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Tag: learning culture

  • Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme

    Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme

    Insights report about Nigeria’s Immunization Agenda 2030 Collaborative surfaces surprising solutions for both demand- and supply-side immunization challenges

    When 4,434 practitioners from all 36 states asked why children in their communities remained unvaccinated, the problems they thought they understood often had entirely different root causes.

    “I ended up being surprised at the answer I got,” said one health worker.

    Half of the health workers who participated in Nigeria’s largest-ever peer learning exercise in July 2024 discovered that their initial assumptions about local immunization challenges were wrong. The six-week programme generated 409 detailed analyses of local immunization challenges, with each reviewed by peers across the country.

    One year after The Geneva Learning Foundation launched the first Immunization Agenda 2030 Collaborative, in partnership with UNICEF and Gavi, under the auspices of the Nigeria Primary Health Care Development Agency (NPHCDA), a comprehensive insights report documents findings that illuminate persistent gaps between health system planning and community realities.

    How to access the Nigeria Immunization Collaborative’s first insights report:

    Chat with the report

    Health workers report being asked for insights for first time

    A recurring theme emerged from participant feedback that surprised programme organizers. “Many said no one has ever asked us what we think should happen or why do you think that is,” said TGLF’s Charlotte Mbuh, during the February 2025 presentation of the findings to NPHCDA and the country’s immunization partners.

    This potential for linking community experience with formal planning processes became evident when systematic analysis revealed that participants consistently identified practical solutions—many of which they could implement with existing resources.

    “Through my participation in the immunization Collaborative, I learned the critical value of root cause analysis,” reported one participant from Apo Resettlement Primary Health Centre in Abuja. “I applied this approach to uncover that insufficient manpower was the primary issue limiting vaccine coverage”—not the community resistance initially assumed.

    Dr. Akinpelu Adetola, a government public health specialist in Lagos State, exemplified this pattern. Her investigation of declining vaccination rates revealed poor scheduling that created both overcrowded and quiet clinic days. “A register and scheduling system were introduced to address this issue,” she shared with colleagues from across the country.

    Implementation gaps – not knowledge gaps – in the Nigeria Immunization Collaborative

    The Collaborative’s most significant finding challenges a common assumption in global health programming. Participants consistently proposed solutions that were “already well-known, suggesting that progress is limited by implementation issues rather than a lack of solutions,” according to the evaluation report.

    This pattern appeared across diverse contexts and challenge types. When health workers applied root cause analysis to local problems, they frequently identified straightforward interventions that had been overlooked by previous efforts focused on changing community attitudes or providing additional training.

    The evaluation found that 42% of participating health workers identified zero-dose challenges as their top local priority—aligning with national strategy priorities while providing granular intelligence about how these challenges manifest in specific communities.

    Nigeria Immunization Agenda 2030 Collaborative: Reconnecting data collection with local problem-solving

    A striking finding illuminated a fundamental disconnect in Nigeria’s health information systems: only 25% of participants knew their local coverage rates for key vaccines, despite many being responsible for collecting and reporting these figures at the local levels.

    “Many said, well, I collect these numbers, pass them on, but I didn’t know I could actually use them. They could actually help me in my work,” Mbuh explained, describing how participants began analyzing data they were already gathering within the first four weeks of the programme.

    While participants initially focused on demand-side issues—why communities do not seek vaccination services—systematic investigation often revealed supply-side problems underlying apparent “hesitancy.”

    Six primary supply-side challenges consistently undermine immunization delivery: poor data quality hampering service planning; vaccine stockouts due to inadequate inventory management; non-functional cold chain equipment; missed opportunities for catch-up vaccination; service quality issues that deter families; and systematic exclusion of hard-to-reach populations.

    Scale, speed, and sustainability across a complex federal system

    Launched by The Geneva Learning Foundation on 22 July 2024 in partnership with NPHCDA with support from UNICEF and Gavi, the Nigeria Immunization Agenda 2030 Collaborative connected health workers and other immunization stakeholders from more than 300 local government areas – with most based in northern States – within two weeks. Over 600 government facilities, private sector providers, and civil society organizations then signed on as organizational partners. Participants included 65% from local government and facility levels—both the community health workers who directly deliver immunization services and the LGA managers who support them.

    The initiative achieved this scale while operating at faster speed and significantly lower cost than conventional technical assistance and capacity-building approaches.

    The programme supported participants in using a simple, practical “five-whys” root cause analysis methodology, with each analysis reviewed by three peers across Nigeria’s diverse contexts. This peer review process provided depth to complement scale: it improved analytical quality regardless of participants’ initial skill levels.

    “The peer review was another mind-blowing innovation where intellect from other parts of Nigeria viewed your work and made constructive input,” noted one reviewer. “It made me realize I can be a team player.”

    Rapid implementation documented within weeks

    Within six weeks, health workers began reporting connections between new activities based on their root cause analyses and improved health outcomes.

    “During the Collaborative, we discussed successful case studies from other regions. Inspired by these stories, I have strengthened partnerships with local health authorities and other stakeholders to deepen immunization coverage, especially among under-fives. This collaboration has resulted in a significant increase in childhood vaccination rates in my community,” reported one participant from Ebonyi State.

    Unlike conventional training programs that end with certificates, evidence emerged that participants were applying insights within their ongoing work responsibilities and sustaining collaboration independently.

    Evidence of sustained networks and application one year later

    In fact, evidence one year on points to surprising sustainability, as the network continues to function without any external support.

    Four months after the programme concluded, TGLF organized a Teach to Reach session with 24,610 health workers participating, featuring Collaborative participants sharing early outcomes from the Nigeria initiative. This session revealed participants maintaining connections and applying methodologies in new contexts.

    “When we applied the root cause analysis, the five ‘whys’, this opened our eyes to see that it was not all about community members alone,” reported Uyebi Enosandra, a disability specialist working in Delta State. “We have challenges with the primary health workers, not knowing how to incorporate children with disability in the immunization programme.”

    Her account exemplified the pattern documented across participant testimonials: systematic analysis revealed different root causes than initially assumed, leading to more targeted solutions.

    Gregory, a retired professional who participated in outbreak response work in Borno State, described encountering Collaborative participants in the field: “I was pleased to hear that they participated in the Collaborative. And whatever step I wanted to take, they were almost ahead of me to say, sir, we have learned this and we are going to apply it.”

    “In my everyday activities at work I use this ‘5 whys’ to get to the root cause of any complaint and in my own little space make an impact on the patient,” one participant reported in follow-up feedback.

    The methodology’s application extended beyond immunization contexts. Participants reported using the analytical framework for disability inclusion, malaria programming, and broader health system challenges, suggesting the transferable value of structured problem-solving approaches.

    The December 2024 Teach to Reach session revealed ongoing demand for the methodology. Despite significant connectivity challenges affecting West Africa during the session, participants expressed eagerness to share the approach with colleagues. “Presently I’m even encouraging my colleagues to join,” one participant noted. “They’ve been asking me, how do I join, when will this come and all that.”

    The most significant sustainability indicator, according to Mbuh, appeared in widespread participant feedback: “I did not realize how much I could do with what we already have.” This response gained particular relevance as Nigeria and other countries navigate current funding constraints affecting global health programming.

