“The Imperative for Climate Action to Protect Health” is an article that examines the current and projected health impacts of climate change, as well as the potential health benefits of actions to reduce greenhouse gas emissions. The authors state that “climate change is causing injuries, illnesses, and deaths, with the risks projected to increase substantially with additional climate change.”
Specifically, the article notes that approximately “250,000 deaths annually between 2030 and 2050 could be due to climate change–related increases in heat exposure in elderly people, as well as increases in diarrheal disease, malaria, dengue, coastal flooding, and childhood stunting.” The impacts will fall disproportionately on vulnerable populations, and climate change “could force more than 100 million people into extreme poverty by 2030.”
The article discusses major exposure pathways that link climate hazards to health outcomes like “heat-related illness and death, illnesses caused by poor air quality, undernutrition from reduced food quality and security, and selected vectorborne diseases.” It also notes that “the effects of climate change on mental health are increasingly recognized.”
Importantly, the authors argue that “opportunities exist to capitalize on environmental data to develop early warning and response systems” to help adaptation efforts. Furthermore, “investments in and policies to promote proactive and effective adaptation and reductions in greenhouse-gas emissions (mitigation) would decrease the magnitude and pattern of health risks.”
The article highlights that “transitions in land, energy, industry, buildings, transportation, and cities” aimed at “limiting global warming to 1.5°C” would bring substantial public health benefits. For example, “strong climate policies consistent with the 2°C Paris Agreement target could prevent approximately 175,000 premature deaths” in the US by 2030. More broadly, the authors state that “policies to reduce greenhouse-gas emissions in the energy sector, housing, transportation; and agriculture and food systems can result in near-term ancillary benefits to human health.”
The review thus underscores that “protecting [public] health demands decisive actions from health professionals and governments” in tackling climate change through adaptation and ambitious mitigation policies that yield health “co-benefits.”
What is the role of education?
The review article presents clear evidence that climate change is already severely harming public health, with escalating threats projected, particularly for vulnerable communities. It rightly argues that responding effectively requires urgent adaptation and emissions reductions prioritizing those most impacted.
However, conventional top-down approaches to climate and health in global health are unlikely to achieve the rapid, scalable results needed. Such traditional modalities tend to be ponderously slow, generate knowledge not readily actionable, and fail to reach those on the frontlines in marginalized locales.
Building a new scientific field around climate and health may take years using conventional approaches.
What we would wish for instead is a decentralized, grassroots peer learning system that can directly empower and assist under-resourced local health workers confronting growing climate-health crises.
Specifically, a digital network interconnecting one million such frontline personnel to share granular insights on how climate change is damaging community health in their areas.
This system would facilitate collaborative design of hyperlocal adaptation initiatives tailored to each locale’s distinct climate-health challenges.
It would channel localized knowledge to shape responsive national policies rooted in lived realities on the ground.
Digital tools would amplify voices of those observing firsthand impacts too often excluded.
And participatory methods would synthesize nuanced community observations lacking in conventional statistics.
This locally-attuned, equity-oriented learning infrastructure could unlock community leadership to catalyze climate-health solutions where needs are greatest.
It represents the kind of decentralized, rapidly scalable approach essential to address the review’s calls for urgent action assisting vulnerable groups most harmed by climate change.
Reference: Haines, A., Ebi, K., 2019. The Imperative for Climate Action to Protect Health. N Engl J Med 380, 263–273. https://doi.org/10.1056/NEJMra1807873
The severe global shortage of health and care workers poses a dangerous threat to health systems, especially in low- and middle-income countries (LMICs). The authors of the article “Prioritising the health and care workforce shortage: protect, invest, together”, including six health ministers and the WHO Director-General, assert that this workforce crisis requires urgent action and propose “protect, invest, together” to tackle it.
Deep protection of the existing workforce, they assert, is needed through improved working conditions, fair compensation, upholding rights, addressing discrimination and violence, closing gender inequities, and implementing the WHO Global Health and Care Worker Compact to ensure dignified working environments. All countries must prioritize retaining workers to build resilient health systems.
Significantly increased and strategic long-term investments are imperative in both training new health workers through educational channels and sustaining their employment. Countries should designate workforce development, especially at the primary care level, as crucial human capital investments impacting population health outcomes. Intersectoral financing is key, bringing together domestic funds, grants, concessional sources, and private sector partners into coordinated national plans. Global solidarity is required to resource-constrained LMIC health workforces.
