Stories

Tag: peer learning

  • HPV vaccination: New learning and leadership to bridge the gap between planning and implementation

    HPV vaccination: New learning and leadership to bridge the gap between planning and implementation

    This article is based on my presentation about HPV vaccination at the 2nd National Conference on Adult Immunization and Allied Medicine of the Indian Society for Adult Immunization (ISAI), Science City, Kolkata, on 15 February 2025.

    The HPV vaccination implementation challenge

    The global landscape of HPV vaccination and cervical cancer prevention reveals a mix of progress and persistent challenges. While 144 countries have introduced HPV vaccines nationally and vaccination has shown remarkable efficacy in reducing cervical cancer incidence, significant disparities persist, particularly in low- and middle-income countries.

    Evidence suggests that challenges in implementing and sustaining HPV vaccination programs in developing countries are significantly influenced by gaps between planning at national level and execution at local levels. Multiple studies confirm this disconnect as a primary barrier to effective HPV vaccination programmes.

    Traditional approaches to knowledge development in global health often rely on expert committee models characterized by hierarchical knowledge flows, formal meeting processes, and bounded timelines. While these approaches offer strengths like high academic rigor and systematic review, they frequently miss frontline insights, develop slowly, and produce static outputs that may be difficult to translate effectively into action.

    How the peer learning network alternative can support HPV vaccination

    At The Geneva Learning Foundation (TGLF), we have developed a complementary model—one that values the collective intelligence of frontline health workers and creates structured opportunities for their insights to inform policy and practice. This peer learning network model features:

    • Large, diverse networks with multi-directional knowledge flow
    • Open participation and flexible engagement
    • Direct field experience and implementation insights
    • Iterative development through experience sharing
    • Continuous refinement and living knowledge

    This approach captures practical knowledge, enables rapid learning cycles, preserves context, and brings together multiple perspectives in a dynamic process that continuously updates as new information emerges.

    HPV vaccination: the peer learning cycle in action

    To address HPV vaccination challenges, we implemented a structured five-stage cycle that connected frontline experiences with policy decisions:

    1. Experience collection at scale: In June 2023, we engaged over 16,000 health professionals to share their HPV vaccination experiences through our Teach to Reach programme. This stage focused specifically on capturing frontline implementation challenges and solutions across diverse contexts.
    2. Synthesis and analysis: TGLF’s Insights Unit identified key themes, success patterns, and common challenges while highlighting local innovations and practical solutions that emerged from the field.
    3. Knowledge deepening: In October 2023, we conducted a second round of experience sharing that built upon earlier discussions at Teach to Reach. This stage featured more in-depth case studies and implementation stories, providing additional contexts and approaches to vaccination challenges.
    4. National-level review: In January 2024, we facilitated a consultation with national EPI (Expanded Programme on Immunization) planners from 31 countries. This created direct connections between field experience and national strategy, validating and enriching the collected insights.
    5. Knowledge mobilization: Finally, we synthesized the insights into practical guidance, ready for sharing back to frontline workers, and established a foundation for continued learning cycles.

    This process uniquely values the practical wisdom that emerges from implementation experience. Rather than assuming solutions flow from the top down, we recognize that those doing the work often develop the most effective approaches to complex challenges.

    Teach to Reach: Building a learning community for HPV vaccination

    Our Teach to Reach programme serves as the hub for this peer learning approach. Since its inception, the community has grown steadily since January 2021 to reach over 24,000 members by December 2024. The participants reflect remarkable diversity.

    This diversity of contexts and experiences creates a rich environment for learning. The programme demonstrates significant impact on participants’ professional capabilities—compared to global baselines, Teach to Reach participants show:

    • 45% stronger worldview change
    • 41% greater impact on professional practice
    • 49% higher professional influence

    7 insights about HPV vaccination from peer learning at Teach to Reach

    Through this process, we uncovered several important implementation insights:

    1. Importance of connecting field experience to policy

    • Each stage deepened understanding of implementation challenges
    • We observed progression from tactical to strategic considerations
    • Growing recognition of systemic factors emerged
    • Evolution from individual to institutional solutions became apparent
    • Value of structured knowledge sharing across levels was demonstrated

    2. Implementation learning

    • Success requires multi-stakeholder engagement
    • Sustained communication proves more effective than one-time campaigns
    • School systems provide critical implementation platforms
    • Community leadership is essential for acceptance
    • Integration with other services increases efficiency
    • Local adaptation is key to successful implementation

    3. Unexpected implementation findings

    • Tribal communities often showed less vaccine hesitancy than urban areas
    • Teachers emerged as more influential than health workers in some contexts
    • Personal stories proved more persuasive than statistical evidence
    • Integration with COVID-19 vaccination improved HPV acceptance
    • Social media played both positive and negative roles
    • School-based programs sometimes reached out-of-school children

    4. Counter-intuitive success factors

    • Less formal settings often produced better results
    • Simple communication strategies outperformed complex ones
    • Male community leaders became strong vaccination advocates
    • Religious institutions provided unexpected support
    • Health worker vaccination of own children became powerful tool
    • Community dialogue proved more effective than expert presentations

    5. Unexpected challenges

    • Urban areas sometimes showed more resistance than rural areas
    • Education level did not correlate with vaccine acceptance
    • Health workers themselves sometimes showed hesitancy
    • Traditional media was less influential than anticipated
    • Formal authority figures were not always the most effective advocates
    • Technical knowledge proved less important than communication skills

    6. Examples of novel solutions

    • Using cancer survivors as advocates
    • WhatsApp groups for community health workers
    • School children as messengers to families
    • Integration with existing women’s groups
    • Leveraging religious texts and teachings
    • Community theater and storytelling approaches

    System-level surprises

    • Success was often independent of resource levels
    • Informal networks proved more important than formal ones
    • Bottom-up strategies were more effective than top-down approaches
    • Social factors were more influential than technical ones
    • Local adaptation was more important than standardization
    • Peer influence was more powerful than expert authority

    In some cases, these findings challenge many conventional assumptions about HPV vaccination programmes. In all cases, they highlight the importance of local knowledge, social factors, and adaptation over standardized approaches based solely on technical expertise.

    The power of health worker collective intelligence

    Our approach demonstrates the value of health worker collective intelligence in improving performance:

    • High-quality data and situational intelligence from our network of 60,000+ health workers provides rapid insights
    • Field observations on changing disease patterns and resistance can be quickly collected
    • Climate change impacts can be tracked through frontline reports
    • The TGLF Insights Unit packages this intelligence into knowledge to inform practice and policy

    This represents a fundamental shift from assuming expert committees have all the answers to recognizing the distributed expertise that exists throughout health systems.