    Potential to strengthen existing systems

    For NPHCDA and international partners, the Collaborative provided intelligence typically unavailable through conventional assessments. The analysis of root cause analyses offers detailed insights into how challenges manifest across Nigeria’s diverse geographic and cultural contexts.

    The approach demonstrated potential to complement existing training, supervision, and technical assistance systems by harnessing health workers’ practical experience and problem-solving capacity. The model addresses real-world challenges participants can immediately influence while building professional networks alongside technical competencies.

    “This pilot programme has demonstrated demand for peer learning, and the feasibility of running a national peer learning programme that brings together the strengths of a national immunization programme, a global partner and an educational organization,” the evaluation concludes.

    For Nigeria’s work toward Zero-Dose Immunization Recovery Plan goals through 2028, the Collaborative provides an innovative approach for translating national strategies into local action while building health worker capacity for continuous adaptation and problem-solving.

    The programme has evolved into what participants describe as a self-sustaining platform that continues operating independent of formal support, suggesting potential for integration with existing health system structures and processes in a true “sector-wide” approach.

    Reference

    Jones, I., Sadki, R., Sequeira, J., & Mbuh, C. (2025). Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme (1.0). The Geneva Learning Foundation (TGLF). https://doi.org/10.5281/zenodo.14167168

    Image: Cover the report “Nigeria Immunization Agenda 2030 Collaborative: Piloting a national peer learning programme”.

  • Artificial intelligence, accountability, and authenticity: knowledge production and power in global health crisis

    Artificial intelligence, accountability, and authenticity: knowledge production and power in global health crisis

    I know and appreciate Joseph, a Kenyan health leader from Murang’a County, for years of diligent leadership and contributions as a Scholar of The Geneva Learning Foundation (TGLF). Recently, he began submitting AI-generated responses to Teach to Reach Questions that were meant to elicit narratives grounded in his personal experience.

    Seemingly unrelated to this, OpenAI just announced plans for specialized AI agents—autonomous systems designed to perform complex cognitive tasks—with pricing ranging from $2,000 monthly for a “high-income knowledge worker” equivalent to $20,000 monthly for “PhD-level” research capabilities.

    This is happening at a time when traditional funding structures in global health, development, and humanitarian response face unprecedented volatility.

    These developments intersect around fundamental questions of knowledge economics, authenticity, and power in global health contexts.

    I want to explore three questions:

    • What happens when health professionals in resource-constrained settings experiment with AI technologies within accountability systems that often penalize innovation?
    • How might systems claiming to replicate human knowledge work transform the economics and ethics of knowledge production?
    • And how should we navigate the tensions between technological adoption and authentic knowledge creation?

    Artificial intelligence within punitive accountability structures of global health

    For years, Joseph had shared thoughtful, context-rich contributions based on his direct experiences. All of a sudden, he was submitting generic mush with all the trappings of bad generative AI content.

    Should we interpret this as disengagement from peer learning?

    Given his history of diligence and commitment, I could not dismiss his exploration of AI tools as diminished engagement. Instead, I understood it as an attempt to incorporate new capabilities into his professional repertoire. This was confirmed when I got to chat with him on a WhatsApp call.

    Our current Teach to Reach Questions system has not yet incorporated the use of AI. Our “old” system did not provide any way for Joseph to communicate what he was exploring.

    Hence, the quality limitations in AI-generated narratives highlight not ethical failings but a developmental process requiring support rather than judgment.

    But what does this look like when situated within global health accountability structures?

    Health workers frequently operate within highly punitive systems where performance evaluation directly impacts funding decisions. International donors maintain extensive surveillance of program implementation, creating environments where experimentation carries significant risk. When knowledge sharing becomes entangled with performance evaluation, the incentives for transparency about AI “co-working” (i.e., collaboration between human and AI in work) diminish dramatically.

    Seen through this lens, the question becomes not whether to prohibit AI-generated contributions but how to create environments where practitioners can explore technological capabilities without fear that disclosure will lead to automatic devaluation of their knowledge, regardless of its substantive quality. This heavily depends on the learning culture, which remains largely ignored or dismissed in global health.

    The transparency paradox: disclosure and devaluation of artificial intelligence in global health

    This case illustrates what might be called the “transparency paradox”—when disclosure or recognition of AI contribution triggers automatic devaluation regardless of substantive quality. Current attitudes create a problematic binary: acknowledge AI assistance and have contributions dismissed regardless of quality, or withhold disclosure and risk accusations of misrepresentation or worse.

    This paradox creates perverse incentives against transparency, particularly in contexts where knowledge production undergoes intensive evaluation linked to resource allocation. The global health sector’s evaluation systems often emphasize compliance over innovation, creating additional barriers to technological experimentation. When every submission potentially affects funding decisions, incentives for technological experimentation become entangled with accountability pressures.

    This dynamic particularly affects practitioners in Global South contexts, who face more intense scrutiny while having less institutional protection for experimentation. The punitive nature of global health accountability systems deserves particular emphasis. Health workers operate within hierarchical structures where performance is consistently monitored by both national governments and international donors. Surveillance extends from quantitative indicators to qualitative assessments of knowledge and practice.

    In environments where funding depends on demonstrating certain types of knowledge or outcomes, the incentive to leverage artificial intelligence in global health may conflict with values of authenticity and transparency. This surveillance culture creates uniquely challenging conditions for technological experimentation. When performance evaluation drives resource allocation decisions, health workers face considerable risk in acknowledging technological assistance—even as they face pressure to incorporate emerging technologies into their practice.

    The economics of knowledge in global health contexts

    OpenAI’s announced “agents” represent a substantial evolution beyond simple chatbots or language models. If they are able to deliver what they just announced, these specialized systems would autonomously perform complex tasks simulating the cognitive work of highly-skilled professionals. The most expensive tier, priced at $20,000 monthly, purportedly offers “PhD-level” research capabilities, working continuously without the limitations of human scheduling or attention.

    These claims, while unproven, suggest a potential future where knowledge work economics fundamentally change. For global health organizations operating in Geneva, where even a basic intern position for a recent master’s degree graduate cost more than 200 times that of a ChatGPT subscription, the economic proposition of systems working 24/7 for potentially comparable costs merits careful examination.

    However, the global health sector has historically operated with significant labor stratification, where personnel in Global North institutions command substantially higher compensation than those working in Global South contexts. Local health workers often provide critical knowledge at compensation rates far below those of international consultants or staff at Northern institutions. This creates a different economic equation than suggested by Geneva-based comparisons. Many organizations have long relied on substantially lower local labor costs, often justified through capacity-building narratives that mask underlying power asymmetries.

    Given this history, the risk that artificial intelligence in global health would replace local knowledge workers might initially appear questionable. Furthermore, the sector has demonstrated considerable resistance to technological adoption, particularly when it might disrupt established operational patterns. However, this analysis overlooks how economic pressures interact with technological change during periods of significant disruption.

    The recent decisions of many government to donors to suddenly and drastically cut funding and shut down programs illustrates how rapidly even established funding structures can collapse. In such environments, organizations face existential questions about maintaining operational capacity, potentially creating conditions where technological substitution becomes more attractive despite institutional resistance.

    A new AI divide

    ChatGPT and other generative AI tools were initially “geo-locked”, making them more difficult to access from outside Europe and North America.

