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Tag: The Geneva Learning Foundation

  • Development is adaptation: Bill Gates’s shift is actually about linking climate change and health

    Development is adaptation: Bill Gates’s shift is actually about linking climate change and health

    Bill Gates’ latest public memo marks a significant shift in how the world’s most influential philanthropist frames the challenge of climate change. He sees a future in which responding to climate threats and promoting well-being become two sides of the same mission, declaring, “development is adaptation.”

    Gates argues that the principal metric for climate action should not be global temperature or near-term emission reductions alone, but measured improvement in the lives of the world’s most vulnerable populations.

    He argues that the focus of climate action should be on the “greatest possible impact for the most vulnerable people.”

    The suffering of poor communities must take priority, since, in his view, “climate change, disease, and poverty are all major problems. We should deal with them in proportion to the suffering they cause.”

    Climate change is about the health of the most vulnerable

    This position resonates with a core message that has emerged across global health over the past several years: climate change is about health.

    New data from the 2025 Lancet Countdown draw a stark picture:

    • Heat-related mortality has risen 63 percent since the 1990s.
    • Deaths from wildfire smoke and air pollution caused by fossil fuels continue to climb.
    • Food insecurity, driven by erratic weather, is destabilizing health and economies at once.
    • Thirteen out of twenty key health indicators linked to climate impacts now signal urgent action is needed.

    Health professionals, policy coalitions, scientists, and patient advocates have succeeded in bringing this nexus between climate and health squarely to the global agenda, culminating in recent summits where health finally shared the main stage with energy and economics.

    Yet just as the science and advocacy align, political attention risks fragmenting.

    Despite sweeping reports, evidence, and high-level declarations, momentum can ebb.

    There is now a risk that the transformative potential embedded in the climate-health linkage may not be fully realized.

    Here, Gates’s pivot could actually be the inflection point that the field needs.

    The case for health workforce-centered adaptation

    For nearly a decade, The Geneva Learning Foundation (TGLF) has been advocating and demonstrating that meeting complex humanitarian, health, and development challenges requires strengthening not just technical capacities or disease programs, but the underlying connective tissue of the health system: its workforce.

    TGLF’s digital peer-learning platform now connects over 70,000 health workers across more than 130 countries.

    These practitioners – mostly in government service, often in low-resource or crisis-affected settings – are the first to observe, and often the first to respond to, the local impacts of climate change on health.

    Their reports show that health impacts are immediate and multi-faceted: rising malnutrition from crop failures, increases in waterborne diseases following floods, new burdens from air pollution and heat, and psychological distress from repeated disasters.

    What sets this approach apart is its systemic focus.

    Climate change is not a threat that can be “verticalized”.

    It demands responses that are adaptive, distributed, and coordinated across all levels of the health system.

    TGLF’s innovation lies in harnessing a distributed network to surface and scale locally-grounded solutions:

    Data from these initiatives demonstrate that such networked learning delivers results at scale, often with return on investment superior to parallel vertical programs, and increases system resilience and flexibility.

    Development is adaptation: the need for human capital investment

    The urgency and logic of these approaches are reinforced by ongoing policy developments ahead of COP30:

    • WHO’s Global Action Plan on Climate Change and Health, adopted at the World Health Assembly in May 2025, recognizes that without context-sensitive system strengthening, existing approaches are insufficient, and positions knowledge and workforce mobilization as strategic imperatives.
    • The COP30 Belem Health Action Plan establishes adaptation of the health sector to climate change as an international priority, calling for holistic, cross-sectoral strategies, and “community engagement and participation as foundational to implementation.”

    Without empowered and connected health workers, no global action plan will reach those most at risk or maintain public trust.

    A strategic investment imperative: why the next breakthrough must be human-centered

    The philanthropic search for cost-effective, scalable, and measurable impact has built immense legacies in reducing child mortality and combating infectious disease.

    Gates’ own approach of pioneering “vertical” innovations, optimizing delivery through metrics, and prioritizing technical solutions has been transformative, especially at the intersection of science and delivery.

    However, emerging science show the limits of technical “magic bullets” absent robust, interconnected local systems.