    Continuous learning: The key to improvement

    In fact, previous TGLF research has demonstrated that continuous learning is often the “Achilles’ heel” in immunization programs. Common issues include:

    1. Relative lack of learning opportunities
    2. Limited ability to experiment and take risks
    3. Low tolerance for failure
    4. Focus on task completion at the expense of building capacity for future performance
    5. Lack of encouragement for learning tied to tangible organizational incentives

    In 2020 and 2022, we conducted large-scale measurements of learning culture of more than 10,000 immunization professionals in low- and middle-income countries. The data showed that ‘learning culture’ (a measure of the capacity for change) correlated more strongly with perceived programme performance than individual motivation did. This challenges the common assumption that poor motivation is the root cause of poor performance.

    These findings help zero in on six ways to strengthen continuous learning to drive HPV vaccination:

    1. Motivate health workers to believe strongly in the importance of what they do
    2. Give them practice dealing with difficult situations they might face
    3. Build mental resilience for facing obstacles
    4. Prompt them to enlist coworkers for support
    5. Help them engage their bosses to provide guidance, support, and resources
    6. Help them identify and overcome workplace obstacles

    Impact and benefits of peer learning

    This approach delivers multiple benefits:

    • Frontline workers gain broader perspective
    • National planners access grounded insights
    • Practical solutions spread more quickly
    • Policy decisions are informed by field experience
    • Continuous improvement cycle gets established

    Key success factors include:

    • Scale that enables diverse input collection
    • Structure that supports quality knowledge creation
    • Regular rhythm that maintains engagement
    • Multiple levels of review that ensure relevance
    • Clear pathways from insight to action

    How can we interpret these findings?

    This model generates implementation-focused evidence that complements rather than competes with traditional epidemiological data. 

    The findings emerge from a structured methodology that includes initial experience collection at scale, synthesis and analysis, knowledge deepening through case studies, national-level review by EPI planners from 31 countries, and systematic knowledge mobilization. This approach provides rigor and scale that elevate these observations beyond mere anecdotes.

    For epidemiologists who become uncomfortable when evidence is not purely quantitative, it is important to understand that structured peer learning fills a critical gap in implementation science by capturing what quantitative studies often miss: the contextual factors and practical adaptations that determine programme success or failure in real-world settings.

    When implementers report across different contexts that tribal communities show less vaccine hesitancy than urban areas, or that teachers emerge as more influential than health workers in specific settings, these patterns represent valuable implementation intelligence.

    Such insights also help explain why interventions that appear effective in controlled studies often fail to deliver similar results when implemented at scale.

    In fact, these findings address precisely what quantitative studies struggle to capture: why education level does not reliably predict vaccine acceptance; why some resource-constrained settings outperform better-resourced ones; how informal networks frequently prove more effective than formal structures; and which communication approaches actually drive behavior change in specific populations.

    For programme planners, this knowledge bridges the gap between general guidance (“engage community leaders”) and actionable specifics (“male community leaders became particularly effective advocates when engaged through these specific approaches”). 

    Accelerating HPV vaccination progress

    To make significant progress on HPV vaccination as part of the Immunization Agenda 2030’s Strategic Priority 4 (life-course and integration), we encourage global health stakeholders to:

    1. Rethink how we learn
    2. Question how we engage with families and communities
    3. Focus on trust

    By combining expert knowledge with the practical wisdom of thousands of implementers, we can develop more effective strategies for HPV vaccination that bridge the gap between planning and execution.

    This peer learning network approach does not replace expertise—it enhances and grounds it in the realities of implementation.

    It recognizes that the frontline health worker in a remote village may hold insights just as valuable as those of a technical expert in a capital city.

    By creating structures that enable these insights to emerge and connect, we can accelerate progress on HPV vaccination and other public health challenges.

    Acknowledgements

    I wish to thank ISAI’s Dr Saurabh Kole and his colleagues for their kind invitation. I also wish to recognize and appreciate Charlotte Mbuh and Ian Jones for their invaluable contributions to the Foundation’s work on HPV vaccination, and Dr Satabdi Mitra for her tireless leadership and boundless commitment. Last but not least, I wish to thank the thousands of health workers who contributed their experiences before, during, and after successive Teach to Reach peer learning events. What little I know comes from their collective intelligence, action, and wisdom.

    References

    Dorji, T. et al. (2021) ‘Human papillomavirus vaccination uptake in low-and middle-income countries: a meta-analysis’, EClinicalMedicine, 34, p. 100836. Available at: https://doi.org/10.1016/j.eclinm.2021.100836.

    Faye, W. et al. (2023) IA2030 Case study 18. Wasnam Faye. Vaccine angels – Give us the opportunity and we can perform miracles. The Geneva Learning Foundation. Immunization Agenda 2030 Case study 18. Available at: https://doi.org/10.5281/ZENODO.7785244.

    Gonçalves, I.M.B. et al. (2020) ‘HPV Vaccination in Young Girls from Developing Countries: What Are the Barriers for Its Implementation? A Systematic Review’, Health, 12(06), pp. 671–693. Available at: https://doi.org/10.4236/health.2020.126050.

    Jones, I. et al. (2024) Making connections at Teach to Reach 8 (IA2030 Listening and Learning Report 6). Available at: https://doi.org/10.5281/ZENODO.8398550.

    Jones, I. et al. (2022) IA2030 Case Study 7. Motivation, learning culture and programme performance. The Geneva Learning Foundation. Available at: https://doi.org/10.5281/ZENODO.7004304.

    Kutz, J.-M. et al. (2023) ‘Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review’, BMC Public Health, 23(1), p. 974. Available at: https://doi.org/10.1186/s12889-023-15842-1.

    Moore, K. et al. (2022) Overcoming barriers to vaccine acceptance in the community: Key learning from the experiences of 734 frontline health workers. The Geneva Learning Foundation. Available at: https://doi.org/10.5281/ZENODO.6965355.

    Umbelino-Walker, I. et al. (2024) ‘Towards a sustainable model for a digital learning network in support of the Immunization Agenda 2030 –a mixed methods study with a transdisciplinary component’, PLOS Global Public Health. Edited by M. Pentecost, 4(12), p. e0003855. Available at: https://doi.org/10.1371/journal.pgph.0003855.

    Watkins, K.E. et al. (2022) ‘Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention’, BMC Health Services Research, 22(1), p. 736. Available at: https://doi.org/10.1186/s12913-022-08138-4.

    Wigle, J., Coast, E. and Watson-Jones, D. (2013) ‘Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects’, Vaccine, 31(37), pp. 3811–3817. Available at: https://doi.org/10.1016/j.vaccine.2013.06.016.

  • Supporting Ukrainian children: New peer learning platform to rapidly expand and scale the network of practitioners across Europe

    Supporting Ukrainian children: New peer learning platform to rapidly expand and scale the network of practitioners across Europe

    The International Federation of Red Cross and Red Crescent Societies (IFRC) and The Geneva Learning Foundation (TGLF) are launching PFA Connect, a new platform for education, social work, and health professionals who support children from Ukraine. The platform builds on a new peer learning network launched by IFRC and TGLF in 2024 that is already reaching more than 2,000 practitioners from 27 European countries.

