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.
In July 2019, barely six months before the pandemic, we worked with alumni of The Geneva Learning Foundation’s immunization programme to build the Impact Accelerator in 86 countries. This global community of action for national and sub-national immunization staff pledged, following completion of one of the Foundation’s courses, to support each other in other to achieve impact.
Closing the loop from learning to impact produced startling results, accelerating the rate at which locally-resourced projects were implemented and fostering new forms of collaborative leadership. Alumni launched what immediately became the largest network of immunization managers in the world.
Then the pandemic dramatically raised the stakes: at least 80 million children under one were placed at risk of vaccine-preventable diseases such as diphtheria, measles and polio as COVID-19 disrupted immunization service as worldwide.
Alumni were amongst the first in their countries to respond, leveraging the power of being connected to each other to create a virtuous circle of peer support that became the COVID-19 Peer Hub. As a result, the pace of growth keeps increasing. Membership doubled during the summer of 2020.
The network effect cannot be replicated by smaller platforms built on top-down legacy models of the past. Nor can the trust and friendship that bind members to each other.
Members are telling their own stories of the COVID-19 pandemic, disseminating rapid learning, first about recovery of immunization services and, more recently, about COVID-19 vaccine introduction.
There is no upper limit to the number of participants or stories. Rather than painstakingly collecting a few stories so highly curated that they seem too sanitized to be authentic or meaningful, we created the conditions for each person to share their story and learn from the stories of others. We do not require you to be “exemplary” to experience or share significant learning. Some of the most powerful lessons learned, in fact, come from the experience of failure.
In November 2020, for example, members worked together to produce in just four weeks over 700 detailed, peer-reviewed case studies of vaccine hesitancy in health facilities and districts. These were used to inform the COVID-19 Peer Hub’s early scenario planning for vaccine introduction and are now being analyzed for the unique insights they contain, available by no other means.
These stories are about collaboration and learning from each other, within and across borders and all levels of the health system, in new ways to do new things required to face the pandemic. I do not believe it is an overstatement to say that participants are writing history.
Visualization of the sharing ideas and practices across borders, roles, and system levels in the COVID-19 Peer Hub
Co-design as a networked practice of continuous invention, innovation, and learning
For COVID-19 vaccine introduction to succeed, we need new ways to disseminate rapid learning. Through co-design with members of our platform, we invented two in the first three months of this year: Teach to Reach: Connect and the COVID-19 Peer Hub Inter-Country Learning Collaborative to support vaccine introduction.
We already knew that presentation webinars do little more than replicate classroom training in a digital format. Yet they proliferate, despite the dearth of evidence about their effectiveness, with unsubstantiated claims that they are somehow “collaborative” or that 10 minutes of attendees asking the experts a few questions qualifies as “peer learning”. Social Network Analysis (SNA) of the COVID-19 Peer Hub by Sasha Poquet and Vitomir Kovanovic at the Centre for Complexity and Change in Learning helped us to understand that the power of the network lies in the relationships between its members, not only in our ability to convene or call to action, and certainly not in one-way information transmission.
So, on Friday 26 March 2021, 1,372 immunization professionals attended Teach to Reach: Connect to meet, network, and learn about COVID-19 vaccine introduction, how to improve immunization training, and how to reach “zero-dose” children. The feedback received from participants has been incredible, starting with their own surprise that they had so much to learn from each other. (You can catch the opening ceremony on our YouTube channel, and we will soon be sharing what we learned in upcoming live-streamed events on our Facebook page.)
My first networking meeting during Teach to Reach: Connect. Wasnam Faye is a district midwife in Senegal. I remembered her sharing powerful testimonial about how she took practical steps to ensure safe vaccination and explained the words she used to reassure caregivers, when the pandemic first hit.
An inter-country peer learning collaborative to accelerate COVID-19 vaccine introduction
The next day, the COVID-19 Peer Hub team from the Democratic Republic of the Congo (DRC) invited their colleagues from Ivory Coast to learn from the latter’s experience of vaccine introduction. Participants compared the enthusiasm to that for a football match, only this time, they said, the purpose was to “kick out the Coronavirus”. The meeting, hosted by DRC Peer Hub team leader Franck Monga and facilitated by a brilliant young doctor from Burkina Faso, Palenfo Dramane, drew over 1,000 attendees from 20 francophone countries. Panelists from Ivory Coast were alumni of Foundation programmes directly involved in vaccine introduction, working at various levels of the system. They shared first-hand experience from the first few weeks of vaccine introduction. Attendance barely declined even though the meeting ran over time by more than 90 minutes.
Our ‘grand challenge’
Our biggest challenge, so far, has been to explain the power, significance, potential, and value of such events to our global partners. This is ironic given that the global immunization community agrees that it is sub-national immunization staff who make the difference needed to achieve Immunization Agenda 2030, the new strategy adopted last year by the World Health Assembly. Some global colleagues did take the time to apologize, explaining that they were too busy on Friday afternoon due to COVID-19 vaccine introduction to take 15 minutes to meet, network, and learn with immunization staff from the countries they serve and who are actually introducing the vaccine. (To be fair, a few colleagues did attend and loved it.) Last but not least, donors remain risk-adverse, preaching innovation while repeatedly choosing conventional approaches and traditional partners, even when they have failed in the past, seemingly driven by considerations other than scale, results, or demand from countries. In some cases, they have even expressed disbelief, doubting our results as too good to be true, flummoxed by how a new entrant with limited immunization experience could achieve them when better-funded, far-more-legitimate institutions have simply not been able to do so.
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.
A few months ago, a malaria guy showed me the $20 dumb Nokia phones he buys in a Geneva convenience store and then gives out to trainees who then use it to collect data via SMS text messages. ARM says that the US$20 smart phone (read: Android with an ARM chip) will arrive this year. At stake: how to get the next four billion people online.