Intersectoral collaboration between ministries of health, finance, economic development, education and employment can develop integrated health workforce strategies. South-South partnerships offer pathways for health worker training and mobility to address regional shortages. Small island nations confront severe but overlooked workforce obstacles requiring specially tailored policy approaches.
The severe projected health workforce shortfall urgently necessitates that actors globally protect existing health workers, strategically invest in growing national workforces, and unite intersectorally behind robust health employment systems, especially in lower resourced contexts. As the authors emphasize, “there can be no health, health systems, or emergency response without the health and care workforce.”
What about the role of education?
This article does not provide much direct discussion of health education systems related to the global health workforce shortage. However, it makes the following relevant points:
Chronic underinvestment in the health and care workforce, including in education and training, has contributed to long-standing shortages.
There is a need for strategic investments in health and care worker education and lifelong learning, with a focus on primary health care, to help address shortages.
Investments in standalone health infrastructure will have little effect unless matched by investments in developing the health workforce through education and training.
Increasing, smarter and sustained long-term financing is crucial for health and care worker education and employment.
Regional and subregional collaboration should be explored to bring together resources and capacities for health workforce education and training.
Intersectoral collaboration between health, education, finance and other sectors is important for developing policies and making investments in health workforce education.
Reference: Agyeman-Manu et al. Prioritising the health and care workforce shortage: protect, invest, together. The Lancet Global Health (2023). https://doi.org/10.1016/S2214-109X(23)00224-3
Three years after the launch of Immunization Agenda 2030 (IA2030), WHO’s 154th Executive Board meeting provided a sobering picture of how the COVID-19 pandemic reversed decades of progress in expanding global immunization coverage and controlling vaccine-preventable diseases.
Over 3 million more zero-dose children in 2022 compared to 2019 and widening inequities between and within countries.
Africa in particular suffered a 25% increase in children missing out on basic vaccines.
Coverage disparities grew between the best- and worst-performing districts in the same countries that previously made gains.
In response, the World Health Organization is calling for action “grounded in local realities”.
Growing evidence supports fresh approaches that do exactly that.
Tom Newton-Lewis is part of the community of researchers and practitioners who have observed that “health systems are complex and adaptive” and, they say, that explains why top-down control rarely succeeds.
The claim is that directive performance management—relying on targets, monitoring, incentives and hierarchical control—is largely ineffective at driving outcomes in low- and middle-income country health systems.
By contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams for improvement.
However, top-down control and directive management appear to have been key to how immunization programmes achieved impressive results in previous decades.
Hence, it may be challenging for the current generation of global immunization leaders to consider that enabling approaches that leverage intrinsic motivation, foster collective responsibility, and empower teams – especially for local staff – are the ones needed now.
One example of an enabling approach is the Movement for Immunization Agenda 2030 (IA2030).
This is a locally-led network, platform, and community of action that emerged in March 2022 in response to the Director-General’s call for a “groundswell of support” for immunization.
In Year 1 (report), this Movement demonstrated the feasibility of establishing a large-scale peer learning platform for immunization professionals, aligned with global IA2030 goals. Specifically:
Over 6,000 practitioners from 99 countries joined initial activities, with 1,021 implementing peer-reviewed local action plans by June 2022.
These participants generated over half a million quantitative and qualitative data points shedding light on local realities.
Regular peer learning events known as Teach to Reach rallied tens of thousands of national and sub-national immunization staff, defying boundaries of geography, hierarchy, gender, and job roles in collaborative sessions with each other, but also with IA2030 Working Groups.
By September 2022, over 10,000 professionals had joined the Movement, turning their commitment to achieving IA2030 into context-specific actions, sharing progress and results to encourage and support each other.
In Year 2, further evidence emerged on participant demand and public health impacts:
By June 2023, the network expanded to 16,835 members across over 100 countries.
Some participants directly attributed coverage increases to the Movement (see Wasnam Faye’s story and other examples), with many sharing a strong sense of IA2030 ownership.
Overall, the Movement has already demonstrated a scalable model facilitating peer exchange between thousands of motivated immunization professionals during its first two years.
Locally-developed solutions are proving indispensable to practitioners, to make sense of generalized guidance from the global level.