    This network responds to a critical need: while traditional training provides essential foundations, professionals benefit most from exchanging practical solutions with peers facing similar challenges. “I felt like I was part of a community of like-minded people who care about children’s mental health,” shares Halyna Fedoryshyn, an education professional from Ukraine who earned her first PFA certificate in 2024. “I had the opportunity to expand my social contacts with professionals outside of Ukraine,” .

    “PFA” refers to Psychological first aid (PFA), a practical way to support children experiencing crisis-related distress. This includes creating safe spaces, listening without pressure to talk, addressing immediate needs, and connecting children with appropriate support services. Through PFA Connect, practitioners will share experience to help problem-solve common challenges.

    Andreea-Elena Andras, a Red Cross health professional in Romania explains: “By hearing and learning from real stories, I learned new ways of linking with children and create a safe place, such as grounding, breathing and other techniques”.

    See what we learned from 873 practitioners…

    PFA Connect aims to address a critical need identified through work with practitioners: while training provides essential foundations, professionals build capacity through experience. Exchanging practical solutions with peers facing similar challenges can accelerate the ability to support children from Ukraine.

    PFA Connect will offer 30-minute online sessions in English and Ukrainian where practitioners share challenges and solutions. The platform aims to complement existing Red Cross activities by focusing on rapid exchange between professionals.

    The initiative operates as part of a broader European Union-funded project through EU4Health programme, involving the Ukrainian Red Cross and 27 other European Red Cross Societies, with the technical support and expertise of the Red Cross Red Crescent (RCRC) Movement MHPSS Hub,

    “Throughout 2024, we have witnessed the power of practitioners learning from each other’s experiences,” says Panu Saaristo , Europe’s Regional Manager for Health and Care at the IFRC. “Our collaboration with The Geneva Learning Foundation represents our commitment to strengthen this peer learning approach, recognizing that the most effective solutions often come from professionals working directly with affected children.”

    “I feel more equipped to make a positive impact in my role,” reported Jelena Horvat Petanjko, an education professional from Croatia. “The practical knowledge and real-life examples inspired me to adapt my methods and approach challenges with greater empathy and creativity.”

    “The challenges facing professionals supporting Ukrainian children cannot be solved through traditional training alone,” explains Reda Sadki Sadki, Executive Director of The Geneva Learning Foundation. “What we have learned is that the solutions already exist within the network of practitioners. Our role is to connect them with each other.”

    PFA Connect will rapidly scale and expand this network, providing a rapid way for professionals to tap into the network’s collective intelligence in supporting Ukrainian children.

    The network’s growth so far has been driven by Ukrainian professionals, especially those working in fragile contexts.

    “Thanks to peer learning that is certified, I am able to provide better quality support and transfer knowledge about it to others,” says Alyona Kryvulyak, a social worker.

    “I had answers to my questions… I can use my knowledge in practice… I saw that there are many perspectives,” notes Olga Synytsyna, a social work professional in Ukraine.

    “In emergency response, we often focus on training and technical solutions,” says Reda Sadki. “But what we have learned from Ukrainian practitioners is that the most powerful solutions often emerge when professionals can learn directly from each other’s experience.”

    For mental health professional Natalia Tsumarieva in Ukraine, peer learning has shifted her approach to supporting Ukrainian children: “I began to pay more attention to providing support in the initial stages of getting to know children. Understanding the importance of teaching these skills to my non-psychology students has also been valuable.”

    While driven by those facing the most acute and urgent situations, this has become a truly Europe-wide project. As a Croatian education professional noted, “It is encouraging and inspiring to connect with people across Europe with the same goal and similar experiences. This shows that culture, gender and age are no barrier to mutual understanding and learning about supporting children.”

    “Connecting practitioners across borders creates new possibilities,” adds Reda Sadki. “A social worker in Ukraine might develop an innovative approach that could help a teacher in Croatia facing similar challenges. Our role is to make these connections possible at scale.”

    Professionals interested in joining the platform can register for the January 29 launch session, which begins at 4:00 PM CET. For additional information and to request your invitation, visit the PFA Connect platform. https://www.learning.foundation/ukraine

    Note: This initiative is funded by the European Union through the EU4Health programme. Its contents are the sole responsibility of TGLF and IFRC, and do not necessarily reflect the views of the European Union.

  • 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

  • The cost of inaction: Quantifying the impact of climate change on health

    The cost of inaction: Quantifying the impact of climate change on health

    This World Bank report ‘The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries’ presents new analysis of climate change impacts on health systems and outcomes in the regions that are bearing the brunt of these impacts.

    Key analytical insights to quantify climate change impacts on health

    The report makes three contributions to our understanding of climate-health interactions:

    First, it quantifies the massive scale of climate change impacts on health, projecting 4.1-5.2 billion climate-related disease cases and 14.5-15.6 million deaths in LMICs by 2050. This represents a significant advancement over previous estimates, which the report demonstrates were substantial underestimates.

    Second, it illuminates the profound economic consequences, calculating costs of $8.6-20.8 trillion by 2050 (0.7-1.3% of LMIC GDP). The report employs both Value of Statistical Life and Years of Life Lost approaches to provide a range of economic impact estimates.

    Third, it reveals stark geographic inequities in impact distribution, with Sub-Saharan Africa bearing approximately 71% of cases and nearly half of deaths, while South Asia faces about 18% of cases and a quarter of deaths. This spatial analysis helps identify where interventions are most urgently needed.

    Policy implications and systemic perspectives

    The report’s findings point to several critical policy directions:

    • The need for systemic rather than disease-specific interventions emerges as a central theme. The authors explicitly advocate for strengthening entire health systems rather than pursuing vertical disease programs.
    • The economic analysis makes a compelling case for immediate action, demonstrating that the costs of inaction far exceed potential investment requirements for climate-resilient health systems.
    • The geographic distribution of impacts highlights the need for globally coordinated responses while prioritizing support for the most vulnerable regions.

    The findings suggest that transforming systems to address climate change impacts on health requires not just technical solutions but fundamental rethinking of how health systems are organized and financed in vulnerable regions.

    This aligns with recent scholarship on complex adaptive systems and organizational transformation in global health.

    The report’s emphasis on systemic approaches represents a significant shift in thinking about climate-health interventions. This merits unpacking on several levels:

    1. Inadequacy of vertical disease silos: The report challenges the traditional vertical disease management paradigm that has dominated global health programming for decades. While vertical programs have achieved notable successes in areas like HIV/AIDS or malaria control, the report argues that climate change’s multifaceted health impacts require a fundamentally different approach.
    2. Need for systemic intervention: Climate change simultaneously affects multiple disease pathways, nutrition status, and health infrastructure. These interactions cannot be effectively addressed through isolated disease-specific programs. Building core health system capabilities (surveillance, emergency response, primary care) creates multiplicative benefits across various climate-related health challenges. Strong health systems can better identify and respond to emerging threats, whereas vertical programs often lack this flexibility.
    3. Implementation implications: The report suggests this systemic approach requires: integrated planning across health system components, flexible funding mechanisms that support system-wide capabilities, enhanced coordination between different health programmes and investment in cross-cutting infrastructure and capabilities.