    Now, the stratified pricing structure of OpenAI’s announced agents raises profound equity concerns. With the most sophisticated capabilities reserved for those able to pay high costs for the most capable agents, we face the potential emergence of an “AI divide” that threatens to reinforce existing knowledge power imbalances.

    This divide presents particular challenges for global health organizations working across diverse contexts. If advanced AI capabilities remain the exclusive province of Northern institutions while Southern partners operate with limited or no AI augmentation, how might this affect knowledge dynamics already characterized by significant inequities?

    The AI divide extends beyond simple access to include quality differentials in available systems. Even as simple AI tools become widely available, sophisticated capabilities that genuinely enhance knowledge work may remain concentrated within well-resourced institutions. This could lead to a scenario where practitioners in resource-constrained settings use rudimentary AI tools that produce low-quality outputs, further reinforcing perceptions of capability gaps between North and South.

    Confronting power dynamics in AI integration

    Traditional knowledge systems in global health position expertise in academic and institutional centers, with information flowing outward to practitioners who implement standardized solutions. This existing structure reflects and reinforces global power imbalances. 

    The integration of AI within these systems could either exacerbate these inequities—by further concentrating knowledge production capabilities within well-resourced institutions—or potentially disrupt them by enabling more distributed knowledge creation processes.

    Joseph’s journey demonstrates this tension. His adoption of AI tools might be viewed as an attempt to access capabilities otherwise reserved for those with greater institutional resources. The question becomes not whether to allow such adoption, but how to ensure it serves genuine knowledge democratization rather than simply producing more sophisticated simulations of participation.

    These emerging dynamics require us to fundamentally rethink how knowledge is valued, created, and shared within global health networks. The transparency paradox, economic pressures, and emerging AI divide suggest that technological integration will not occur within neutral space but rather within contexts already characterized by significant power asymmetries.

    Developing effective responses requires moving beyond simple prescriptions about AI adoption toward deeper analysis of how these technologies interact with existing power structures—and how they might be intentionally directed toward either reinforcing or transforming these structures.

    My framework for Artificial Intelligence as co-worker to support networked learning and local action is intended to contribute to such efforts.

    Illustration: The Geneva Learning Foundation Collection © 2025

    References

    Frehywot, S., Vovides, Y., 2024. Contextualizing algorithmic literacy framework for global health workforce education. AIH 0, 4903. https://doi.org/10.36922/aih.4903

    Hazarika, I., 2020. Artificial intelligence: opportunities and implications for the health workforce. International Health 12, 241–245. https://doi.org/10.1093/inthealth/ihaa007

    John, A., Newton-Lewis, T., Srinivasan, S., 2019. Means, Motives and Opportunity: determinants of community health worker performance. BMJ Glob Health 4, e001790. https://doi.org/10.1136/bmjgh-2019-001790

    Newton-Lewis, T., Munar, W., Chanturidze, T., 2021. Performance management in complex adaptive systems: a conceptual framework for health systems. BMJ Glob Health 6, e005582. https://doi.org/10.1136/bmjgh-2021-005582

    Newton-Lewis, T., Nanda, P., 2021. Problematic problem diagnostics: why digital health interventions for community health workers do not always achieve their desired impact. BMJ Glob Health 6, e005942. https://doi.org/10.1136/bmjgh-2021-005942

    Artificial Intelligence and the health workforce: Perspectives from medical associations on AI in health (OECD Artificial Intelligence Papers No. 28), 2024. , OECD Artificial Intelligence Papers. https://doi.org/10.1787/9a31d8af-en

    Sadki, R. (2025). A global health framework for Artificial Intelligence as co-worker to support networked learning and local action. Reda Sadki. https://doi.org/10.59350/gr56c-cdd51

  • AI podcast explores surprising insights from health workers about HPV vaccination

    AI podcast explores surprising insights from health workers about HPV vaccination

    This is an AI podcast featuring two hosts discussing an article by Reda Sadki titled “New Ways to Learn and Lead HPV Vaccination: Bridging Planning and Implementation Gaps.” The conversational format involves the AI hosts taking turns explaining key points and sharing insights about Sadki’s work on HPV vaccination strategies. While the conversation is AI-generated, everything is based on the published article and insights from the experiences of thousands of health workers participating in Teach to Reach.

    The Geneva Learning Foundation’s approach

    Throughout the podcast, the hosts explore how the Geneva Learning Foundation (TGLF) has developed a five-step process to improve HPV vaccination implementation through their “Teach to Reach” program. This process involves:

    1. Gathering experiences from health workers worldwide
    2. Analyzing these experiences for patterns and innovative solutions
    3. Conducting deep dives into specific case studies
    4. Bringing national EPI planners into the conversation
    5. Synthesizing and sharing knowledge back with frontline workers

    The hosts emphasize that this approach represents a shift from traditional top-down strategies to one that values the collective intelligence of over 16,000 global health workers who implement these programs.

    Surprising findings

    The AI hosts discuss several findings from peer learning that may seem counterintuitive, including:

    • Tribal communities often show less vaccine hesitancy than urban populations, potentially due to stronger community ties and trust in traditional leaders
    • Teachers sometimes have more influence than health workers when it comes to vaccination recommendations
    • Simple, clear communication is often more effective than complex strategies
    • Religious institutions can become powerful allies when approached respectfully
    • Male community leaders can be crucial advocates for what’s typically framed as a women’s health issue

    Effective implementation strategies

    The hosts highlight various successful implementation approaches mentioned in Sadki’s article:

    • Cancer survivors serving as powerful advocates
    • WhatsApp groups connecting community health workers for information sharing
    • Engaging schoolchildren as messengers to initiate family conversations
    • Integrating vaccination efforts with existing women’s groups
    • Community theater and traditional storytelling methods
    • Less formal settings often producing better results than clinical environments

    System-level insights

    The podcast discussion reveals that successful vaccination programs don’t necessarily require abundant resources. Instead, key factors include:

    • Strong leadership and clear vision
    • Commitment to continuous learning
    • Community mobilization and trust-building
    • Leveraging informal networks
    • Prioritizing social factors over technical ones
    • Local adaptation rather than standardization

    The AI hosts conclude by reflecting on how these principles challenge global health epidemiologists to reconsider their roles—moving beyond data analysis to becoming facilitators who empower communities to develop their own solutions.

  • Peer learning in immunization programmes

    Peer learning in immunization programmes

    The path to strengthening immunization systems requires innovative technical assistance approaches to learning and capacity building. A recent correspondence in The Lancet proposes peer learning in immunization programmes as a crucial mechanism for achieving the goals of the Immunization Agenda 2030 (IA2030), arguing for “an intentional, well coordinated, fit-for-purpose, data-driven, and government-led immunisation peer-learning plan of action.” This proposal merits careful examination, particularly as immunization programmes face complex challenges in reaching 2030 goals.

    Learn more: 50 years of the Expanded Programme on Immunization (EPI)

    Beyond traditional knowledge exchange

    The Lancet commentary identifies several key rationales for peer learning in immunization.