    Trust, legitimacy, and action flow from the relationships health workers build in – and with – their communities.

    If development is adaptation, what does this mean for the next phase in climate-health philanthropy?

    If the measure of climate action’s value is the scale and speed at which lives are improved and disasters averted, investing in the human infrastructure of the health system is the most evidence-based, cost-effective, and legacy-ensuring play available.

    1. Investing in the health workforce is itself a breakthrough technology: It increases the absorptive capacity of low-resource health systems, making innovations stick and catalyzing uptake well beyond single-disease silos or narrow infrastructure projects.
    2. Long-term, system-wide resilience is built by equipping health workers – not simply with technology or training from above, but with platforms for peer learning, rapid response, and locally-driven adaptation coordinated through agile networks.
    3. The network effect is real: A million motivated and networked health practitioners is likely to surface, refine, and implement interventions at a scale and pace that outstrips most top-down models. Digitally-enabled peer learning, tested by TGLF, could link to AI systems to provide distributed AI-human intelligence that supports effective action.

    Without these bridges, even the best technology or policies will fail to gain a durable footprint at community level, especially as climate impacts deepen.

    Health is where climate change action matters most

    The world is waking to the reality that technical solutions alone cannot future-proof health against climate risks.

    We need to focus on the highest-value levers.

    This starts with a distributed, networked workforce at the coalface of the crisis, empowered to adapt, share, and lead.

    In a world of accelerating climate shocks and retreating political will, the boldest, most rational bet for sustained global impact is to go “horizontal” – to invest in the people and the systems that connect them.

    By helping build adaptive, digitally connected networks of health professionals, philanthropy can reinforce the foundation upon which all high-impact innovation rests.

    This is not a departure from the pursuit of technology-driven change, but rather the necessary evolution to ensure every breakthrough finds its mark – and that trust in science and public health stays strong under pressure.

    If ever there was a time for rigorous, data-driven engagement that bridges technology, health, and community resilience, this is it.

    Every indicator – scientific, economic, social – suggests that communities will confront more climate disruptions in the coming years.

    Investing in the people who translate science into health, who stand with their communities in crisis, is the most robust, scalable, and sustainable bet that any philanthropist or society can make.

    By focusing on these vital human connections, the world can ensure that innovation works where it matters most – and that the next chapter of climate action measures true success by the health, security, and opportunity it delivers for all.

    History will honor those whose support creates not only tools and policies, but the living networks of trust and craft upon which community resilience depends.

    That is the climate breakthrough waiting to happen.

    References

    1. COP30 Belém Action Plan. (2025). The Belém Health Action Plan for the Adaptation of the Health Sector to Climate Change. https://www.who.int/teams/environment-climate-change-and-health/climate-change-and-health/advocacy-partnerships/talks/health-at-cop30
    2. Ebi, K.L., et al. (2025). The attribution of human health outcomes to climate change: transdisciplinary practical guidance. Climatic Change, 178, 143. https://doi.org/10.1007/s10584-025-03976-7
    3. Ebi, K.L., Haines, A. (2019). The imperative for climate action to protect health. The New England Journal of Medicine, 380, 263–273. https://doi.org/10.1056/NEJMra1807873
    4. Jacobson, J., Brooks, A., Mbuh, C., Sadki, R. (2023). Learning from frontline health workers in the climate change era. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7316466
    5. Jones, I., Mbuh, C., Sadki, R., Steed, I. (2024). Climate change and health: Health workers on climate, community, and the urgent need for action (Version 1.0). The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.11194918
    6. Romanello, M., et al. (2025). The 2025 report of the Lancet Countdown on health and climate change. The Lancet S0140673625019191. https://doi.org/10.1016/S0140-6736(25)01919-1
    7. Sadki, R. (2024). Health at COP29: Workforce crisis meets climate crisis. The Geneva Learning Foundation. https://doi.org/10.59350/sdmgt-ptt98
    8. Sadki, R. (2024). Strengthening primary health care in a changing climate. The Geneva Learning Foundation. https://doi.org/10.59350/5s2zf-s6879
    9. Sadki, R. (2024). The cost of inaction: Quantifying the impact of climate change on health. The Geneva Learning Foundation. https://doi.org/10.59350/gn95w-jpt34
    10. Sanchez, J.J., et al. (2025). The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health. https://doi.org/10.1016/S2214-109X(25)00003-8
    11. Storeng, K. T. (2014). The GAVI Alliance and the Gates approach to health system strengthening. Global Public Health, 9(8), 865–879. https://doi.org/10.1080/17441692.2014.940362
    12. World Health Organization. (2025). Draft Global Action Plan on Climate Change and Health. Seventy-eighth World Health Assembly. https://apps.who.int/gb/ebwha/pdf_files/WHA78/A78_4Add2-en.pdf
  • Gender in emergencies: a new peer learning programme from The Geneva Learning Foundation