    What about the health workforce facing impacts of climate change on health?

    Between this clear-eyed assessment and effective action lies a critical implementation gap.

    Interestingly, the report gives limited explicit attention to the health workforce dimension of climate-health challenges. Yet that is precisely where we need to focus attention, given that:

    • Health workers based in communities are first responders to climate-related health emergencies
    • Workforce capacity significantly determines a health system’s adaptive capabilities
    • Climate change itself affects health worker distribution and effectiveness

    Given the report’s emphasis on systemic approaches, the lack of detailed discussion about human resources for health represents a missed opportunity to explore what effective action might look like.

    The Geneva Learning Foundation’s network, developed through nearly a decade of research and practice, has led us to identify a path for supporting the health workforce to strengthen preparedness and response in response to climate change impacts on health.

    The network already connects over 60,000 health workers. They represent all job roles, rank, and levels of the health system.

    One distinguishing feature of this network is its deep integration with existing government health systems. Over half of network participants are government employees, from community health workers to district officers to national planners.

    62% of participants work in remote rural areas, 47% serve urban poor populations, and 21% operate in conflict zones.

    These are not just statistics: they represent an unprecedented capability to mobilize knowledge and action where it’s most needed.

    Since 2023, network participants have been sharing observations, experiences, and insights of climate change impacts on health. 

    The model connects different levels of health systems:

    • Community-based health workers share ground-level observations
    • District managers identify emerging patterns
    • National planners gauge system-wide implications
    • Global partners access real-time insights

    When a malaria control officer in Kenya observes changing disease patterns due to altered rainfall, the network enables rapid sharing of this insight with colleagues working on water safety, nutrition, and primary care. These cross-domain connections do not need to be left to chance – they can be enabled through structured peer learning processes that transcend traditional programme, geographic, and hierarchical boundaries

    This creates what organizational theorists call “embedded transformation” – where system change emerges through existing structures rather than requiring new ones.

    Rather than creating new coordination mechanisms, the network enables:

    • Health workers to learn directly from peers in other programs
    • Rapid identification of cross-cutting challenges
    • Spontaneous formation of problem-solving groups
    • Systematic sharing of effective practices

    Rather than replacing existing structures, TGLF’s model demonstrates how digital networks can enable health systems to:

    • Maintain necessary specialization while fostering crucial connections
    • Enable rapid learning and adaptation across programs
    • Optimize resource use through enhanced coordination
    • Build system-wide resilience through structured peer learning

    Such a network enables what complexity theorists call “distributed sensing” that can provide:

    • Early warning of emerging threats
    • Rapid sharing of local solutions
    • System-wide learning from local innovations
    • Continuous adaptation to changing conditions

    This has led us to posit that investment in such emergent digital networks could enable health systems to maintain necessary specialization while fostering crucial connections across domains.

    This is obviously critical to respond to the systems-level complexity of climate change impacts on health.

    World Bank findingTGLF model strategic fit
    Scale of impact (4.1-5.2B cases, 14.5-15.6M deaths by 2050)TGLF’s digital network model demonstrates scalability, already connecting over 60,000 health practitioners across 137 countries. More significantly, the model’s effectiveness increases with scale – as more practitioners join, the network’s ability to identify emerging threats and disseminate effective responses improves. Network analysis shows that larger scale enables more diverse inputs and faster adaptation, suggesting this approach could help health systems respond to the massive scale of projected impacts.
    Economic consequences ($8.6-20.8T by 2050)TGLF’s model offers remarkable cost-effectiveness through its networked learning structure. Rather than requiring massive new investments in parallel systems, it leverages existing health system resources while enabling and accelerating both learning and action. The model demonstrates how digital infrastructure can maximize return on investment – practitioners implement solutions using existing resources, with 82% reporting ability to continue without external support. This suggests potential for significant cost savings while building system resilience.
    Geographic inequities (71% SSA, 18% SA)TGLF’s network already demonstrates strongest presence precisely where the World Bank identifies greatest need – 70% of participants work in Sub-Saharan Africa and South Asia. This concentration is not coincidental; the model’s digital infrastructure and peer learning approach prove particularly effective in resource-constrained settings. The network enables rapid sharing of context-appropriate solutions between regions facing similar challenges, while maintaining sensitivity to local conditions.
    Need for systemic interventionThe network transcends traditional program boundaries through what organizational theorists call “structured emergence” – practitioners naturally form cross-program connections based on shared challenges. When a malaria control officer observes changing disease patterns due to climate shifts, the network enables rapid sharing with colleagues in water safety, nutrition, and primary care. This organic integration emerges through peer learning rather than requiring new coordination mechanisms.
    Urgency of investmentTGLF’s model offers an immediately scalable approach that builds on existing health system capabilities. Rather than waiting years to develop new infrastructure, the network can rapidly expand to connect more practitioners and regions. Evidence shows 7x acceleration in implementation of new approaches compared to conventional means of technical assistance, suggesting potential for rapid, sustainable strengthening of health system resilience.
    Global coordination needWhile enabling global connection, the network maintains strong local grounding through its emphasis on locally-led action and contextual adaptation. Government health workers comprise over 50% of participants, creating what scholars term “embedded transformation” – change emerging through existing structures rather than imposed from outside. This enables coordinated response while respecting local health system authority.
    System transformationThe model demonstrates how digital networks can fundamentally transform how health systems operate without requiring complete restructuring. By enabling rapid knowledge flow across traditional boundaries, supporting emergence of new coordination patterns, and fostering system-wide learning, it shows how transformation can emerge through enhanced connection rather than structural overhaul. Analysis reveals development of new capabilities in surveillance, response, and adaptation through networked learning.

    Reference

    Uribe, J.P., Rabie, T., 2024. The Cost of Inaction: Quantifying the Impact of Climate Change on Health in Low- and Middle-Income Countries. The World Bank, Washington, D.C. https://doi.org/10.1596/42419

    Image: The Geneva Learning Foundation Collection © 2024

  • Knowing-in-action: Bridging the theory-practice divide in global health

    Knowing-in-action: Bridging the theory-practice divide in global health

    The gap between theoretical knowledge and practical implementation remains one of the most persistent challenges in global health. This divide manifests in multiple ways: research that fails to address practitioners’ urgent needs, innovations from the field that never inform formal evidence systems, and capacity building approaches that cannot meet the massive scale of learning required. Donald Schön’s seminal 1995 analysis of the “dilemma of rigor or relevance” in professional practice offers crucial insights for “knowing-in-action“. It can help us understand why transforming global health requires new ways of knowing – a new epistemology.

    Listen to this article below. Subscribe to The Geneva Learning Foundation’s podcast for more audio content.

    Schön’s analysis: The dilemma of rigor or relevance

    Schön begins by examining how knowledge becomes institutionalized through education. Using elementary school mathematics as an example, he describes how knowledge is broken into discrete units (“math facts”), organized into progressive modules, assembled into curricula, and measured through standardized tests. This systematization shapes not just content but the entire organization of time, space, and institutional arrangements.