Movement research confirmed that “progress more likely comes from the systematic application and adaptation of existing good practice, tailored to local contexts and communities.”
Connecting local innovation to global knowledge could be “instrumental for resuscitating progress” towards more equitable immunization, especially when integrated into coordinated action across health system levels.
It could be part of a teachable moment in which global partners learn from local action, rather than prescribe it.
The Movement has already been making sparks. It will take the fuel of global partners to propel it to accelerate progress in new ways that could meet or exceed IA2030 goals.
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).
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.
What difference can peer-led learning and action make for national EPI planners seeking new strategies to support HPV vaccine introduction or reintroduction?
The stakes are high: HPV vaccination efforts, if successful, will avert 3.4 million deaths by 2030.
On Friday, EPI focal points for HPV and other national-level MOH colleagues from 31 countries convened under the banner of the Movement for Immunization Agenda 2030 (IA2030), which connects over 60,000 primarily sub-national health staff worldwide.
This time, it was national HPV vaccination focal points and other national EPI planners who joined to share experience between countries of ‘what works’ (and how).
Such a pathway can complement existing, top-down forms of vertical technical assistance and may provide a new ‘lever’ for national planners.
In June and October 2023, health workers – primarily from districts and facilities – in over 60 countries shared 298 lessons learned and success stories about HPV vaccination in the Foundation’s Teach to Reach peer learning events. Watch the video: Why HPV matters for women who deliver vaccines.
The active participation of national EPI managers from Burkina Faso and key stakeholders Sierra Leone led to the consultative engagement in January.
Although HPV vaccine is not new, the global community’s effort to introduce it has been stymied by a number of factors.
Doing what has been done before is unlikely to produce the change that is needed.
For example, it remains unclear how early gains achieved through campaigns can sustainably become part of routine immunization.
TGLF’s Insights Unit will now produce a short summary of key learning from this inter-country peer learning exchange, which will be shared back with participants.
If you are interested in learning more about the Movement for Immunization Agenda 2030 (IA2030) or the Geneva Learning Foundation’s HPV vaccination learning-to-action pathway, please do get in touch.
The Geneva Learning Foundation’s Charlotte Mbuh spoke today at the COP28 Health Pavilion in Dubai, United Arab Emirates (UAE).Watch the speech at COP28…
Good afternoon. I am Charlotte Mbuh. I have worked for the health of children and families in Cameroon for over 15 years.
I am one of more than 5,500 health workers from 68 countries who have connected to share our observations of how climate is affecting the health of those we serve.
“Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow so that you can easily walk through a river you required a boat to cross in years past.”
These are the words of Samuel Chukwuemeka Obasi, a health worker from Nigeria.
Dr Kumbha Gopi, a health worker from India said: “The use of motor vehicles has led to an increase in air pollution and we see respiratory problems and skin diseases”.
Climate change is hurting the health of those we serve. And it is getting worse.
Few here would deny that health workers are an essential voice to listen to in order to understand climate impacts on health.
Yet, a man named Jacob on social media snapped: “Since when are health workers the authority on air pollution?”
Here are the words of Bie Lilian Mbando, a health worker from my country: “Where I live in Buea, the flood from Mount Cameroon took away all belongings of people in my neighborhood and killed a secondary school student who was playing football with his friends.”
Climate change is killing communities.
Cecilia Nabwirwa, a nurse in Nairobi, Kenya: “I remember my grand-son getting sick after eating vegetables grown along areas flooded by sewage. Since then I resolved to growing my own vegetables to ensure healthy eating.”
And yet, another man on social media, Robert, found this “ridiculous. As if my friend who sells fish at his fish stall comes as an expert on water quality.”
I wondered: why such brutal responses?
Well, unlike scientists or global agencies, we cannot be dismissed as “experts from on-high”.
What we know, we know because we are here every day.
We are part of the community.
And we know that climate change is a threat to the health of the communities we serve.
We are already having to manage the impacts of climate change on health.
We are doing the best that we can.
But we need your support.
The global community is investing in building a new scientific field around climate and health.
Massive investments are also being made in policy.
Are we making a commensurate investment in people and communities?
That should mean investing in health workers.
What will happen if this investment is neglected?
What if big global donors say: “it’s important, but it’s not part of our strategy?”
Well, in 5, 10, or 15 years, we will certainly have much improved science and, hopefully, policy.
Yet, some communities might reject better science and policy.