    Gender in emergencies: a new peer learning programme from The Geneva Learning Foundation

    This is a critical moment for work on gender in emergencies.

    Across the humanitarian sector, we are witnessing a coordinated backlash.

    Decades of progress are threatened by targeted funding cuts, the erasure of essential research and tools, and a political climate that seeks to silence our work.

    Many dedicated practitioners feel isolated and that their work is being devalued.

    This is not a time for silence.

    It is a time for solidarity and for finding resilient ways to sustain our practice.

    In this spirit, The Geneva Learning Foundation is pleased to announce the new Certificate peer learning programme for gender in emergencies.

    We offer this programme to build upon the decades of vital work by countless practitioners and activists, seeing our role as one of contribution to the collective effort of all who continue to champion gender equality in emergencies.

    Learn more and request your invitation to the programme and its first course here.

    Our approach: A programme built from the ground up

    This programme was built from scratch with a distinct philosophy.

    We did not start with a pre-packaged curriculum.

    Instead, we turned to two foundational sources of knowledge.

    • First, we listened to the most valuable resource we have: the firsthand experiences of thousands of practitioners in our global network. Their stories of what truly happens on the front lines—what works, what fails, and why—form the living heart of this programme.
    • Second, we grounded our approach in the deep insights of intersectional, decolonial, and feminist scholarship. These perspectives challenge us to move beyond technical fixes and to analyze the systems of power that create gender inequality in the first place.

    This unique origin means our programme is a dynamic space co-created with and for practitioners who are serious about transformative change.

    Gender in emergencies: Gender through an intersectional lens

    Our focus is squarely on gender in emergencies.

    We start with gender analysis because it is a fundamental tool for effective humanitarian action.

    However, we use an intersectional lens.

    We recognize that a person’s experience is shaped not by gender alone, but by how their gender compounds with their age, disability, ethnicity, and other aspects of their identity.

    This lens does not replace gender analysis.

    It makes it stronger.

    It allows us to see how power works differently for different women, men, girls, and boys, and helps us to design solutions that do not inadvertently leave behind the people marginalized by something other than their gender.

    Gender in emergencies requires learning at the speed of crisis

    Humanitarian response must be rapid, and so must our learning.

    A slow, top-down training model cannot keep pace with the reality of a crisis.

    The Geneva Learning Foundation’s Impact Accelerator is a peer learning-to-action model built for the speed and complexity of humanitarian settings.

    It is a ‘learn-by-doing’ experience where your frontline experience is the textbook.

    The model is designed to quickly turn your individual insights into collective knowledge and practical action.

    You analyze a real challenge from your work, share it with a small group of global peers, and use their feedback to build a concrete plan.

    This process accelerates the development of context-specific solutions that are grounded in reality, not just theory.

    Your first step: The foundational primer for gender in emergencies

    We are starting this new programme with a free, open-access foundational course.

    Enrollment is now open.

    The course is a quick primer that introduces core concepts of gender, intersectionality, and bias through the real-world stories of practitioners.

    It provides the shared language and practical tools to begin your journey of reflection, peer collaboration, and action.

    Building a resilient community

    This is more than a training programme.

    It is an invitation to join a global community of practice.

    In a time of backlash and division, creating spaces where we can learn from each other, share our struggles, and find solidarity is a critical act of resistance.

    If you are ready to deepen your practice and connect with colleagues who share your commitment, we invite you to join us.