    From this foundation, Schön introduces his central metaphor of two contrasting landscapes in professional practice that prevent “knowing-in-action”. As he describes it:

    “In the varied topography of professional practice, there is a high, hard ground overlooking a swamp. On the high ground, manageable problems lend themselves to solution through the use of research-based theory and technique. In the swampy lowlands, problems are messy and confusing and incapable of technical solution.”

    The cruel irony, Schön observes, lies in the relative importance of these terrains: “The problems of the high ground tend to be relatively unimportant to individuals or to society at large, however great their technical interest may be, while in the swamp lie the problems of greatest human concern.”

    This creates what Schön calls the “dilemma of rigor or relevance” – practitioners must choose between remaining on the high ground where they can maintain technical rigor or descending into the swamp where they must rely on experience, intuition, and what he terms “muddling through.”

    The historical roots of the divide

    Schön traces this dilemma to the epistemology embedded in modern research universities. Drawing on Edward Shils’s historical analysis, he describes how American scholars returning from Germany after the Civil War brought back “the German idea of the university as a place in which to do research that contributes to fundamental knowledge, preferably through science.”

    This was, as Schön notes, “a very strange idea in 1870,” running counter to the prevailing British model of universities as sanctuaries for liberal arts or finishing schools for gentlemen. The new model first took root at Johns Hopkins University, whose president embraced the “bizarre notion that professors should be recruited, promoted, and granted tenure on the basis of their contributions to fundamental knowledge.”

    This shift created what Schön terms the “Veblenian bargain” (named after Thorstein Veblen), establishing a separation between:

    • Research universities focused on “true scholarship” and fundamental knowledge
    • Professional schools dedicated to practical training

    Knowing-in-action in global health: From fragmentation to integration

    The historical division between theory and practice that Schön identified continues to shape global health in profound and often problematic ways. This manifests in three interconnected challenges that demand our urgent attention: the knowledge-practice gap, the scale challenge, and the complexity challenge. Yet emerging approaches suggest potential paths forward, particularly through structured peer learning networks that could help bridge Schön’s “high ground” and “swamp.”

    Three fundamental challenges

    Challenge #1: The knowing-in-action divide

    The separation between research institutions and field practice creates not just an academic concern but a practical crisis in healthcare delivery. Consider the response to COVID-19: while research institutions rapidly generated new knowledge about the virus, frontline health workers struggled to translate this into practical approaches for their specific contexts. Their hard-won insights about what worked in different settings rarely made it back into formal evidence systems, epitomizing the one-way flow of knowledge that impoverishes both research and practice.

    This pattern repeats across global health. Research agendas, shaped by academic incentives and funding priorities, often fail to address practitioners’ most pressing challenges. A community health worker in rural Bangladesh facing complex challenges around vaccine hesitancy may struggle to find relevant guidance – while global experts are convinced that they already have all the answers. Meanwhile, local solutions to building vaccine confidence remain uncaptured by formal knowledge systems.

    The rise of implementation science attempts to bridge this divide, yet often remains subordinate to “pure” research in academic hierarchies. This reflects Schön’s observation about the privileging of high ground problems over swampy ones, even when the latter hold greater practical significance.

    Challenge #2: The scale imperative

    Traditional approaches to professional education face fundamental limitations in meeting the massive need for health worker capacity building. The World Health Organization projects a shortfall of 10 million health workers by 2030, mostly in low- and middle-income countries. Conventional training approaches that rely on cascading knowledge through workshops and formal courses can reach only a fraction of those who need support.

    More fundamentally, these knowledge transmission models prove inadequate for addressing complex local realities. A standardized curriculum developed by experts, no matter how well-designed, cannot anticipate the diverse challenges health workers face across different contexts. When a district immunization manager in Nigeria must adapt vaccination strategies for nomadic populations during a drought, they need more than pre-packaged knowledge – they need ways to learn from others who are facing similar challenges.

    Resource constraints further limit the reach of conventional approaches. The cost of traditional training programmes, both in money and time away from service delivery, makes it impossible to scale them to meet the need. Yet the human cost of this capacity gap, measured in preventable illness and death, demands urgent solutions.

    Challenge #3: The complexity conundrum

    Contemporary global health faces challenges that fundamentally resist standardized technical solutions. Climate change exemplifies this complexity, creating cascading effects on health systems and communities that cannot be addressed through linear interventions. When rising temperatures alter disease patterns while simultaneously disrupting cold chains for vaccine delivery, no single technical fix suffices.

    Similarly, emerging and re-emerging infectious diseases demand responses that cross traditional boundaries between animal and human health, environmental factors, and social determinants. Health workforce development must grapple with complex systemic issues around motivation, retention, and capacity building. The COVID-19 pandemic demonstrated how traditional approaches to health system strengthening often prove inadequate in the face of complex adaptive challenges.

    Emerging solutions: A new paradigm for learning and practice

    Recent innovations suggest promising approaches to bridging these divides through structured peer learning networks. Digital platforms enable health workers to share experiences and solutions across geographical boundaries, creating new possibilities for scaled learning that maintains local relevance.

    Solution #1: The power of structured peer learning

    Experience from digital learning networks demonstrates how structured peer interaction can enable more efficient and effective knowledge sharing than traditional top-down approaches. When health workers can directly connect with peers facing similar challenges, they not only share solutions but collectively generate new knowledge through their interactions.

    These networks provide mechanisms for validating practical knowledge through peer review processes that complement traditional academic validation. A successful intervention developed by a rural clinic in Thailand can be critically examined by peers, adapted for different contexts, and rapidly disseminated across the network. This creates a more dynamic and responsive knowledge ecosystem than traditional publication cycles allow.

    Solution #2: Network effects and collective intelligence

    The potential of practitioner networks extends beyond simple knowledge sharing. When properly structured, these networks create possibilities for:

    1. Rapid adaptation to emerging challenges through real-time sharing of experiences
    2. Collective problem-solving that draws on diverse perspectives and contexts
    3. Systematic capture and analysis of field innovations
    4. Development of context-specific solutions that build on shared learning

    Most importantly, these networks can help bridge Schön’s high ground and swamp by creating dialogue between different forms of knowledge and practice. They provide spaces where academic research can inform field practice while simultaneously allowing field insights to shape research agendas.

    Four principles toward knowing-in-action for global health

    Drawing on Schön’s call for a “new epistemology,” we can identify four principles for transforming how we know what we know in global health:

    Principle #1: Valuing multiple forms of knowledge

    The complexity of contemporary health challenges demands recognition of multiple valid forms of knowledge. The practical wisdom developed by a community health worker through years of service deserves attention alongside randomized controlled trials. This requires challenging existing hierarchies of evidence while maintaining rigorous standards for validating knowledge claims.

    Principle #2: Enabling knowledge creation from practice

    Health workers must be supported as knowledge producers, not just knowledge consumers. This means creating structures for systematically capturing and validating field insights, building evidence from implementation experience, and enabling continuous learning from practice. Digital platforms can provide scaffolding for this knowledge creation while ensuring quality through peer review processes.