    • First, “immunisation policy makers operate in dynamic sociopolitical and economic contexts that often compel quick decision making.” In such environments, peer knowledge becomes crucial “when research evidence is scarce.”
    • Second, the authors recognize that “contextual factors in immunisation systems are constantly interacting to exhibit emergent behaviour and self-organisation,” necessitating constant adaptation of technical approaches.

    These insights point toward an important truth: traditional approaches to knowledge sharing – whether through technical guidelines, formal training, or policy exchange – remain necessary but increasingly insufficient for today’s challenges.

    The question becomes not just how to share what we know, but how to systematically generate new knowledge about what works in different contexts.

    Complementary approaches to peer learning in immunization programmes

    While government counterparts learning from each other offers valuable benefits for policy coordination and strategic alignment, implementation challenges are situated – and solved – at the local levels. This call for complementary peer learning approaches. Three stand out as particularly critical:

    • First, the persistent gap between national planning and local implementation suggests the need for systematic learning about how policies and strategies are turned into effective, community-led and -owned action on the ground.
    • Second, as programmes work to sustain coverage gains beyond campaign-based interventions, they need reliable mechanisms for identifying and spreading effective practices for routine immunization.
    • Third, the continuous influx of new staff into EPI teams creates an ongoing need for rapid capacity building that goes beyond technical training to include development of professional networks and practical implementation skills.

    From reporting challenges to creating implementation knowledge

    A crucial distinction emerges between simply documenting implementation challenges and systematically creating new knowledge about effective implementation. This difference parallels the distinction in epidemiology between case reporting and analytical epidemiology.

    When health workers report challenges, they might note that coverage is low in remote areas due to transport limitations, staff shortages, and cold chain issues. This provides valuable surveillance data but does not necessarily generate actionable knowledge. In contrast, systematic analysis of successful remote area coverage can reveal specific transport solutions that work, staff deployment patterns that succeed, and cold chain adaptations that enable reach.

    This shift from reporting to knowledge creation requires careful structure and support. Just as analytical epidemiology employs specific methods to move from observation to insight, systematic peer learning needs frameworks and processes that enable pattern recognition, cross-context learning, and theory building about what works.

    Enabling systematic learning at scale

    Recent experience demonstrates the feasibility of systematic peer learning at scale. For example, Gavi-supported country-led initiatives facilitated by The Geneva Learning Foundation (TGLF) in Côte d’Ivoire and Nigeria, health workers from districts and facilities shared specific strategies through structured processes, they collectively generate new knowledge about effective implementation. Launched in 2022 with support from Wellcome, the Movement for Immunization Agenda 2030 (IA2030) has demonstrated that such ground-level learning, when properly captured and analyzed, provides crucial insights for national planning.

    Consider the introduction of new vaccines. When thousands of practitioners share specific experiences about what enables successful introduction, patterns emerge that might be missed in smaller exchanges or formal evaluations. These patterns help reveal not just what works, but how solutions adapt and evolve across contexts.

    Learn more: Movement for Immunization Agenda 2030 (IA2030): National EPI leaders from 31 countries share experience of HPV vaccination

    Supporting new EPI staff through networked learning

    The challenge of rapidly building capacity when new staff join EPI teams highlights the potential value of structured peer learning. Training approaches like Mid-Level Management (MLM) Training provide essential technical foundations, and have been able to reach more professionals by moving online. However, new staff also need to rapidly build professional networks and learn from peers facing similar challenges.

    A cohort-based approach combining technical training with structured peer learning can accelerate both capability development and network formation. This helps new staff analyze local challenges, identify priorities, and access peer support for implementation. Cross-country learning opportunities are particularly valuable for young professionals, enabling them to build relationships beyond hierarchical constraints.

    From vaccination campaigns to sustainable primary health care systems that integrate routine immunization

    For immunization programmes work to sustain coverage gains beyond campaign-based interventions, peer learning networks are needed to support the transition to stronger routine immunization systems. By connecting practitioners across health system levels, these networks help identify and spread effective practices for reaching families through regular services.

    This network-based approach complements formal exchange mechanisms by creating multiple pathways for knowledge flow:

    • Ground-level innovations inform national strategy through systematic capture and analysis
    • Peer feedback helps practitioners adapt solutions to local contexts
    • Implementation experiences create evidence about what works and why
    • Cross-level dialogue strengthens connections between policy and practice

    Peer learning embedded into government-owned health systems

    This peer learning approach does not replace traditional technical assistance, capacity building, or policy exchange. Rather, it transforms them by creating new connections between levels and actors in health systems. While formal exchanges remain crucial for policy coordination, structured peer learning adds vital capabilities:

    1. Granular understanding of implementation challenges while maintaining systematic rigor in knowledge capture;
    2. Documentation of practical innovations while creating frameworks for adaptation across contexts; and
    3. Evidence-based feedback loops between policy and practice.

    Success requires careful attention to structure. Through carefully designed processes, practitioners engage in cycles of sharing, feedback, connection, and action. This structure is not bureaucratic control but scaffolding that supports genuine knowledge creation and application.

    Looking forward

    The World Health Organization’s Executive Board has highlighted widening inequities between and within countries as a critical challenge for immunization programmes. In the African region particularly, where many countries are introducing new vaccines while working to strengthen basic immunization services, innovative approaches are needed.

    New evidence from recent large-scale peer learning initiatives suggests that structured approaches can help bridge the gap between strategy and implementation while strengthening both. Success requires investment in learning processes and support structures – but the potential rewards, in terms of accelerated progress and improved outcomes, make this investment worthwhile.

    This offers a concrete path toward what WHO calls for: “grounding action in local realities.” By systematically connecting learning across health system levels while maintaining rigorous standards for evidence and implementation support, we can create learning systems that effectively link regional strategy with local innovation and action.

    The future of immunization capacity building lies not in choosing between formal exchanges and practitioner networks, but in thoughtfully combining them to create comprehensive learning systems. These systems can drive rapid improvement while strengthening health systems as a whole – an essential goal as we work toward ambitious immunization targets for 2030 and beyond.

    Reference

    • Adamu AA, Ndwandwe D, Jalo RI, Ndoutabe M, Wiysonge CS. Peer learning in immunisation programmes. The Lancet [Internet]. 2024 Jul; 404(10450):334–5. Available from: https://doi.org/10.1016/S0140-6736(24)01340-0
    • Jones, I., Sadki, R., Brooks, A., Gasse, F., Mbuh, C., Zha, M., Steed, I., Sequeira, J., Churchill, S., & Kovanovic, V. (2022). IA2030 Movement Year 1 report. Consultative engagement through a digitally enabled peer learning platform (1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7119648

    Image: The Geneva Learning Foundation Collection © 2024

  • Why answer Teach to Reach Questions?

    Why answer Teach to Reach Questions?

    Have you ever wished you could talk to another health worker who has faced the same challenges as you? Someone who found a way to keep helping people, even when things seemed impossible? That’s exactly the kind of active learning that Teach to Reach Questions make possible. They make peer learning easy for everyone who works for health.

    What are Teach to Reach Questions?

    Once you join Teach to Reach (what is it?), you’ll receive questions about real-world challenges that matter to health professionals.

    How does it work?

    1. You choose what to share: Answer only questions where you have actual experience. No need to respond to everything – focus on what matters to you.
    2. Share specific moments: Instead of general information, we ask about real situations you’ve faced. What exactly happened? What did you do? How did you know it worked?
    3. Learn from others: Within weeks, you’ll receive a collection of experiences shared by health workers from over 70 countries. See how others solved problems similar to yours.