Will the global community then wonder: “Why don’t they know what’s good for them?”
I am an immunization worker. For over 15 years, I have worked for my country’s ministry of health.
Like my colleagues from all over the world, I know more than a little about what it takes to establish and maintain trust.
Trust in vaccination, trust in public health.
Trust that by standing together in the face of critical threats to our societies, we all stand to do better.
Local communities in the poorest countries are already bearing the brunt of climate change effects on health.
Local solutions are needed.
Health workers are trusted advisors to the communities we serve.
With every challenge, there is an opportunity.
On 28 July 2023, 4,700 health workers began learning from each other through the Geneva Learning Foundation’s platform, community, and network.
Thousands more are connecting with each other, because they choose to.
And because they want to take action.
It is our duty to support them.
In March 2024, we will hold the tenth Teach to Reach conference.
The last edition reached over 17,000 health workers from more than 80 countries.
This time, our focus will be on climate and health.
We invite global partners to join, to listen and to learn.
We invite you to consider how you, your organization, your government might support action by health workers on the frontline.
Because we will rise.
As health workers, with or without your support, we will continue to stand up with courage, compassion and commitment, working to lift up our communities.
Our perseverance calls us all to press forward towards climate justice and health equity.
I wish to challenge us, as a global community, to rise together, so that the voices of those on the frontline of climate change will be at the next Conference of Parties.
Geneva, Switzerland (1 December 2023) – The Geneva Learning Foundation has published a new report titled “On the frontline of climate change and health: A health worker eyewitness report.” The report shares first-hand experiences from over 1,200 health workers in 68 countries who are first responders already battling climate consequences on health.
As climate change intensifies health threats, local health professionals may offer one of the most high-impact solutions.
Charlotte Mbuh of The Geneva Learning Foundation, said: “Local health workers are trusted advisers to communities. They are first to observe health consequences of climate change, before the global community is able to respond. They can also be first to respond to limit damage to health.”
Listen to Charlotte Mbuh’s speech at the COP28 Healthcare Pavilion on 11 December 2023. Read the full speech…
“Health workers are already taking action with communities to mitigate and respond to the health effects of climate change, often with little or no recognition,” said Reda Sadki, President of The Geneva Learning Foundation (TGLF). “If we want to build and maintain trust in climate science, policy, and action, we need to invest in the workforce, as they are the ones that communities rely on to make sense of what is changing.”
The report vividly illustrates the profound impacts climate change is already having on health, as shared by health workers themselves.
The wide-ranging health consequences directly observed by health workers include malnutrition due to crop failures, increasing incidence of infectious diseases, widespread mental health impacts, and reduced access to health services. Here are three examples.
Bie Lilian Mbando, a health worker in Cameroon: “Where I live in Buea, the flood from Mount Cameroon took away all belongings of people in my neighbourhood and killed a secondary school student who was playing football with his friends.”
Cecilia Nabwirwa, a nurse in Nairobi, Kenya: “I remember my grand-child getting sick after eating vegetables grown along sewage areas. Since then I resolved to growing my own vegetables to ensure healthy eating.”
Alhassan Kenneth Mohammed, health facility worker in Ghana: “During the rainy season, it is very difficult for people to seek care for their health needs. They wait for the condition to get worse before coming to the facility.”
Surprising insights from these experiences include:
Climate change worsens menstrual hygiene: Scarce water access brought by droughts can severely affect women’s ability to maintain proper menstrual hygiene. “Women and girls have challenges during menstruation as there is limited water,” noted one community health worker.
Respiratory disease spikes with prolonged dust storms: Multiple health workers traced a rise in chronic coughs and other respiratory illness directly back to longer dry seasons and dust storms in areas turned to desert by climate shifts.
Crop failure drives up alcohol abuse among men: In farming regions struggling with drought, women health practitioners connected livelihood loss to a stark rise in substance abuse, specifically alcoholism among men. “There has been job loss, low income, and depression. Also, men became alcoholics, which is now a national menace,” described one district-level worker.
Reda Sadki explains: “The experiences shared provide vivid illustrations of the human impacts of climate change. By giving a voice to health workers on the front lines, the report highlights the urgent need to support local action with communities to build resilience. This report is only a first step that needs to lead to action.”