    Principle #3: Scaling through networked learning

    Traditional scaling approaches that rely on standardization and top-down dissemination must be complemented by networked learning to create and amplify knowing-in-action. This means building systems that can:

    1. Connect practitioners across contexts and boundaries
    2. Enable peer validation of knowledge
    3. Support rapid dissemination of innovations
    4. Build collective intelligence through structured interaction

    Principle #4: Embracing complexity

    Rather than seeking to reduce complexity through standardization, health systems must build capacity for working effectively within complex adaptive systems. This means supporting adaptive learning, enabling context-specific solutions, and building capacity for systems thinking at all levels.

    The challenges facing global health today demand new ways of creating, validating, and sharing knowledge. By embracing approaches that bridge Schön’s high ground and swamp, we may find paths toward health systems that are both more rigorous and more relevant to the communities they serve.

    Looking forward

    Schön’s analysis helps explain why traditional approaches to global health knowledge and learning often fall short. More importantly, it points toward solutions that could help bridge the theory-practice divide to support knowing-in-action:

    1. New digital platforms that enable peer learning at scale
    2. Networks that connect practitioners across contexts
    3. Approaches that validate practical knowledge
    4. Systems that support rapid learning and adaptation

    Schön’s insights remain remarkably relevant to contemporary global health challenges. His call for a new epistemology that can bridge theory and practice speaks directly to our current needs. By embracing new approaches to learning and knowledge creation that honor both rigor and relevance, we may find ways to address the complex challenges that lie ahead.

    The key lies not in choosing between high ground and swamp, but in building new kinds of bridges between them – bridges that can support the massive scale of learning needed while maintaining the local relevance essential for impact. Recent innovations in peer learning networks and digital platforms suggest this bridging may be increasingly possible, offering hope for more effective global health practice in an increasingly complex world.

    The challenge now is to develop and implement these bridging approaches at the scale needed to support global health workers worldwide. This will require new ways of thinking about knowledge, learning, and practice – ways that honor both the rigor of research and the wisdom of experience. The future of global health may depend on our success in this endeavor.

    Listen to the AI podcast deep dive about this article

    Reference

    Schön, Donald A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34. https://doi.org/10.1080/00091383.1995.10544673

    Image: The Geneva Learning Foundation Collection © 2024

  • You are not alone: Health workers are sharing how they protected their communities when extreme weather hit

    You are not alone: Health workers are sharing how they protected their communities when extreme weather hit

    Today, The Geneva Learning Foundation launched a new set of “Teach to Reach Questions” focused on how health workers protect community health during extreme weather events. This initiative comes at a crucial time, as world leaders at COP29 discuss climate change’s mounting impacts on health.

    As climate change intensifies extreme weather events worldwide, health workers are often the first to respond when disasters strike their communities. Their experiences – whether facing floods, droughts, heatwaves, or storms – contain vital lessons that could help others prepare for and respond to similar challenges.

    Read the eyewitness report: From community to planet: Health professionals on the frontlines of climate change, Online. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660

    Why ask health workers about floods, droughts, and heatwaves?

    “Traditional surveys often ask for general information or statistics,” explains Charlotte Mbuh of The Geneva Learning Foundation. “Teach to Reach Questions are different. We ask health workers to share specific moments – a time when they had to act quickly during a flood, or how they kept services running during a drought. These stories of extreme weather events reveal not just what happened, but how people actually solved problems on the ground.”

    The questions cover six key scenarios:

    1. Disease outbreaks during floods
    2. Health impacts of drought
    3. Care delivery during heatwaves
    4. Mental health support before, during, and after
    5. Maintaining healthcare access
    6. Quick action and local solutions to protect health

    Each scenario includes detailed prompts that help health workers recall and share the specifics of their experience: What exactly did they do? Who helped? What obstacles did they face? How did they know their actions made a difference?

    Strengthening local action: From individual experience to collective learning to protect community health

    What makes Teach to Reach Questions unique is not just how they are asked, but what happens next. Every experience of an extreme weather event shared becomes part of a larger learning process that benefits the entire community.

    “We don’t just collect these experiences – we give them back,” says Reda Sadki, President of The Geneva Learning Foundation. “Whether someone shares their own story or not, they gain access to the complete collection of experiences of extreme weather events. This creates a virtuous cycle of peer learning, where solutions discovered in one community can help another on the other side of the world.”

    The process unfolds in four phases:

    1. Experience Collection: Health workers share their stories through structured questions ahead of the live Teach to Reach event
    2. Live Event: During the Teach to Reach live event, Contributors who shared their experience are invited to do so in plenary sessions. Everyone can listen in – and join one-to-one networking sessions to learn from the experiences of colleagues from all over the world.
    3. Analysis and Synthesis: After the live event, the Foundation’s Insights team works with the Teach to Reach community to identify patterns, innovations, and key lessons
    4. Knowledge Sharing: Insights are returned to the community through comprehensive collections of experiences, thematic insights reports, and Insights Live sessions

    Building momentum for Teach to Reach 11

    These questions are part of the lead-up to Teach to Reach 11, scheduled for December 5-6, 2024. The experiences shared will inform discussions among the 23,000+ registered participants from over 70 countries.

    “But the learning starts now,” emphasizes Mbuh. “Health workers who request their invitation today can immediately begin sharing and learning from peers. The earlier they join, the more they can benefit from this collective knowledge exchange.”

    Why protecting community health against extreme weather events matters

    As extreme weather events become more frequent and severe, the expertise of health workers who have already faced these challenges becomes increasingly valuable.

    “These aren’t just stories – they’re a vital source of knowledge for protecting community health in a changing climate,” says Sadki. “By sharing them widely, we help ensure that health workers everywhere are better prepared when extreme weather strikes their communities.”

    Health professionals interested in participating can request their invitation.

    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

  • 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

  • How can we reliably spread evidence-based practices at the speed and scale modern health challenges demand?

    How can we reliably spread evidence-based practices at the speed and scale modern health challenges demand?

    At a symposium of the American Society for Tropical Medicine and Hygiene (ASTMH) Annual Meeting, I explored how peer learning could help us tackle five critical challenges that limit effectiveness in global health.

    1. Performance: How do we move beyond knowledge gains to measurable improvements in health outcomes?
    2. Scale and access: How do we reach and include tens of thousands of health workers, not just dozens?
    3. Applicability: How do we ensure learning translates into changed practice?
    4. Diversity: How do we leverage different perspectives and contexts rather than enforce standardization?
    5. Complexity: How do we support locally-led leadership for change to tackle complex challenges that have no standard solutions?

    For epidemiologists working on implementation science, peer learning provides a new path for solving one of global health’s most persistent challenges: how to reliably spread evidence-based practices at the speed and scale modern health challenges demand.

    The evidence suggests we should view peer learning not just as a training approach, but as a mechanism for viral spread of effective practices through health systems.

    How do we get to attribution?