    What’s different about these questions?

    Unlike typical surveys that just collect data, Teach to Reach Questions are active learning that:

    • Focus on your real-world experience.
    • Help you reflect on what worked (and what didn’t).
    • Connect you to solutions from other health workers.
    • Give back everything shared to help everyone learn.

    See what we give back to the community. Get the English-language collection of Experiences shared from Teach to Reach 10. The new compendium includes over 600 health worker experiences about immunisation, climate change, malaria, NTDs, and digital health. A second collection of more than 600 experiences shared by French-speaking participants is also available.

    What’s in it for you?

    Peer learning happens when we learn from each other. Your answers can help others – and their answers can help you.

    1. Get recognized: You’ll be honored as a Teach to Reach Contributor and receive certification.
    2. Learn practical solutions: See how other health workers tackle challenges like yours.
    3. Make connections: At Teach to Reach, you’ll meet others who have been sharing and learning about the same issues.
    4. Access support: Global partners will share how they can support solutions you and other health workers develop.

    A health worker’s experience

    Here is what on community health worker from Kenya said:

    “When flooding hit our area, I felt so alone trying to figure out how to keep helping people. Through Teach to Reach, I learned that a colleague in another country had faced the same problem. Their solution helped me prepare better for the next flood. Now I’m sharing my experience to help others.”

    Think about how peer learning could help you when more than 23,000 health professionals are asked to share their experience on a challenge that matters to you.

    Ready to start?

    1. Request your invitation to Teach to Reach now.
    2. Look for questions in your inbox.
    3. Share your experience on topics you know about.
    4. Receive the complete collection of shared experiences.
    5. Join us in December to meet others face-to-face.

    Remember: Your experience, no matter how small it might seem to you, could be exactly what another health worker needs to hear.

    The sooner you join, the more you’ll learn from colleagues worldwide.

    Together, we can turn what each of us knows into knowledge that helps everyone.

    Listen to the Teach to Reach podcast:

    Is your organisation interested in learning from health workers? Learn more about becoming a Teach to Reach partner.

    Image: The Geneva Learning Foundation Collection © 2024

  • What is the pedagogy of Teach to Reach?

    What is the pedagogy of Teach to Reach?

    In a rural health center in Kenya, a community health worker develops an innovative approach to reaching families who have been hesitant about vaccination.

    Meanwhile, in a Brazilian city, a nurse has gotten everyone involved – including families and communities – onboard to integrate information about HPV vaccination into cervical cancer screening.

    These valuable insights might once have remained isolated, their potential impact limited to their immediate contexts.

    But through Teach to Reach – a peer learning platform, network, and community hosted by The Geneva Learning Foundation – these experiences become part of a larger tapestry of knowledge that transforms how health workers learn and adapt their practices worldwide.

    Since January 2021, the event series has grown to connect over 21,000 health professionals from more than 70 countries, reaching its tenth edition with 21,398 participants in June 2024.

    Scale matters, but this level of engagement begs the question: how and why does it work?

    The challenge in global health is not just about what people need to learn – it is about reimagining how learning happens and gets applied in complex, rapidly-changing environments to improve performance, improve health outcomes, and prepare the next generation of leaders.

    Traditional approaches to professional development, built around expert-led training and top-down knowledge transfer, often fail to create lasting change.

    They tend to ignore the rich knowledge that exists in practice – what we know when we are there every day, side-by-side with the community we serve – and the complex ways that learning actually occurs in professional networks and communities.

    Teach to Reach is one component in The Geneva Learning Foundation’s emergent model for learning and change.

    This article describes the pedagogical patterns that Teach to Reach brings to life.

    A new vision for digital-first, networked professional learning

    Teach to Reach represents a shift in how we think about professional learning in global health.

    Its pedagogical pattern draws from three complementary theoretical frameworks that together create a more complete understanding of how professionals learn and how that learning translates into improved practice.

    At its foundation lies Bill Cope’s and Mary Kalantzis’s New Learning framework, which recognizes that knowledge creation in the digital age requires new approaches to learning and assessment.

    Teach to Reach then integrates insights from Watkins and Marsick’s research on the strong relationship between learning culture (a measure of the capacity for change) and performance and George Siemens’s learning theory of connectivism to create something syncretic: a learning approach that simultaneously builds individual capability, organizational capacity, and network strength.

    Active knowledge making

    The prevailing model of professional development often treats learners as empty vessels to be filled with expert knowledge.

    Drawing from constructivist learning theory, it positions health workers as knowledge creators rather than passive recipients.

    When a community health worker in Kenya shares how they’ve adapted vaccination strategies for remote communities, they are not just describing their work – they’re creating valuable knowledge that others can learn from and adapt.

    The role of experts is even more significant in this model: experts become “Guides on the side”, listening to challenges and their contexts to identify what expert knowledge is most likely to be useful to a specific challenge and context.

    (This is the oft-neglected “downstream” to the “upstream” work that goes into the creation of global guidelines.)

    This principle manifests in how questions are framed.

    Instead of asking “What should you do when faced with vaccine hesitancy?” Teach to Reach asks “Tell us about a time when you successfully addressed vaccine hesitancy in your community.” This subtle shift transforms the learning dynamic from theoretical to practical, from passive to active.

    Collaborative intelligence

    The concept of collaborative intelligence, inspired by social learning theory, recognizes that knowledge in complex fields like global health is distributed across many individuals and contexts.

    No single expert or institution holds all the answers.

    By creating structures for health workers to share and learn from each other’s experiences, Teach to Reach taps into what cognitive scientists call “distributed cognition” – the idea that knowledge and understanding emerge from networks of people rather than individual minds.

    This plays out practically in how experiences are shared and synthesized.

    When a nurse in Brazil shares their approach to integrating COVID-19 vaccination with routine immunization, their experience becomes part of a larger tapestry of knowledge that includes perspectives from diverse contexts and roles.

    Metacognitive reflection

    Metacognition – thinking about thinking – is crucial for professional development, yet it is often overlooked in traditional training.

    Teach to Reach deliberately builds in opportunities for metacognitive reflection through its question design and response framework.

    When participants share experiences, they are prompted not just to describe what happened, but to analyze why they made certain decisions and what they learned from the experience.
    This reflective practice helps health workers develop deeper understanding of their own practice and decision-making processes.

    It transforms individual experiences into learning opportunities that benefit both the sharer and the wider community.

    Recursive feedback

    Learning is not linear – it is a cyclical process of sharing, reflecting, applying, and refining.

    Teach to Reach’s model of recursive feedback, inspired by systems thinking, creates multiple opportunities for participants to engage with and build upon each other’s experiences.

    This goes beyond communities of practice, because the community component is part of a broader, dynamic and ongoing process.

    Executing a complex pedagogical pattern

    The pedagogical pattern of Teach to Reach come to life through a carefully designed implementation framework over a six-month period, before, during, and after the live event.

    This extended timeframe is not arbitrary – it is based on research showing that sustained engagement over time leads to deeper learning and more lasting change than one-off learning events.
    The core of the learning process is the Teach to Reach Questions – weekly prompts that guide participants through progressively more complex reflection and sharing.