Beyond the report, an opportunity to scale locally-led action using innovative approaches
As John Wabwire Shikuku, a community health worker from Port Victoria Sun County Hospital in Kenya, explains: “What gives me hope and keeps me going in my work is witnessing the growing awareness and mobilization of young people to address climate change, the development of sustainable solutions, and the potential for global collaboration to safeguard their future.”
We need new approaches to supporting climate and health action. We need to go directly to those on climate change’s frontlines – connecting local health workers globally not just to share struggles but lead action.
Rather than siloed programs, we need radically participatory solutions that distill and share hyperlocal innovations across massive peer groups in real-time.
Through new approaches, we can rapidly distill hyperlocal insights and multiplier solutions no top-down program matches.
The Geneva Learning Foundation’s proven peer learning model provides one such solution to connect and amplify local action across boundaries, offering those on the frontline tailored support and capabilities to lead context-specific solutions.
During COP28, health workers are answering this question: “If you could ask the leaders at COP28 to do one thing right now to keep your community healthy, what would it be?”. You can find their responses on LinkedIn, Twitter/X, Facebook, and Instagram.
Created by a group of learning innovators and scientists with the mission to discover new ways to lead change, TGLF’s team combines over 70 years of experience with both country-based (field) work and country, region, and global partners.
Our small, fully remote agile team already supports over 60,000 health practitioners leading change in 137 countries.
We reach the front lines: 21% face armed conflict; 25% work with refugees or internally-displaced populations; 62% work in remote rural areas; 47% with the urban poor; 36% support the needs of nomadic/migrant populations.
TGLF’s unique package:
Helps local actors take action with communities to tackle local challenges, and
provides the tools to build a global network, platform, and community of health workers that can scale up local impact for global health.
In 2019, research showed that TGLF’s approach can accelerate locally-led implementation of innovative strategies by 7X, and works especially well in fragile contexts.
The Geneva Learning Foundation (TGLF) has created a platform enabling health workers to describe the impacts of climate change on their local communities. Here are ten of the most striking reports.
Published on 30 November 2023 on the Gavi #VaccinesWork blog. Written by Ian Jones for Gavi.
In July 2023, more than 1,200 health workers from 68 countries shared their experiences of changes in climate and health at a unique Geneva Learning Foundation event designed to shed light on the realities of climate impacts on the health of the communities they serve.
Samuel Chukwuemeka Obasi, who works for the Ministry of Health in Abuja, Nigeria, has noticed big changes to the environment.
“Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow, so that you can easily walk through a river you required a boat to cross in years past.”
Iruoma Chinedu Ofortube, who works at the district level in Lagos State, Nigeria, recounts two stories that illustrate the lethal impact of extreme weather.
“A family embarked on a journey without potentially expecting any danger. Sadly, on their way, heavy rainfall started. The family was oblivious to the reality that the rain started ahead of them while they were en route to their destination. Unfortunately, they ran into a massive flood near a river. The force and the current from the flood swept their vehicle down the river, and before help could come for them, they drowned helplessly alongside other victims of the same circumstances.
“There was also a pregnant woman in labour. Unfortunately, they couldn’t get a strong boat or canoe that could stand the high current and waves coming from the seaside. In the process of searching for a better means of taking her to the nearest health centre, she got exhausted and died.”
Assoumane Mahamadou Issifou, who works for an NGO in Agadez, Niger, points out how food shortages are leading to malnutrition and anaemia, particularly in women and children.
“During the five years that I served in the health service in the Agadez region, I observed significant changes, particularly in the occurrence of heavy rains, which were uncommon in the past. These heavy rains have led to flooding and the displacement of populations, often forcing them to settle wherever they can. Due to their vulnerability during these challenging times, children and women suffer greatly.
“This situation, especially prevalent among newborns and children under five, contributes to malnutrition. The challenges persist because the Agadez region is situated in a desert area with very low rainfall.
“However, even with minimal rain, the region faces immense difficulties. Nutritional foods are insufficient, and environmental degradation compounds the issue. As a result, the population struggles to access daily sustenance. Pregnant women and children lack foods rich in vitamins, leading to undernourishment and subsequent diseases such as malnutrition and anaemia.
“Historically, Agadez was known for its scarcity of rain. With the recent climate change-induced increase in rainfall, few people have come to accept and understand this phenomenon. The region’s architecture is outdated, and the city has transformed into a migratory hub where diverse behaviours converge. New diseases emerge, and the indigenous population is grappling with illnesses that were previously unknown to them.”
