambo Yendoukoua from Niger’s Red Cross developed an integrated approach addressing rural women’s exclusion from maternal care: “Women from villages and farming hamlets have three times less access to obstetric care than urban women. We grouped women into Mothers’ Clubs, provided literacy training, set up income-generating activities, and established traditional ambulances managed by women.”

    This emphasis on community-based solutions resonated with Esther Y. Yakubu, a health worker with the Health and Development Support Programme in Nigeria: “This program will surely be of great value in the health sector. If put in place, it will make a huge difference and patients will receive quality treatment without any segregations.”

    Practical action – not academic debates – to decolonize global health

    The event itself embodied the principles it aimed to teach. Rather than positioning Western experts as authorities, TGLF structured the event to value diverse forms of expertise.

    “Community health workers can see barriers that researchers miss. Global researchers spot patterns invisible at the local level. Policy makers understand system constraints that affect implementation,” explained Reda Sadki, TGLF’s Executive Director. “It’s when these perspectives connect that we find better solutions.”

    On 24-25 April 2025, this community will reconvene to determine if there is enough interest and momentum to launch the Foundation’s Certificate peer learning programme for equity in research and practice. An inaugural course could be launched as early as June 2025.

    “Your participation helps determine if we develop a full program on identifying and removing bias in health systems,” TGLF explained in its materials. “When more than 1,000 people participate, it shows enough interest to create a more comprehensive learning opportunity.”

    The certificate program will bring together participants from across professional hierarchies—community health workers, district managers, national planners, and global researchers—creating a rare space where knowledge flows in all directions.

    Across time zones and contexts, the conversation highlighted a shared understanding: addressing bias in healthcare isn’t just about fairness—it’s about survival. As Haske Akiti Joseph, a radiographer from Nigeria’s National Orthopaedic Hospital, reflected: “These issues are happening everywhere because governments will not provide free medical services to the people, and medical considerations come due to who you are, not based on priority.”

    In a world where your chances of receiving timely, appropriate healthcare often depend on your gender, ethnicity, wealth, or location, the BIAS FREE Framework offers a practical way forward—one that begins with recognizing patterns of oppression that transcend borders and cultures.

    Image: The Geneva Learning Foundation Collection © 2025

  • L’équité compte: quand les soignants du monde entier témoignent des inégalités en santé

    L’équité compte: quand les soignants du monde entier témoignent des inégalités en santé

    English | Français

    GENÈVE, le 11 avril 2025 – Une initiative internationale inédite a rassemblé près de 5000 professionnels de santé pour partager leurs expériences face aux discriminations dans l’accès aux soins

    « Un enfant est mort parce que sa famille ne pouvait pas déposer 500 000 nairas [environ 300 francs suisses] avant le début des soins. Le père avait pourtant supplié qu’on s’occupe de l’enfant, proposant 100 000 nairas et promettant de vendre son bétail pour payer le reste. » Ce récit glaçant d’un professionnel de santé nigérian illustre la dure réalité des inégalités d’accès aux soins dont de nombreux témoignages ont été partagés lors d’un événement international consacré à l’équité en santé.

    Le 11 avril dernier, la Fondation Apprendre Genève a créé un espace de dialogue sans précédent, rassemblant près de 5 000 professionnels de la santé de 72 pays, dont 1 830 francophones. Intitulé « L’équité compte: une approche pratique pour identifier et éliminer les biais », cet événement a permis à des médecins, infirmiers, agents de santé communautaires et autres acteurs du terrain de raconter, dans leurs propres mots, les discriminations qu’ils observent quotidiennement.