    These questions are crafted to elicit not just information, but insight and understanding.

    They follow a deliberate sequence that moves from description to analysis to reflection to application, mirroring the natural cycle of experiential learning.

    Communication as pedagogy

    In Teach to Reach, communication is not just about delivering information – it is an integral part of the learning process.

    The model uses what scholars call “pedagogical communication” – communication designed specifically to facilitate learning.

    This manifests in several ways:

    • Personal and warm tone that creates psychological safety for sharing
    • Clear calls to action that guide participants through the learning process
    • Multiple touchpoints that reinforce learning and maintain engagement
    • Progressive engagement that builds complexity gradually

    Learning culture and performance

    Watkins and Marsick’s work helps us understand why Teach to Reach’s approach is so effective.

    Learning culture – the set of organizational values, practices, and systems that support continuous learning – is crucial for translating individual insights into improved organizational performance.

    Teach to Reach deliberately builds elements of strong learning cultures into its design.

    Furthermore, the Geneva Learning Foundation’s research found that continuous learning is the weakest dimension of learning culture in immunization – and probably global health.

    Hence, Teach to Reach itself provides a mechanism to strengthen specifically this dimension.

    Take the simple act of asking questions about real work experiences.

    This is not just about gathering information – it’s about creating what Watkins and Marsick call “inquiry and dialogue,” a fundamental dimension of learning organizations.

    When health workers share their experiences, they are not just describing what happened.

    They are engaging in a form of collaborative inquiry that helps everyone involved develop deeper understanding.

    Networks of knowledge

    George Siemens’s connectivism theory provides another crucial lens for understanding Teach to Reach’s effectiveness.

    In today’s world, knowledge is not just what is in our heads – it is distributed across networks of people and resources.

    Teach to Reach creates and strengthens these networks through its unique approach to asynchronous peer learning.

    The process begins with carefully designed questions that prompt health workers to share specific experiences.

    But it does not stop there.

    These experiences become nodes in a growing network of knowledge, connected through themes, challenges, and solutions.

    When a health worker in India reads about how a colleague in Nigeria addressed a particular challenge, they are not just learning about one solution – they are becoming part of a network that makes everyone’s practice stronger.

    From theory to practice

    What makes Teach to Reach particularly powerful is how it fuses multiple theories of learning into a practical model that works in real-world conditions.

    The model recognizes that learning must be accessible to health workers dealing with limited connectivity, heavy workloads, and diverse linguistic and cultural contexts.

    New Learning’s emphasis on multimodal meaning-making supports the use of multiple communication channels ensuring accessibility.

    Learning culture principles guide the creation of supportive structures that make continuous learning possible even in challenging conditions.

    Connectivist insights inform how knowledge is shared and distributed across the network.

    Creating sustainable change

    The real test of any learning approach is whether it creates sustainable change in practice.

    By simultaneously building individual capability, organizational capacity, and network strength, it creates the conditions for continuous improvement and adaptation.

    Health workers do not just learn new approaches – they develop the capacity to learn continuously from their own experience and the experiences of others.

    Organizations do not just gain new knowledge – they develop stronger learning cultures that support ongoing innovation.

    And the broader health system gains not just a collection of good practices, but a living network of practitioners who continue to learn and adapt together.

    Looking forward

    As global health challenges have become more complex, the need for more effective approaches to professional learning becomes more urgent.

    Teach to Reach’s pedagogical model, grounded in complementary theoretical frameworks and proven in practice, offers valuable insights for anyone interested in creating impactful professional learning experiences.

    The model suggests that effective professional learning in complex fields like global health requires more than just good content or engaging delivery.

    It requires careful attention to how learning cultures are built, how networks are strengthened, and how individual learning connects to organizational and system performance.

    Most importantly, it reminds us that the most powerful learning often happens not through traditional training but through thoughtfully structured opportunities for professionals to learn from and with each other.

    In this way, Teach to Reach is a demonstration of what becomes possible when we reimagine how professional learning happens in service of better health outcomes worldwide.

    Image: The Geneva Learning Foundation Collection © 2024

  • Experiences shared at Teach to Reach 10

    Experiences shared at Teach to Reach 10

    Before, during, and after Teach to Reach on 20-21 June 2024, 21,398 health workers across the Global South—from veteran national managers to newly-trained community health workers—shared their unfiltered, frontline experiences of delivering care in an increasingly complex world.

    Ahead of Teach to Reach 11, The Geneva Learning Foundation has just released the English-language collection of “Experiences shared“.

    A second collection of experiences shared by French-speaking participants is also available.

    This remarkable collection captures over 600 experiences that health workers shared, in their own words, offering rare, ground-level perspectives on how global health challenges manifest in communities.

    Themes and topics explored in this collection:

    • How we use what we learn from Teach to Reach
    • Learning culture and performance
    • On the frontlines of climate change and health
    • Health workers insights to end malaria
    • Health workers insights to fight neglected tropical diseases
    • Integration of health services
    • Health workers insights on e-health
    • 50 years of the Expanded Programme for Immunization

    Through questions that probe specific moments rather than seeking generalizations, these accounts detail personal encounters with everything from climate change’s effects on malaria transmission to the challenges of integrating immunization with other health services.

    Health workers share candid stories of their successes, failures, and innovations: using WhatsApp for vaccine advocacy, adapting disease control strategies as weather patterns shift, building community trust during mass drug administration campaigns, and more.

    While these experiences are inherently context-specific and should not be mistaken for systematic evidence, their value lies in illuminating the lived reality of health service delivery—the kind of rich, qualitative insight that often eludes formal research.

    The collection represents a mosaic of perspectives from different levels of the health system, each contributor speaking in a personal capacity about their direct observations and experiences.

    This comprehensive volume is part of Teach to Reach, an ongoing cycle of learning and exchange facilitated by The Geneva Learning Foundation.

    Contributors receive back the complete collection of shared experiences, enabling them to learn from peers facing similar challenges across contexts.

    The experiences are also available as focused thematic publications on specific topics such as malaria control, climate change adaptation, and immunization integration.

    Finally, an accompanying insights report provides concise thematic summaries and analysis of key learnings about each of the topics that were explored.

    Whether your focus is immunization, digital health, climate change adaptation, or disease control, these raw accounts provide crucial context for anyone seeking to bridge the gap between global health policy and local implementation.

    Rather than providing definitive answers, this volume offers a unique window into how health workers learn, adapt, and drive change in their communities—making it an invaluable complement to traditional evidence for understanding and improving global health delivery.

    These Shared Experiences should be required reading for global health practitioners, policymakers, and researchers interested in understanding how macro-level health challenges and interventions play out on the ground.

    The Geneva Learning Foundation (TGLF). (2024). Teach to Reach 10. Experiences shared (1.0). Teach to Reach 10, Online. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.13366491

    La Fondation Apprendre Genève. (2024). Teach to Reach 10. Expériences partagées (1.0). Teach to Reach 10, En ligne. La Fondation Apprendre Genève (TGLF). https://doi.org/10.5281/zenodo.13769081

  • Why participate in Teach to Reach?

    Why participate in Teach to Reach?

    In global health, where challenges are as diverse as they are complex, we need new ways for health professionals to connect, learn, and drive change.