    Image: The Geneva Learning Foundation © 2025

  • From diagnosis to duty: health workers confront their own role in inequity

    From diagnosis to duty: health workers confront their own role in inequity

    A thirteen-year-old girl in Nigeria, bitten by a snake, arrived at a hospital with her frantic family. The hospital demanded payment before administering the antivenom. The family could not afford it. The girl died.

    This was one of the stark stories shared by health professionals on September 10, 2025, during “Exploration Day,” the third day of The Geneva Learning Foundation’s inaugural peer learning exercise on health equity. The previous day had been about diagnosing the external systems that create such tragedies. But today, the focus shifted.

    “Yesterday, we looked at the problem,” said TGLF facilitator Dr María Fernanda Monzón. “Today, we look in the mirror. We move from analyzing the situation to analyzing ourselves, our own role, our own power, and our own assumptions”.

    The practitioner’s role

    The day’s intensive, small-group workshops challenged participants to move beyond naming a problem to questioning their own connection to it. Groups brought their findings back to the plenary, where the work of exploration continued.

    Oyelaja Olayide, a medical laboratory scientist from Nigeria, presented her group’s analysis of a child’s death following a lab misdiagnosis. The group’s root cause analysis pointed to a systemic issue: the lack of a quality management system in the laboratory. But then the facilitator turned the question back to her. “What was your role in this?”.

    The question hung in the air, shifting the focus from an abstract system to individual responsibility. This pivot is central to the learning process, and the cohort’s diversity is a core element of its design. The majority of participants are frontline health workers—nurses, midwives, doctors, and community health promoters. They work side-by-side as peers with national-level staff and international partners, with government employees making up over 40% of the group. This mix intentionally breaks down traditional hierarchies, creating a space where a policy-maker can learn directly from the lived experience of a clinician in a remote village.

    Learn more about the Certificate peer learning programme for equity in research and practice https://www.learning.foundation/bias

    After a moment of reflection, Olayide acknowledged her role as a professional with the expertise to see the gap. “My role is to be an advocate,” she concluded, recognizing her duty to push for the implementation of quality control systems that could prevent future tragedies.

    From reflection to a plan for action

    This deep self-reflection is the foundation for the next stage of the process: creating a viable action plan. For the remainder of the day, participants worked on the third part of their course project, which is due by the end of the week.

    The programme’s methodology insists that a good plan is not made for a community, but with a community. Participants were guided to develop action steps that involve listening to the people most affected and ensuring they help lead the change. This requires practitioners to think honestly about their position and power and how they can share it to empower others.

    The day’s exploration pushed participants beyond easy answers. It asked them to confront their own biases, acknowledge their power, and accept their professional duty not just to treat patients, but to help fix the broken systems that make them sick. By turning the analytical lens inward, they began to forge the tools they need to build a more equitable future.

    About the Certificate peer learning programme for equity in research and practice

    The Geneva Learning Foundation is an organization that helps health workers from around the world learn together as equals. It offers the Certificate peer learning programme for equity in research and practice, where health professionals work with each other to make health care more fair for everyone, both in how care is given and in how health is studied. The first course in this program is called EQUITY-001 Equity matters, which introduces a method called HEART. This method helps you turn your experience into a real plan for change. HEART stands for Human Equity, Action, Reflection, and Transformation. This means you will learn to see unfairness in health (Human Equity), create a practical plan to do something about it (Action), think carefully about the problem to find its root cause (Reflection), and make a lasting, positive change for your community (Transformation).

    Image: The Geneva Learning Foundation Collection © 2025

  • From Murang’a to the world: remembering Joseph Ngugi, champion of peer learning for community health

    From Murang’a to the world: remembering Joseph Ngugi, champion of peer learning for community health

    “What keeps me going now is the excitement of the clients who receive the service and the sad faces of those clients who need the services and cannot get them.” Joseph Mbari Ngugi shared these words on May 30, 2023, capturing the profound empathy and dedication that defined his life’s work. This commitment to serving those most in need—and his deep awareness of those still unreached—characterized not only his career as a senior community health officer and public health specialist in Kenya’s Murang’a County, but also his extraordinary five-year journey through the Geneva Learning Foundation’s most rigorous learning programmes.