    Of course, an epidemiologist will want to know if and how improved health outcomes can be attributed to peer learning interventions.

    The Geneva Learning Foundation (TGLF) addresses this fundamental challenge in implementation science – proving attribution – through a three-stage process that combines quantitative indicators with qualitative validation.

    The process begins with baseline health indicators relevant to each context (such as vaccination coverage rates, if it is immunization), which are then tracked through regular “acceleration reports” that capture both metrics and implementation progress.

    Rather than assuming causation from correlation, participants must explicitly rate the extent to which they attribute observed improvements to their intervention.

    The critical innovation comes in the third stage: those claiming attribution must “prove it” to the community of peers, by providing specific evidence of how their actions led to the observed changes – a requirement that both controls for self-reporting limitations and generates rich qualitative data about implementation mechanisms.

    This methodology has proven particularly valuable in complex interventions where randomized controlled trials may be impractical or insufficient.

    What are examples of peer learning in action?

    Here are three examples from The Geneva Learning Foundation’s work that demonstrate scale, reach, and sustainability.

    Within four weeks, a single Teach to Reach cohort of 17,662 health workers across over 80 countries generated 1,800 context-specific experiences describing the “how” of implementation, especially at the district and community levels.

    In Côte d’Ivoire, working with Gavi and The Geneva Learning Foundation, the national immunization team used TGLF’s model to support community engagement. Within two weeks, over 500 health workers representing 85% of the country’s districts had begun implementing locally-led innovations. 82% of participants said they would use TGLF’s model for their own needs, without requiring any further assistance or support.

    In TGLF’s COVID-19 Peer Hub, 30% of participants successfully implemented recovery plans within three months – a rate seven times higher than a control group that did not use TGLF’s model.

    Participants who actively engaged with peers were not only more likely to report successful implementation, but could demonstrate concrete evidence of how peer interactions contributed to their success, creating a robust framework for understanding not just whether interventions work, but how and why they succeed or fail across different contexts.

    Quantifying learning

    Using a simple methodology that measures learning efficacy across five key variables – scalability, information fidelity, cost effectiveness, feedback quality, and uniformity – we calculated that properly structured peer learning networks achieve an efficacy score of 3.2 out of 4, significantly outperforming both traditional cascade training (1.4) and expert coaching (2.2).

    But the real breakthrough came when considering scale. When calculating the Efficacy-Scale Score (ESS) – which multiplies learning efficacy by the number of learners reached – the differences became stark:

    • Peer Learning: 3,200 (reaching 1,000 learners)
    • Cascade Training: 700 (reaching 500 learners)
    • Expert Coaching: 132 (reaching 60 learners)

    Learn more: Calculating the relative effectiveness of expert coaching, peer learning, and cascade training

    The mathematics of scale

    For epidemiologists, the mechanics of this scaling effect may feel familiar.

    In traditional expert-led training, if N is the total number of learners and M is the number of available experts who can each effectively coach K learners, we quickly hit a ceiling where N far exceeds M×K.

    TGLF’s model transforms this equation by structuring interactions so each learner gives and receives feedback from exactly three peers, guided by expert-designed rubrics.

    This creates a linear scaling pattern where total learning interactions = 3N, allowing for theoretically unlimited scale while maintaining quality through structured feedback loops.

    Information loss and network resilience

    One of the most interesting findings concerns information fidelity. In cascade training, knowledge degradation follows a predictable pattern:

    $latex K_n = K \cdot \alpha^n&s=3$

    where Kn is the knowledge at the nth level of the cascade and α is the loss rate at each step. This explains why cascade training, despite its theoretical appeal, consistently underperforms.

    In contrast, TGLF’s peer learning-to-action networks showed remarkable resilience. By creating multiple pathways for knowledge transmission and building in structured feedback loops, the system maintains high information fidelity even at scale.

    Learn more: Why does cascade training fail?

    References

    Arling, P.A., Doebbeling, B.N., Fox, R.L., 2011. Improving the Implementation of Evidence-Based Practice and Information Systems in Healthcare: A Social Network Approach. International Journal of Healthcare Information Systems and Informatics 6, 37–59. https://doi.org/10.4018/jhisi.2011040104

    Hogan, M.J., Barton, A., Twiner, A., James, C., Ahmed, F., Casebourne, I., Steed, I., Hamilton, P., Shi, S., Zhao, Y., Harney, O.M., Wegerif, R., 2023. Education for collective intelligence. Irish Educational Studies 1–30. https://doi.org/10.1080/03323315.2023.2250309

    Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4

  • Anecdote or lived experience: reimagining knowledge for climate-resilient health systems

    Anecdote or lived experience: reimagining knowledge for climate-resilient health systems

    A health worker in rural Kenya notices that malaria cases are appearing earlier in the season than usual.

    A nurse in Bangladesh observes that certain neighborhoods are experiencing more heat-related illnesses despite similar temperatures.

    These observations often remain trapped in the realm of “anecdotal evidence.” 

    The dominant epistemological framework in public health traditionally dismisses such knowledge as unreliable, subjective, and of limited scientific value.

    This dismissal stems from a deeply-rooted global health paradigm that privileges quantitative data, randomized controlled trials, and statistical significance over the nuanced, contextual understanding that emerges from direct experience.

    The phrase “it’s just anecdotal” has become a subtle but powerful way of delegitimizing knowledge that does not conform to established scientific methodologies.

    Yet this epistemological stance creates a significant blind spot in our understanding of how climate change affects health at the community level.

    Climate change manifests in complex, locally specific ways that often elude traditional epidemiological surveillance systems.

    The health worker who notices shifting disease patterns or the community nurse who identifies vulnerable populations possesses what philosopher Donald Schön termed “knowing-in-action” – a form of knowledge that emerges from sustained engagement with complex, dynamic situations.

    Experiential knowledge often precedes formal scientific understanding, particularly in the context of climate change where impacts are emerging and evolving rapidly.

    Health workers’ observations are not mere anecdotes but rather early warning signals of climate-health relationships that would take years to document through traditional research methods.

    Why would we build early warning systems that ignore the significance or value of health worker observations and insights?

    Is the risk of error greater than the risk of inaction?

    In late 2023, more than 1 million people were displaced by flooding from intense rainfall in parts of Somalia, Kenya, and Ethiopia, attributed to a combination of climate change and the Indian Ocean Dipole, a natural climate phenomenon.

    Are there signals that health workers might be attuned to, alongside weather systems to measure them?

    The challenge, then, is not to replace scientific methodologies but to develop new epistemological frameworks that can integrate different forms of knowing.

    This requires recognizing that knowledge exists on a spectrum rather than in hierarchical tiers.

    Experiential knowledge, systematic observation, statistical analysis, and randomized controlled trials each offer different and complementary insights into complex climate-health relationships.

    A new epistemological framework would recognize that the health worker who notices changing disease patterns is engaging in what anthropologist James Scott calls “mētis” – a form of practical knowledge that comes from intimate familiarity with local conditions.

    Is this knowledge necessarily less valuable than statistical data or no data?