A woman working for the Ministry of Health in the DRC, based in Kinshasa, describes how water level changes are affecting insect proliferation and leading to changing patterns of malaria and other diseases.
“A drought, characterised by a drop in rainfall during recent rainy seasons, has affected the City Province of Kinshasa, particularly in the Makelele District (located in the Bandalungwa commune) where I live.
“This area is bordered by two rivers, Mâkelele 1 and 2. The scarcity of rain in the region during the past rainy seasons has led to a significant reduction in water flow within these two rivers. Consequently, rubbish and debris have accumulated along the riverbanks.
“This situation has resulted in the proliferation of mosquitoes and other unidentified insects. This increase in insect activity has not only led to a rise in malaria cases, but has also given rise to a newly emerging form of dermatosis, the exact nature of which is yet to be determined. It is suspected that these skin lesions develop due to scratching after insect bites. Disturbingly, over 10% of the population within the municipality has been affected by this condition.”
Dieudonne Tanasngar, who works for the Ministry of Health in Chad, explains how displacement contributes to poor sanitation practices, leading to increased spread of water-borne diseases.
“In Lake Chad, during the rainy season, the various arms of the lake expand, causing flooding that affects the villages situated along its shores. This flooding often forces the inhabitants to relocate to higher ground.
“However, a significant portion of the population around the lake lacks proper sanitation facilities, leading to open defecation near the water’s edge. As the water levels rise, this practice contributes to the spread of diseases, particularly when access to health care facilities becomes challenging.
“Access to health care centres is hindered by the need to cross one or two bodies of water before reaching the nearest facility. This geographical challenge adds to the difficulties faced by the affected population. Consequently, a range of diseases can emerge and afflict the community due to these conditions.
“The combination of poor sanitation practices, flooding, and limited access to health care facilities creates a complex situation that requires concerted efforts to improve living conditions, sanitation infrastructure, and health care access for the people living around Lake Chad.”
Coulibaly Seydou, who works for the Ministry of Health in Boussé District, Burkina Faso, has noted how changing dietary habits, alongside declining mental wellbeing, is leading to an increased risk of non-communicable diseases such as high blood pressure and diabetes.
“For several years, the pattern of rainfall has been becoming increasingly irregular. The duration of the rainy season is progressively getting shorter, interspersed with periods of drought. This unpredictability makes it challenging for farmers to adjust their crop choices according to the rainfall pattern, leading to growing concerns. Discussions about the upcoming rainy season can induce anxiety and worry among rural communities.
“When it comes to the impact of climate change on mental health, we can observe a significant disturbance in the well-being of farmers. Even just a couple of days without rainfall can trigger a sense of sadness among them. Instances of minor depression have been noted among household heads who helplessly witness their crops withering due to inadequate moisture.
“In terms of physical health, there has been an uptick in the prevalence of diseases and conditions that can be attributed to changes in dietary habits. Conditions such as hypertension, diabetes and obesity are on the rise. This can be linked to the shift towards consuming industrially processed foods that are low in nutritional value and high in chemical additives.”
A man working for the Ministry of Health in Beni in the DRC describes the tragic case of a family driven into poverty and unable to afford health care for the children.
“As a result of the disruption in the seasonal shifts, a modest family reliant solely on agriculture experienced the tragic death of their young son within their community.
“The critical factors involved were as follows: their crop yield plummeted to zero due to their inability to manage the erratic changes in the seasons, and malnutrition, likely compounded by other illnesses, afflicted the family. Faced with financial constraints stemming from the complete failure of their agricultural efforts, they resorted to providing home-based care for their family.
“Tragically, their youngest son paid the ultimate price with his life. In summary, the ever-changing climate dynamics have left us disoriented and uncertain about the future.”
Fokzia Elijah, who works for the Ministry of Health in the Province of Batha, Chad, highlights how climate change is having multiple health and social impacts, particularly on pastoralists.
“Batha is the first pastoral province, often experiencing prolonged droughts followed by irregular and sometimes excessive rainfall. These climatic variations lead to challenges in cattle herding, house collapses, and difficulties in sustaining pastoralism, which typically lasts only two to three months.