    It was the morning of the first day of August, 2025. The message from his daughter was simple and devastating: “Hello this is Wanjiru Mbari Ngugi’s Daughter. I am the one currently with his phone. This is to inform you that Dad passed away this morning.”

    Joseph’s passing represents more than the loss of a dedicated health worker in Kenya’s Murang’a County. It marks the end of an extraordinary journey that saw him evolve from participant to peer mentor within the Geneva Learning Foundation’s learning networks—a community where over 60,000 practitioners now connect across country borders and between continents to learn from and support each other to solve problems and drive change from the ground up.

    Joseph Ngugi: The making of a global health scholar

    Over the years, Joseph shared his personal story. His path to leadership in this global community began with family tragedy. “When I was young, my sister contracted malaria number of times, leading to numerous hospital visits and long periods of missed school,” he told us. “These experiences were not only distressing but also financially draining for my family, as medical costs piled up and my parents had to take time off work to care for her.” That childhood experience of watching illness devastate a family became the foundation for his professional mission. 

    In November 2020, when the world was grappling with the challenges of the COVID-19 pandemic, Joseph joined the Foundation’s COVID-19 Peer Hub—a groundbreaking initiative launched in April 2020 that connected over 6,000 health professionals from 86 countries to face the early consequences of the pandemic. Unlike traditional training programmes that positioned experts as sole knowledge sources, the Peer Hub recognized that frontline workers like Joseph possessed crucial insights about overcoming vaccine hesitancy that needed to be shared across borders.

    The timing was significant. When news of the first vaccines came, participants decided to examine how they had previously helped communities move “from hesitancy to acceptance of a vaccine.” Joseph’s case study, developed through peer collaboration between November and December 2020, drew on his extensive experience with routine immunization programs in Murang’a County. His documented approach to building trust with communities became a teaching resource for colleagues across Africa and beyond—knowledge that would prove invaluable when COVID-19 vaccines began arriving in Africa months later, starting with Ghana and Côte d’Ivoire in March 2021.

    Joseph Ngugi: The Scholar’s progression

    Joseph’s engagement with what would become the Movement for Immunization Agenda 2030 (IA2030) reflected his deepening sophistication as both learner and teacher. The Movement initiative, launched globally in support of the ambitious aims of the world’s immunization strategy to leave no one behind, required more than technical knowledge—it demanded practitioners who could analyze complex local challenges and adapt global strategies to diverse contexts.

    Starting with the WHO Scholar Level 1 certification in 2021, Joseph mastered the Foundation’s approach to structured problem-solving. But it was his progression to the 2022 Full Learning Cycle, where he earned certification with distinction, that revealed his true analytical capabilities. His systematic deconstruction of vaccine storage challenges in Murang’a County exemplified this growth.

    Rather than accepting equipment failures as inevitable, Joseph deployed rigorous root cause analysis: “Why are vaccines not stored properly? Because the refrigeration units are often outdated or malfunctioning.” But he didn’t stop there. Through five levels of inquiry, he traced the problem to its fundamental source: “The most important root cause: inadequate training and information dissemination among healthcare workers and administrators.”

    This insight—that knowledge gaps, not resource constraints, lay at the heart of vaccine storage failures—helped colleagues in other countries to address similar challenges in very different contexts.

    Joseph Ngugi: From local practice to global knowledge

    Joseph’s work exemplified how the Foundation’s network transforms individual insights into collective wisdom. His malaria prevention campaigns in Murang’a County carried particular personal significance—having witnessed his sister’s repeated malaria infections as a child, he understood intimately how the disease devastated families. Now, as a health professional, he could take systematic action to prevent other families from experiencing similar suffering.

    “Local leaders, health workers, and volunteers went door-to-door distributing nets and educating families about their importance,” he shared. “The project was successful due to the collaborative effort and the support of local influencers who championed the cause. This grassroots approach helped build trust and ensured widespread adoption of bed nets.” The boy who had watched helplessly as his sister endured “numerous hospital visits and long periods of missed school” had become the health worker who could mobilize entire communities for prevention.