    Des récits convergents malgré la diversité des contextes

    « L’originalité de cette rencontre réside dans sa capacité à faire émerger des expériences habituellement invisibilisées », explique Reda Sadki, directeur exécutif de la Fondation. « Des praticiens qui n’ont jamais accès aux tribunes internationales ont pu témoigner des réalités qu’ils affrontent chaque jour. »

    Ces témoignages, remarquablement similaires malgré la diversité des contextes, révèlent que le statut social détermine encore largement la qualité et la rapidité des soins. « Nous avions amené un enfant gravement malade à l’hôpital », raconte Neville Kasongo, du Corps des jeunes contre le paludisme en République démocratique du Congo. « Pendant que nous attendions plus de six heures, j’ai vu notre voisin arriver avec son enfant malade. Comme il avait des relations particulières dans cette institution, les cadres soignants se sont précipités pour s’occuper de son fils. Pour nous qui n’avions aucune connexion, quand ils sont finalement venus, l’enfant était déjà très affaibli. Une heure après, il est décédé. »

    Brigitte Meugang, point focal du Programme élargi de vaccination au Cameroun, a observé un phénomène similaire lors d’une visite à l’hôpital: « J’avais un malade hospitalisé et je suis arrivée un peu en retard pendant les heures de visite. Le vigile m’a dit: “Tu n’entres pas parce que l’heure de visite est déjà passée.” Quelques minutes plus tard, un cousin militaire est arrivé en tenue. Le vigile a ouvert le portail et lui a dit d’entrer. » Quand elle a demandé pourquoi, on lui a répondu qu’il était en uniforme. C’est seulement après avoir présenté sa carte professionnelle qu’elle a été autorisée à entrer.

    Les intervenants ont également souligné comment des groupes entiers sont systématiquement laissés pour compte. « Dans les zones de conflit au Burkina Faso, les femmes, les enfants et les personnes âgées déplacés subissent des violences basées sur le genre car leurs besoins spécifiques ne sont pas pris en compte », témoigne une spécialiste genre et inclusion sociale. « Les enfants souffrent de malnutrition, les femmes enceintes n’ont pas accès aux consultations prénatales, et les personnes âgées ne bénéficient pas de soins adaptés. »

    Quand l’injustice touche même les soignants

    Particulièrement frappants sont les témoignages de professionnels de santé ayant eux-mêmes subi des discriminations. Le Dr Balkissa Modibo Hama, coordonnatrice du programme mondial d’éradication de la poliomyélite pour l’OMS en Guinée, raconte: « Lors de l’accouchement de ma seconde fille, le personnel ne s’est pas occupé de moi jusqu’à ce que la sage-femme responsable arrive et leur dise qui j’étais. Soudain, tous se sont mobilisés autour de moi en me reprochant de ne pas m’être présentée. Après mon accouchement, j’ai convoqué tout le personnel pour les sensibiliser sur le fait qu’on ne devrait pas avoir besoin de dire qui on est pour recevoir des soins de qualité. »

    Dans certains cas, c’est l’expérience personnelle de l’injustice qui a motivé l’engagement professionnel. « À 13 ans, j’ai accompagné ma mère à l’hôpital », poursuit le Dr Hama. « L’infirmière, qui connaissait ma mère, a voulu me faire passer avant une femme Bororo dont l’enfant était plus mal en point. J’ai refusé, mais j’ai ensuite constaté que cette femme et son enfant avaient été négligés. Cette expérience m’a profondément marquée et a motivé ma décision de devenir médecin. »

    Christian Kpoyablé Clahin, infirmier en Côte d’Ivoire, a partagé un cas tragique: « Une femme est venue avec son enfant gravement malade. Elle n’avait pas d’argent pour payer les analyses. L’enfant a été mis à l’écart au laboratoire et cela a traîné jusqu’à ce qu’il soit trop tard. L’enfant est mort. J’ai interpellé le directeur de l’hôpital, mais les sanctions n’ont été que verbales. »

    Des initiatives locales qui font la différence

    Au-delà du constat, les participants ont partagé des solutions concrètes qu’ils ont développées face à ces inégalités. Arthur Fidelis Metsampito Bamlatol, coordinateur d’une association de santé au Cameroun, explique: « J’avais observé que les enfants Baka [pygmées] étaient insuffisamment vaccinés. Après avoir signalé ce problème au médecin-chef de district, nous avons cartographié les campements dans la forêt et institué des stratégies spéciales. Lors des campagnes suivantes, nous marchions parfois plusieurs heures à pied pour atteindre ces communautés isolées. »