“Pastoralists often migrate southward with women and children following them. Consequently, malnutrition prevails, affecting over 14% of the population, with women and children being the most vulnerable. Women who remain in the villages demonstrate resilience by engaging in limited market gardening and gathering wild oilseeds to produce sweet syrup for porridge.
“A significant issue is the death of animals between March and June due to inadequate pasture and water. This impacts the most vulnerable, particularly women and children. Batha Province, once renowned for its diverse flora and fauna, has seen the disappearance of most animals except for birds. Hyena attacks have become frequent as they search for food in communities, often targeting domestic pets.”
Linda Raji, who works for an NGO in the Kaida and Waru communities in Nigeria, highlights the implication of enviornmental change for young women – one of a range of gender-specific impacts of climate change.
“Prolonged drought dries up the dirty community stream that serves both livestock and residents. This makes it difficult for community members to access water and much harder for menstrual hygiene management for teenage girls leading to an increase in infections in the unbearable heat.
“Due to the difficulty in managing the monthly menstrual cycle due to limited access to water sanitation hygiene and period poverty, many teenage girls prefer to get pregnant to save them the worry of menstruating monthly for nine months.”
Dr Chinedu Anthony Iwu, who works at a health facility in Orlu Local Government Area in Nigeria, describes how working with communities can build resilience to climate change impacts.
“The changing climate has brought about an increase in the prevalence of vector-borne diseases. Mosquitoes are now breeding and transmitting diseases like malaria more intensely. The community lacked proper health care facilities and resources to effectively combat these diseases, leading to a rise in illness and mortality rates. Mothers’ means of livelihood were usually disrupted due to the time and effort spent in caring for their sick children with a significant impact on household welfare.
“Recognising the urgent need to address these climate-related health challenges, we engaged in community-led initiatives that included comprehensive health awareness campaigns to provide education on sanitation and hygiene practices, and education of residents about preventive measures against vector-borne diseases. By engaging our community health extension workers, we were able to organise regular health check-ups in the communities, focusing on early detection and treatment of illnesses.
“Over time, these collective efforts began to yield positive results. The mothers in the communities witnessed improvements in income as they progressively began to spend less time pursuing children’s health care challenges due to the adoption of preventive measures, thereby becoming more resilient to the changing climate.
This experience highlights the challenges faced by rural communities in Nigeria due to climate change. It demonstrates the importance of community engagement, sustainable practices, and support from relevant stakeholders in addressing the climate-health nexus and building resilience in the face of a changing climate.”
Photo credit: Aerial view of a flooded urban residential area of Dera Allah yar city in Jaffarabad District, Baluchistan Province, Pakistan. Credit: Gavi/2022/Asad Zaidi
Samuel Chukwuemeka Obasi, a health professional from Nigeria:
“Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow so that you can easily walk through a river you required a boat to cross in years past.”
In July 2023, more than 1200 health workers from 68 countries shared their experiences of changes in climate and health, at a unique event designed to shed light on the realities of climate impacts on the health of the communities they serve.
Before, during and after COP28, we are sharing health workers’ observations and insights.
How extreme weather events can lead to tragic loss of life.
How changing weather patterns are leading to crop failures and malnutrition, and forcing people to abandon their homes.
How infectious diseases are surging as mosquitoes proliferate and water sources are contaminated.
How climate stresses are particularly problematic for those with existing health conditions, like cardiovascular disease and diabetes.
How climate impacts are having a devastating effect on mental health as people’s ways of life are destroyed.
How climate change is changing the very fabric of society, driving displacement and social hardship that undermines health and wellbeing.
How a volatile climate is disrupting the delivery of essential health services and people’s ability to access them.
We will finish the series with inspiring stories of how health workers are already responding to such challenges, working with communities to counter the effects of a changing climate.
On 1 December 2023, TGLF will be publishing a compendium and analysis of these 1200 contributions – On the frontline of climate change and health: A health worker eyewitness report. Get the report…
This landmark report – a global first – kickstarts our campaign to ensure that health workers in the Global South are recognized as:
The people already having to manage the impacts of climate change on health.
An essential voice to listen to in order to understand climate impacts on health.
A potentially critical group to work with to protect the health of communities in the face of a changing climate.
Before, during, and after COP28, we are advocating for the recognition and support of health workers as trusted advisers to communities bearing the brunt of climate change effects on health.
Watch the Special Event: From community to planet: Health professionals on the frontlines of climate change
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.
