Stories

Category: Education business models

  • Renaissance

    Renaissance

    For decades, learning in global health has depended on a conventional model premised on the scarcity of available knowledge and an emphasis on establishing mechanisms to transmit that knowledge from the center (capital city, headquarters) to the periphery (field, village, training room).

    With the Internet, scarcity disappeared. But the economy of high-cost, low-volume training has persisted, with little or no accountability. Worse, transmissive training – replicating the least-effective practices from physical spaces – began to proliferate online in video-based training and webinars.

    That economy need to be rebuilt in a digital-first age. It requires a new, long-term infrastructure.

    The platforms that could do this are the ones that deeply care about the people they reach, with teams who understand that trust in boundless digital spaces must be earned. It has to come from the heart.

    The quality of content also matters, but it is not sufficient.

    The quality of conversation in the network – as well as the quality of the ‘pipes’ that connect those in it – matter more.

    So does the quality of the relationships, both between the team and its members, but – perhaps even more so – between its members. 

    There are a number of digital platforms that are trying to connect health workers. In aggregate, it is going to work. 

    The fledgling efforts have been about how to reach people. The next phase is going to be about rebuilding the knowledge and learning engine that can drive not just performance and results, but also renew meaning and purpose.

    This rebuilding will be based on trust. And on transferring ownership from those who initiated these platforms to those who need them.

    Trust does not happen because a platform is easy to use. It does not happen because great content is being offered. It is not about getting the “user” to click the “register here” or “join now” calls to action. 

    We have seen what happens when social media customers are advertisers rather than content creators. 

    What is the business model for digital health education?

    Competition in digital health education can foster a Renaissance for global public health.

    We need platforms to succeed if we do not want to remain in the Dark Ages.

  • Can the transformation of global health education for impact rely on input-based accreditation?

    Can the transformation of global health education for impact rely on input-based accreditation?

    Burck Smith wrote in 2012 what remains one of the clearest summaries of how accreditation is based primarily on a higher education institution’s inputs rather than its outcomes, and serves to create an “iron triangle” to maintain high prices, keep out new entrants, and resist change.

    It is worth quoting Smith at length (summary and references via this link) as we think through the proposal that the transformation of global health education for impact should rely solely on accredited institutions. Global health efforts are focused on outcomes and aim to achieve impact. The focus on results makes the prevailing input-based accreditation criteria unlikely to be the most useful ones to help achieve global health goals. This calls for rethinking a broad swath of fairly fundamental issues, from how to construct education to what philosophy should underpin what we design and develop.

    The call for a “revolution” in education for public health is unlikely to be answered by institutions that form a protected monopoly. It is critical to understand how accreditation, intended to guarantee quality in education, serves to buttress a protected monopoly. The most exciting and promising innovations in education are happening on the fringes of the education landscape, in bootcamps, edtech startups, and other non-traditional organizations that are catalyzing change. Such change remains primarily seen as a threat by established institutions that, in a protected market buttressed by accreditation, are seeking to preserve gross margins that hover at around sixty percent in the United States.

    Of course, there is a very real problem with the proliferation of degree mills and other shady profit-first organizations that sell the promise of career development and opportunities but cannot deliver them. Unfortunately, many such outfits are, it turns out, accredited ones. This explains why, alongside accreditation, a parallel industry of quality labels and certifications is supposed to help potential “customers” make better purchasing decision.

    Instead, we should rethink what determines the value of a credential. Moving toward competency-based degrees is one necessary but insufficient step that has already been explored. Could we invent a “lifelong credential” that would increase in value over time, as its holder applies what was learned in order to progress and ultimately achieve measurable impact? The tools (blockchain, AI, etc.) to support this already exist. A reductive obsession with legitimacy based on accreditation and the prestige and rankings it supposedly confers will only serve to hinder those of us who are working toward new forms of credentialing, grounded in the needs of people working in countries and guided by what will actually save lives and improve health.

    Image: Walled garden, New College (Oxford). Photo by Elaine Heathcote on Flickr.

  • Solidarity across public health and medicine silos during a pandemic

    Solidarity across public health and medicine silos during a pandemic

    We are launching a new Scholar programme about environmental threats to health, with an initial focus on radiation. (I mapped out what this might look like in 2017.) As part of the launch, we are enlisting support of immunization colleagues.

    Our immunization programme is our largest and most advanced programme, and still growing fast since its inception in 2016. At The Geneva Learning Foundation, we have spent 5 years pouring mind, body, and soul into building what has become the largest digital platform for national and sub-national immunization leaders.

    Along the way, we discovered that it is not only about scale. Social Network Analysis (SNA) by colleagues Sasha Poquet and Vitomir Kovanovic at the Centre for Complexity and Change in Learning is now helping us to understand the power in the relationships not just one-to-many but many-to-many across the network.

    Yes, there is a linkage as most vaccines are for children, and our first course in the new programme (with WHO) is about communicating radiation risks in paediatric imaging. But I was not sure if our request for help would make sense to the immunization network, especially when so many immunization staff are overwhelmed by COVID-19 vaccine introduction.