    D’autres adaptations créatives ont été mentionnées, comme celle rapportée par Bouréma Mounkoro, assistant médical au Mali: « Le planning des activités de vaccination n’était pas synchronisé avec la disponibilité de la communauté. Nous avons reprogrammé les jours de vaccination en tenant compte des réalités locales, ce qui a amélioré la couverture vaccinale et réduit considérablement les cas d’abandon. »

    Pour Brice Alain Dakam Ncheuta, responsable de l’engagement communautaire à Médecins Sans Frontières au Niger, comprendre les dynamiques culturelles est essentiel: « Dans le Grand Sahel, pour réduire les biais dans la prise en charge des violences basées sur le genre, nous travaillons étroitement avec les leaders communautaires. Nous proposons des soins médicaux sans heurter la sensibilité culturelle, car cela fait partie de l’identité des personnes que nous accompagnons. »

    Les solutions peuvent parfois être simples mais révolutionnaires, comme l’illustre l’initiative de Dayambo Yendoukoua, délégué de programme santé à la Croix-Rouge au Niger: « Dans les villages et hameaux agricoles, nous avons constaté que les femmes ont trois fois moins accès aux soins obstétricaux que les femmes urbaines. Nous avons créé des Clubs de Mères, offert des formations d’alphabétisation, mis en place des activités génératrices de revenus, et établi des ambulances traditionnelles gérées par les femmes elles-mêmes. »

    Vers un partage de savoirs plus équitable

    L’originalité de cet événement réside également dans sa méthodologie même. Plutôt que de suivre le schéma classique des conférences internationales où les experts occidentaux partagent leur savoir avec les praticiens du Sud, la Fondation Apprendre Genève a délibérément inversé cette logique. « Ce sont les professionnels de terrain qui ont pris la parole en premier », souligne Reda Sadki, directeur exécutif de la Fondation.

    « Les agents de santé communautaire peuvent voir des obstacles que les chercheurs manquent. Les décideurs comprennent les contraintes systémiques qui affectent la mise en œuvre des politiques. C’est lorsque ces perspectives se connectent que nous trouvons de meilleures solutions », poursuit-il.

    Pour faciliter l’analyse de ces expériences, Brigid Burke a accompagné la rencontre en tant que Guide. Burke est une chercheuse spécialisée dans le cadre BIAS FREE, un outil développé par Mary-Anne Burke et Margaret Eichler, permettant d’identifier différents types de biais. Cela a permis d’aller au-delà des constats en proposant une grille d’analyse des échanges entre participants qui ont constitué le cœur de la rencontre.

    Le succès de cette approche pourrait conduire à la création d’un programme de formation international, dont le lancement sera discuté lors d’une nouvelle rencontre fin avril. « Nous souhaitons développer un espace où les connaissances circulent véritablement dans toutes les directions, plutôt que du Nord vers le Sud », précise M. Sadki.

    La participation massive à cet événement – bien au-delà des attentes des organisateurs – témoigne d’un besoin urgent d’aborder ces questions. « Votre participation aide à déterminer si nous développons un programme plus complet sur ces questions », a expliqué la Fondation. « Quand près de 5000 personnes participent, cela montre qu’il y a suffisamment d’intérêt. »

    « La meilleure stratégie pour corriger tous les biais reste l’installation partout dans nos pays d’une couverture maladie universelle », suggère le Dr Oumar Traoré, médecin de santé publique en Guinée. Une vision à laquelle fait écho Amadou Gueye, président du Malaria Youth Corps en Guinée: « Ces témoignages nous rappellent que l’équité en santé n’est pas qu’une question technique, mais aussi une question de justice fondamentale. »

    Image: Collection de la Fondation Apprendre Genève © 2025

  • Chilling effect

    Chilling effect

    We reached out to senior decision makers working in global health about the new Certificate peer learning programme for equity in research and practice.

    Crickets.

    One CEO wrote: “We aren’t currently in a position to enter into new strategic partnerships on the topic.”

    The chilling effect is real.

    Many organizations are retreating from publicly championing equity work—even those with deep commitments to fairness and inclusion.

    But here’s the opportunity: While public discourse faces headwinds, meaningful work continues through trusted networks and communities of practice.