    Imagine a digital space where a nurse from rural Nigeria, a policymaker from India, and a WHO expert can share experiences, learn from each other, and collectively tackle global health challenges.

    That’s the essence of Teach to Reach.

    Welcome to Teach to Reach, a peer learning initiative launched in January 2021 by a collection of over 300 health professionals from Africa, Asia, and Latin America as they were getting ready to introduce COVID-19 vaccination.

    Four years later, the tenth edition of Teach to Reach on 20-21 June 2024 brought together an astounding 21,389 health professionals from over 70 countries.

    Discussion has expanded beyond immunization to include a range of challenges that matter for the survival and resilience of local communities.

    What makes this gathering extraordinary is not just its size, but its composition.

    Unlike traditional conferences dominated by high-level experts, 80% of Teach to Reach participants work at district and facility levels, bringing ground-level insights to global discussions.

    Half are government workers.

    One in five work for health in the context of armed conflict.

    Why do so many health workers join and contribute to Teach to Reach?

    The event’s success lies in its unique process.

    Weeks before the main event, participants start sharing their experiences through targeted questions.

    In June, these “Teach to Reach Questions” resulted in over 2,000 real-world stories and insights being collected and shared back with the community.

    This pre-event engagement ensures that when participants finally meet virtually, conversations are rich, relevant, and rooted in real-world challenges.

    During the two-day event, participants engage in a mix of plenary sessions, interactive workshops, and one-on-one networking.

    “It’s like speed dating for global health professionals,” jokes The Geneva Learning Foundation’s Charlotte Mbuh. “But instead of romantic connections, we’re forming professional bonds that can transform health outcomes in our communities.”

    This structure facilitates direct dialogue between global health leaders and frontline workers.

    How does this relate to the work done by global partners?

    Ahead of Teach to Reach 10, Dr. Kate O’Brien, Director of Immunization at WHO, noted, “Our job is to take everything that you all know at the grassroots level and bring it together into sort of that collated guidance.”

    Jaded global health staff may ask “So what?”.

    The impact of Teach to Reach extends far beyond the event itself.

    Health workers leading Teach to Reach helped create the Movement for Immunization Agenda 2030 (IA2030).

    This year, over 2,400 civil society and community-based organizations and at least as many local leaders engaged as as partners, creating a diverse network that spans from grassroots NGOs and local government agencies to global institutions like Gavi and UNICEF.

    Connections made through the network outlast the event itself, strengthening local action and creating new ways to inform global strategies.

    For global partners, Teach to Reach offers an unparalleled opportunity.

    Dr. Ephraim T. Lemango, Chief of Immunization at UNICEF, said: “We’ve said we want to listen and that co-creation is very important… This is exactly the type of innovative approach that we need to overcome the complex challenges we are faced with in global health.”

    Teach to Reach 10 demonstrated the event’s growing impact and reach:

    • Diverse participation: 80% of attendees were district and facility-level health workers, providing ground-level perspectives often missing from global health dialogues.
    • Organizational engagement: 2,400 organizations participated in the partnership process, with 240 selected as official partners, spanning local NGOs to global institutions.
    • Thematic relevance: The event addressed critical issues like climate change’s impact on health, with insights from 4,700 health workers informing discussions.
    • Global-local collaboration: Sessions featured partnerships between international organizations and local implementers, such as UNICEF’s work on reaching zero-dose children in urban settings.
    • Tangible outcomes: Post-event surveys revealed that 99.7% of respondents reported increased motivation, and 97.4% learned something new and applicable to their work.

    We are pleased to announce Teach to Reach 11 that will be held on 5-6 December 2024.

    As Teach to Reach 11 approaches, the excitement is palpable.

    This year’s event promises to continue to explore critical issues like climate change’s impact on health, malaria, and immunization, bringing new partners seeking to listen and learn with communities.

    The running thread across all these issues is expressed in a groundbreaking Manifesto for investment in health workers, developed collaboratively by over 1,300 Teach to Reach participants.

    For those new to Teach to Reach, participating is straightforward.

    The event is free for health professionals from low and middle-income countries, with options for low-bandwidth participation to ensure inclusivity.

    Global organizations can join as partners, gaining access to a wealth of insights and opportunities through their respectful, meaningful engagement with health workers.

    By harnessing the collective wisdom of health professionals worldwide, Teach to Reach is creating a new paradigm for learning, collaboration, and action in global health.

    So, whether you’re a community health worker in rural Asia or a decision-maker at a global health institution, Teach to Reach invites you to be part of this transformative journey.

    Together, we can bridge the gap between global strategies and local realities, turning shared knowledge into powerful action for better health worldwide.

  • Brevity’s burden: The executive summary trap in global health

    Brevity’s burden: The executive summary trap in global health

    It was James Gleick who noted in his book “Faster: The Acceleration of Just About Everything” the societal shift towards valuing speed over depth:

    “We have become a quick-reflexed, multitasking, channel-flipping, fast-forwarding species. We don’t completely understand it, and we’re not altogether happy about it.”

    In global health, there’s a growing tendency to demand ever-shorter summaries of complex information.
     
    “Can you condense this into four pages?”

    “Is there an executive summary?”

    These requests, while stemming from real time constraints, reveal fundamental misunderstandings about the nature of knowledge and learning.

    Worse, they contribute to perpetuating existing global health inequities.

    Here is why – and a few ideas of what we can do about it.

    We lose more than time in the race to brevity

    The push for shortened summaries is understandable on the surface.

    Some clinical researchers, for example, undeniably face increasing time pressures.

    Many are swamped due to underlying structural issues, such as healthcare professional shortages.

    This is the result of a significant shift over time, leaving less time for deep engagement with new information.

    If we accept these changes, we lose far more than time.

    Why does learning require time, depth, and context?

    True understanding and the ability to apply knowledge in diverse contexts demands deep engagement, reflection, and often, struggle with our own assumptions and mental models.

    Consider the process of learning a new language.

    No one expects to become fluent by reading a few pages of grammar rules.

    Mastery requires immersion, practice, making mistakes, and gradually building competence over time.

    The same principle applies to making sense of multifaceted global health issues.

    5 risks of executive summaries

    Here are five risks of demanding summaries of everything:

    1. Oversimplification: Complex health challenges often cannot be adequately captured in a few pages. Crucial nuances and context-specific details get lost. Those ‘details’ may actually be the ‘how’ of what makes the difference for those leading change to achieve results.
    2. Losing context: Information that can be easily summarized (quantitative data, broad generalizations) gets prioritized over more nuanced, qualitative, or context-specific knowledge. 
    3. Stunting critical thinking: The habit of relying on summaries can atrophy our capacity for deep, critical engagement with complex ideas.
    4. Overconfidence: It assumes that learning is primarily about information transfer, rather than a process of engagement, reflection, and application. Reading a summary can give the false impression that one has grasped a topic, leading to overconfidence in decision-making.
    5. Devaluing local knowledge: Rich, contextual experiences from health workers and communities often do not lend themselves to easy summarization.

    The expectation that complex local realities can always be distilled into brief summaries for consumption by decision-makers (often in the Global North) perpetuates existing power structures in global health.

    The ability to demand summaries often comes from positions of power.