    Yet, in less than 2 hours, immunization colleagues had already shared the announcement over 300 times. This is an impressive display of solidarity across public health and medicine silos.

    This bodes well for the Foundation’s work as we are developing new programmes in other areas of global health, such as non-communicable diseases (NCDs) or neglected tropical diseases (NTDs) like female genital schistomiosis (FGS).

    Until this morning, I was not sure to what extent one programme’s members would be willing to support others, outside their field of specialty.

  • Inventing by investing in new business models for humanitarian training

    Inventing by investing in new business models for humanitarian training

    Through research and broad sector collaboration, a consensus has emerged on the recognition that uneven quality of personnel is a major limiting factor in humanitarian response, and that serious effort is needed to address the global gap in skills and build capacity of countries and local communities. At the same time, there is growing recognition that existing models for learning, education and training (LET) are not succeeding in addressing this gap, and that new approaches are needed.

    Structured learning has long been assumed to be an expenditure and, for a long time, remained unquestioned as a necessary investment. Yet learning advocates increasingly find themselves in a defensive posture, in part due to the complexity involved in correlating education initiatives with measurable outcomes for a cost centre. However, new business models point to education driven by demand that can not only cover its own costs but generate revenue to be reinvested in the organization’s growth. Challenges include transforming cultural norms around trainings and workshops, rethinking the roles of those who earn their livelihoods from such activities, and correctly assessing markets in which those who pay are usually not those who learn.

    In a world of knowledge abundance, selling content is an increasingly tough proposition. The objective of market research is no longer to decide which courses to issue. Rather, it is about determining the value of content – to the extent that content adds to a credential of value. In the search for new business models for education, marketing itself may be considered to be a learning function, with the goal of establishing meaningful connections and loyalty with end users through the utilization of learning processes.

    The bottom line of humanitarian learning, education and training is still mostly an afterthought. Supply-driven initiatives are launched with donor funding traded for vague promises of sustainability within five years, but no incentives built into the project that will help it get there. Scrambling for alternatives to an existing model in which financing has long been assumed rather than earned may be the toughest challenge of them all for established organizations.

    The path of least resistance is to do more of what has been done in the past. In a startling failure of imagination, scaling up resources results in more courses and programmes, more trainings of trainers, more classrooms in shiny new training centres, and more online platforms. Those tasked with spending are then bound to ensure that the metrics will look good, fast enough so that donor support remains unwavering. Yet it is vital for such initiatives to also invest in questioning their own assumptions, starting with those that underpin the business model of a status quo that is unlikely to produce the results that are needed tomorrow, irrespective of the impressive announcements about resources secured today.

    Image: Old cash register (Andrés Moreira/flickr)

  • Accreditation in higher education is based primarily on inputs rather than outcomes

    Accreditation in higher education is based primarily on inputs rather than outcomes

    Burck Smith describes how accreditation is based primarily on a higher education institution’s inputs rather than its outcomes, and creates an “iron triangle” to maintain high prices, keep out new entrants, and resist change.

    To be accredited, a college must meet a variety of criteria, but most of these deal with a college’s inputs rather than its outcomes [emphasis mine]. Furthermore, only providers of entire degree programs (rather than individual courses) can be accredited. And even though they are accredited by the same organizations, colleges have complete discretion over their “articulation” policies—the agreements that stipulate the credits that they will honor or deny when transferred from somewhere else. This inherent conflict of interest between the provision of courses and the certification of other’s courses is a powerful tool to keep competition out. Articulation agreements, like API’s for computer operating systems, are the standards that enable or deny integration. In short, by controlling the flow of funding, accreditation insures a number of things: All colleges look reasonably similar to each other, the college can’t easily be “disaggregated” into individual courses, and coursework provided by those outside of accreditation can’t easily be counted as credible.

    Lastly, to further tip the scales toward incumbent providers, accreditation bodies are funded by member colleges, and accreditation reviews are conducted by representatives from the colleges themselves. The “iron triangle” of input-focused accreditation, taxpayer subsidies tied to accreditation, and subjective course articulation ensures that almost all of the taxpayer funds set aside for higher education flows to providers that look the same. And by keeping innovations out, colleges can maintain their pricing structures [emphasis mine].

    This explains why most online courses are priced the same or higher than face-to-face courses despite massive cost efficiencies. Such enormous profit margins available to the delivery of accredited online learning explains the quick growth of for-profit colleges, nonprofit colleges offering online degree programs in conjunction with private-sector providers who share in tuition revenue, and colleges running separate online divisions that subsidize face-to-face operations.

    A more accurate characterization of today’s higher education is that individual colleges offer online learning as a “feature,” but use their regulatory clout as a group to resist disruption.

    Source: Young, J.R., McCormick, T., Smith, B. (Eds.), 2012. Disrupting College: Lessons from iTunes, in: Rebooting the Academy: 12 Tech Innovators Who Are Transforming Campuses. The Chronicle of Higher Education, Washington D.C.

    See also: Kaufmann Foundation report, College 2.0: An Entrepreneurial Approach to Reforming Higher Education and Burck Smith’s blog post similar to the quoted article.