    This is precisely when innovation in equity approaches accelerates—away from the spotlight but with profound impact.

    The evidence is clear: health systems that neglect equity waste resources and deliver poorer outcomes.

    When research excludes key populations or policies overlook certain communities, we all lose—through inefficiency, increased costs, and diminished impact.

    This moment calls for courage from those who understand that equity is fundamental to effective health systems.

    “The ultimate measure of a person is not where they stand in moments of comfort, but where they stand at times of challenge.” – Martin Luther King Jr.

    If you’re still committed to this essential work, you’re not alone.

    Question: How are you maintaining momentum on equity work during challenging times?

    Image: The Geneva Learning Foundation Collection © 2025

  • Widening inequities: Immunization Agenda 2030 remains “off-track”

    Widening inequities: Immunization Agenda 2030 remains “off-track”

    The WHO Director General’s report to the 154th session of the Executive Board on progress towards the Immunization Agenda 2030 (IA2030) goals paints a “sobering picture” of uneven global recovery since COVID-19.

    As of 2022, 3 out of 7 main impact indicators remain “off-track”, including numbers of zero-dose children, future deaths averted through vaccination, and outbreak control targets.

    Current evidence indicates substantial acceleration is essential in order to shift indicators out of the “off-track” categories over the next 7 years.

    While some indicators showed recovery from pandemic backsliding, the report makes clear these improvements are generally insufficient to achieve targets set for 2030.

    While some indicators have improved from 2021, overall performance still “lags 2019 levels” (para 5).

    Specifically, global coverage of three childhood DTP vaccine doses rose from 81% in 2021 to 84% in 2022, but remains below the 86% rate achieved in 2019 before the pandemic (para 5).

    The number of zero-dose children fell from 18.1 million in 2021 to 14.3 million in 2022. However, this number is still 11% higher compared to baseline year 2019, when there were 12.9 million zero-dose children (para 10).

    Furthermore, the report stresses that recovery has been “very uneven” (para 6), with minimal gains observed in low-income countries:

    “As a group, there was no increase in DTP3 coverage across 26 low-income countries between 2021 and 2022.” (para 6)

    Regions are also recovering unevenly, especially Africa.

    “In the African Region, the number of zero-dose children increased from 7.64 million in 2021 to 7.78 million in 2022 − a 25% increase since baseline year 2019.” (para 6)

    Inequities within countries also continue expanding, with gaps widening “between the best-performing and worst-performing districts” since 2019 (para 6).

    The top priorities (para 34) include:

    1) “Catch-up and strengthening” immunization activities
    2) “Promoting equity” to reach underserved communities
    3) “Regaining control of measles” with intensified responses
    4) Advocacy for “increased investment in immunization, integrated into primary health care”
    5) “Accelerating new vaccine introduction” in alignment with WHO recommendations
    6) “Advancing vaccination in adolescence” such as HPV vaccine introduction

    The report stresses that “coordinated action” on these priorities can get countries back on track towards IA2030 targets in the wake of COVID-19 disruptions (para 27).

    What is needed, says WHO, is “grounding action in local realities” (para 32) to reach underserved areas thus far left behind.

    Given this context, this document asks: “What actions can global partners take to support countries to accelerate progress in the six priority areas highlighted?” (para 37).

    In response, WHO contends that “the operational model under IA2030 must continue shifting focus to the regional level, to facilitate coordinated and tailored support to countries.”

    It is unclear how devolution to the regional level could truly respond to highly localized barriers and enablers.

    Such a claim may best be understood with respect to the internal equilibrium between WHO’s Headquarters (HQ) and the Regional Offices, with IA2030 being initially driven by HQ.

    What other changes might be needed? And what are the barriers that might hinder global immunization partners from recognizing and supporting such changes?

    Reference: Tedros Adhanom Ghebreyesus, 2023. Progress towards global immunization goals and implementation of the Immunization Agenda 2030. Report by the Director-General, Executive Board 154th session Provisional agenda item 9. World Health Organization, Geneva, Switzerland.

    Illustration: The Geneva Learning Foundation Collection © 2024