    This can lead to privileging certain voices (those who can produce polished summaries) over others (those with deep, context-specific knowledge that resists easy summarization).

    This knowledge then gets sidelined in favor of more easily digestible but potentially less relevant information.

    10 ways to value and engage with knowledge in global health

    Addressing the “summary culture” requires more than better time management.

    It calls for a fundamental rethinking of how we value and engage with knowledge in global health.

    Instead of defaulting to demands for ever-shorter summaries, we need to rethink how we engage with knowledge.

    Here are 10 practical ways to do so.

    1. Prioritize productive diversity over reductive simplicity: Sometimes, it is better to engage deeply many different ideas than to seek one reductive generalization.
    2. Value local expertise: Prioritize knowledge from those closest to the issues, even when it does not fit neatly into summary format.
    3. Value diverse knowledge forms: Recognize that not all valuable knowledge can be easily summarized. Create space for stories, case studies, and rich qualitative data.
    4. Improve information design: Instead of just shortening, focus on presenting information in more accessible and engaging ways that do not sacrifice complexity.
    5. Create new formats: Develop ways of sharing information that balance accessibility with depth and nuance.
    6. Pause and reflect: What might be lost in the condensing? Are you truly seeking efficiency, or avoiding the discomfort of engaging with complex, potentially challenging ideas? Are you willing to advocate for systemic changes that truly value deep learning and diverse knowledge sources?
    7. Challenge the demand: When asked for summaries, push back (respectfully) and explain why certain information resists easy summarization.
    8. Foster critical engagement: Encourage professionals to develop skills in quickly assessing and engaging with complex information, rather than providing pre-digested summaries.
    9. Educate funders and decision-makers: Help those in power understand the value of engaging with complexity and diverse knowledge forms.
    10. Rethink the economy of time allocation: Advocate for systemic changes that value time spent on deep learning and reflection as core to effective practice and leadership.

    Image: The Geneva Learning Foundation Collection © 2024

  • The Nigeria Immunization Collaborative: Early learning from a novel sector-wide approach model for zero-dose challenges

    The Nigeria Immunization Collaborative: Early learning from a novel sector-wide approach model for zero-dose challenges

    Less than three weeks after its launch, the Nigeria Immunization Collaborative – a partnership between the Geneva Learning Foundation, the National Primary Health Care Development Agency (NPHCDA), and UNICEF – has already connected over 4,000 participants from all 36 states and more than 300 Local Government Areas (LGAs).

    The Collaborative is part of the Movement for Immunization Agenda 2030 (IA2030).

    In the Collaborative’s first peer learning exercise that concluded on 6 August 2024, over 600 participants conducted root cause analyses of immunization barriers in their communities.

    Participants engaged in a two-week intensive process of analyzing immunization challenges, conducting root cause analyses, and developing actionable plans to address these issues.

    They did this without having to stop their daily work or travel, a key characteristic of The Geneva Learning Foundation’s model to support work-based learning.

    Watch the General Assembly of the Nigeria Immunization Collaborative on 6 August 2024

    What are health workers saying about the Collaborative?

    For Mariam Mustapha, a participant from Kano State, the Collaborative is “multiple individuals that perform a task”, united around a shared purpose.

    She highlighted the importance of engaging with community members, noting, “These people from the community, most of them, they don’t have enough knowledge or they are receiving misinformation about immunization and vaccines.”

    The peer learning exercise employed a structured approach, asking participants to explain their immunization challenge, conduct a “5 Whys” analysis to identify root causes, and develop actionable plans within their scope of work.

    How does the Collaborative help health workers?

    This method proved enlightening for many participants.

    John Emmanuel, a community health worker from Bauchi State, shared his experience: “I just discovered that over the years, I have been superficial in my approach. I’ve been one sided. I’ve been actually peripheral in my approach. So during the root cause analysis, I was able to identify the broader perspective of identifying the challenge and then fixing it as it affects my job here in the community.”

    The Collaborative also fostered connections between health workers across different regions of Nigeria.

    Mohammed Nasir Umar, a JSI HPV program associate in Zamfara State, noted the value of this cross-pollination of ideas: “The root cause analysis really widened my horizon on how I think around the challenges. The ‘5 Whys’ techniques approach was really, really helpful.”

    Participants identified a range of immunization challenges, including vaccine hesitancy, lack of information and awareness, sociocultural and religious factors, reaching zero-dose children, incomplete immunization, healthcare worker issues, logistical challenges, political interference, poor documentation, and community trust issues.

    But then each one started asking ‘why’, stopping only once they found a root cause that they are in a position to do something about.

    Esther Sharma, working with NPHCDA in a local government area, identified a critical issue in her facility: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here.”

    Her solution involves ensuring consistent staffing during immunization days, which should encourage more community members to seek vaccination services.

    How are new stakeholders participating in the Collaborative?

    The Collaborative also welcomed participation from organizations not traditionally involved in immunization services.

    Angela Emmanuel, a nurse and founder of the Emmanuel Cancer Foundation in Lagos, found value in the exercise for her work on HPV vaccination and cancer prevention.

    She emphasized the need for a more educational approach: “Our motive should be education. Our motive should be the awareness, not just asking them to take this vaccine.”

    Chijioke Kaduru, a public health physician who served as a Guide for the Collaborative, reflected: “While some of these challenges are similar in many settings, the local context and the nuances that shape these challenges clearly make them a good opportunity to engage, to interact, to understand them better, and to start to also see the ideas that colleagues have about how to solve those problems.”

    By connecting frontline health workers, fostering critical thinking, and encouraging the development of locally-tailored solutions, the Nigeria Immunization Collaborative represents a potentially scalable model for strengthening health systems and improving immunization coverage.

    As the exercise concludes, participants are poised to implement their action plans in their respective communities.

    How are government workers participating in the Collaborative?

    A key focus of the final session was the presentation of root cause analyses by government workers from the Federal and State Primary Health Care Development Agencies.

    These presentations provided valuable insights into the challenges faced at various levels of the health system and the innovative solutions being developed.

    Maimuna Tata, a deputy in-charge at a health facility in Bunkura local government area of Kano State, presented her analysis of why routine immunization sessions were not being conducted at her facility.

    Through her “5 Whys” analysis, she uncovered a systemic issue: “The health facility is newly built and was commissioned after the 2024 micro plan exercise and needs to undergo several processes for provision of routine immunization.”

    Tata’s proposed solution demonstrated the kind of innovative thinking the Collaborative aimed to foster: “Instead of them coming for outreach session in the settlement, I think the vaccine should be channeled to the health facility so that the health facility can conduct the sessions. And at the end of the day, we will now be submitting our reports to the health facility, that is the model health facility, pending the time the health facility will be recorded or will be updated in the server.”

    Esther Sharma, working with NPHCDA in a local government area, identified a critical staffing issue: “The reason why people turn out low for immunization is because there are no health workers in the facilities to attend to them when they get here. I am the routine immuunization focal person where I currently work and when I went there newly, I asked a lot of people, why don’t they come to the hospital for immunization? And they said when they come, they don’t find anybody to attend to them.”

    Her solution involves ensuring consistent staffing during immunization days, which she reported has already encouraged more community members to seek vaccination services.

    Image: The Geneva Learning Foundation Collection © 2024