    It is different and often provides crucial context that helps interpret quantitative findings.

    Let us imagine how this integration might work in practice.

    In the Philippines, a climate-health surveillance system could combine traditional epidemiological data with structured documentation of health workers’ observations.

    Health workers would use a mobile app to share unusual patterns or emerging concerns with each other.

    This could then be analyzed alongside conventional surveillance data.

    Such an approach could identify climate-health relationships that are not visible through standard surveillance alone.

    Health workers can also form “knowledge circles” in which they regularly meet to share observations and insights about climate-related health impacts.

    These observations can then be systematically documented and analyzed, creating a bridge between experiential knowledge and formal evidence bases.

    When patterns emerge across multiple knowledge circles, they trigger more formal investigation.

    This shift requires rethinking how we validate knowledge.

    Instead of asking whether an observation is “merely anecdotal,” we might ask: What does this observation tell us about local conditions? How does it complement our quantitative data? What patterns emerge when we more systematically collect and analyze experiential knowledge?

    The implications of this epistemological shift extend beyond climate change.

    By recognizing the value of experiential knowledge, health systems will become more adaptive and responsive to emerging challenges.

    Health workers, feeling their knowledge is valued, become more engaged in systematic observation and documentation.

    Communities, seeing their experiences reflected in health system responses, develop greater trust in health institutions.

    However, this shift faces significant challenges.

    Academic institutions, funding bodies, and policy makers often remain wedded to traditional hierarchies of evidence.

    Publishing systems privilege certain types of knowledge over others.

    Career advancement often depends on producing conventional scientific evidence rather than integrating different forms of knowing.

    Overcoming these challenges requires institutional change.

    Medical and public health education needs to incorporate training in recognizing and documenting experiential knowledge.

    Research methodologies need to expand to include systematic ways of collecting and analyzing practical knowledge.

    Funding mechanisms need to support projects that bridge different epistemological approaches.

    The climate crisis demands this evolution in how we think about knowledge.

    As health systems face unprecedented challenges, we cannot afford to ignore any source of understanding about how climate change affects human health.

    The health worker’s observation, the community’s experience, and the statistician’s analysis all have crucial roles to play in building climate-resilient health systems.

    This is not about replacing scientific rigor but about expanding our understanding of what constitutes valid knowledge.

    By creating frameworks that can integrate different forms of knowing, we strengthen our ability to respond effectively to the complex challenges posed by climate change.

    The future of climate-resilient health systems depends not just on what we know, but on how we think about knowing itself.

    References

    Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7

    Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.10204660

    Jones, I., Mbuh, C., Sadki, R., Steed, I., 2024. Climate change and health: Health workers on climate, community, and the urgent need for action. The Geneva Learning Foundation. https://doi.org/10.5281/ZENODO.11194918

    Romanello, M., et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet 404, 1847–1896. https://doi.org/10.1016/S0140-6736(24)01822-1

    Schön, D.A., 1995. Knowing-in-action: The new scholarship requires a new epistemology. Change: The Magazine of Higher Learning 27, 27–34.

    Scott, J.C., 2020. Seeing like a state: how certain schemes to improve the human condition have failed. ed, Yale agrarian studies. Yale University Press, New Haven, CT London.

  • Teach to Reach’s new leadership network connects health organizations tackling common challenges

    Teach to Reach’s new leadership network connects health organizations tackling common challenges

    The Geneva Learning Foundation is launching REACH (Relate, Engage, Act, Connect, Help), a new leadership network to connect local, national, and international leaders of health organizations who are solving similar problems in different countries.

    Launching November 6, 2024 REACH responds to an unexpected outcome of Teach to Reach, a peer learning platform that–in less than four years–has already documented over 10,000 local solutions and experiences to health challenges by connecting more than 60,000 participants across 77 countries.

    When organizations began formally participating in Teach to Reach in June 2024, many leaders discovered they were tackling similar challenges.

    A digital immunization tracking system in Rwanda sparked interest from several African countries.

    A community engagement approach to vaccine hesitancy in Nigeria resonated with teams in Kenya and Zimbabwe.

    These spontaneous connections led to the creation of REACH.

    What is Teach to Reach?

    “Teach to Reach is a place where you learn in the most formidable way. You’re learning from people’s experiences and it makes the learning very easy to adapt, very easy to replicate wherever you are,” says Ful Marine Fuen, Humanitarian Program Coordinator at Cameroon Baptist Convention Health Services.

    Teach to Reach is a bilingual (French/English) peer learning platform where government health workers, local organizations, and frontline staff document, analyze, and share implementation solutions across borders.

    Half of all participants work in government health services, with around 80% based at district and facility levels where policy meets practice.

    The platform’s structured peer learning process includes pre-event experience sharing, live sessions for discussion and networking, and post-event analysis to capture insights.

    “It’s a meeting of giving and receiving. Because with Teach to Reach, we always learn from peers and we develop ourselves and develop others,” notes Arthur Fidelis Metsampito Bamlatol, Coordinator at AAPSEB Cameroon.

    From individual learning to organizational impact

    The impact of these connections is already visible.

    Nduka Ozor, Project Director at the Centre for HIV/AIDS and STD RESEARCH in Nigeria, describes how a single connection expanded his organization’s reach: “I was able to meet with a potential partner who stays in Australia. Something I thought is just an online stuff is moving into a greater partnership. We have had several meetings with other networks from that initial meeting, including with representatives of New York University.”

    These kinds of partnerships form naturally as organizations share their work.

    Imagine what else might happen as health leaders like these meet, connect, and learn:

    • In Rwanda, Albert Ndagijimana shared how his country achieved 95% childhood vaccination coverage through initiatives like digital tracking of immunization outreach
    • In Kenya, Samuel Mutambuki‘s organization works with other civil society groups to rehabilitate areas affected by illegal dumping and create community gardens
    • In Zimbabwe, Rebecca Chirenga’s team addresses how climate change and food insecurity are driving early marriage and teenage pregnancy, with half of girls dropping out before completing secondary school

    “It is essentially a framework that allows us to share experiences… to strengthen our capacities,” says Patrice Kazadi, Project Director at Save the Children International DR Congo. “The challenges in DRC can be the same as in Ivory Coast and what is done in Ivory Coast can also help address challenges in DRC.”

    REACH: A new network exclusively for Teach to Reach Partners

    REACH builds on this foundation but with an important distinction – it’s exclusively for leaders of organizations that have committed to partnership with Teach to Reach.

    Over 700 organizational leaders have already confirmed their participation, representing both government agencies and civil society organizations.

    The first REACH sessions will:

    1. Connect organizations working on similar challenges
    2. Share practical approaches that have worked in different contexts
    3. Facilitate direct conversations between organizational leaders
    4. Identify potential areas for collaboration

    How can organizations join REACH?

    To participate in REACH, organizations must complete all partnership steps for Teach to Reach:

    1. Attend a Partner briefing
    2. Complete the Partnership application
    3. Share the Teach to Reach announcement
    4. Have organizational leadership endorse participation