    Meanwhile, his immunization work achieved impressive results by using lessons learned and shared across the network. His measurable success spoke to the power of peer-tested approaches: “My county was listed in 2nd position with 95% with the highest percentage of children (aged 12-23 months) who are fully vaccinated for basic antigens as per basic schedule compared with the leading at 96% and the lowest with 23%.”

    Through peer learning that he helped facilitate – giving and receiving feedback– both his malaria prevention methods and immunization strategies became available to thousands of colleagues facing similar challenges. When global immunization leaders engaged with TGLF’s network, asking for feedback on a new framework to support integration of immunization into primary health care, Joseph’s feedback illustrated this knowledge multiplication effect. “I have referred to [the] framework more than once and shared with my colleagues and supervisors and it has been very useful,” he reported. “My colleagues were excited to know such a tool existed and were ready to use it. The framework made a difference in solving the vaccine advocacy as it has the solutions to most of my challenges.”

    Joseph Ngugi: Crisis leadership in a changing climate

    When Kenya’s devastating 2019 floods tested every assumption about health service delivery, Joseph emerged as an innovative crisis leader whose documented responses became learning resources for the Foundation’s growing focus on climate change and health. His detailed accounts revealed both the scale of climate disruption and the ingenuity required to maintain health services under extreme conditions.

    Working with local government and humanitarian agencies, Joseph helped coordinate emergency airlifts using helicopters to deliver essential medical supplies to isolated communities, with the Kenya Red Cross playing a critical coordination role. When helicopter transport was unavailable, his team improvised: “We resorted to unconventional means, such as using motorbikes and porters to deliver medicines to stranded populations.”

    His documentation captured both community solidarity and the chaos of disaster response: “People were incredibly supportive, offering shelter and food to those displaced. Local youth groups helped clear debris from roads, making some areas passable. On the other hand, there were instances of looting of medical supplies during the chaos, which slowed down our efforts.”

    Joseph’s prescient observations about the health impact of climate patterns became increasingly relevant: “Over the years, I’ve noticed that such weather-related disruptions have become more frequent and severe, a clear sign of climate change. The rainy seasons are no longer predictable, and their intensity often overwhelms existing infrastructure.” His first-hand accounts became part of a growing body of evidence showing how health workers worldwide are witnessing climate change impacts firsthand—knowledge that often precedes formal scientific documentation by years.

    Joseph Ngugi, the equity advocate

    Perhaps nowhere was Joseph’s moral clarity more evident than in his systematic approach to health equity challenges. When he witnessed an elderly rural woman being ignored at a hospital registration desk while younger, well-dressed patients received immediate attention, he documented both his direct intervention and his proposed systemic solutions.

    “I later engaged hospital staff in a discussion about unconscious bias and the need to treat all patients with dignity,” he explained. His characteristically systematic solution—implementing a token system for patient queuing that would ensure first-come, first-served service regardless of appearance or language—provided concrete guidance that colleagues could adapt to their own contexts.

    Joseph’s approach to neglected tropical diseases demonstrated similar principled persistence. Working on lymphatic filariasis in Murang’a County, he documented comprehensive community intervention approaches that included support groups for affected patients and collaboration with traditional healers to address cultural misconceptions. “Building partnerships and fostering ownership within the community were crucial in sustaining our efforts and driving positive change,” he noted—an insight that resonated across the Foundation’s network of practitioners facing similar challenges with stigmatized conditions.

    A family committed to learning

    Joseph’s commitment to collaborative learning extended to his household. His wife Caroline participated alongside him in Foundation activities, making their home a center of both local health advocacy and global knowledge sharing. Caroline documented her own community engagement successes: “Positive response from the community on the importance of taking their children for immunization. Able to reach pregnant mothers and sensitized them the importance of starting antenatal care clinic early.”

    Their partnership embodied the Foundation’s philosophy that effective global health work requires both deep local engagement and broad network connections. Joseph’s honest assessment of community health work captured both its frustrations and profound rewards: “The worst part of my job is when you reach out to the community for services and [they] are not willing. The best part is when you reach the community members and they listen to you and hear what you have brought in the ground.”

    The pioneer’s final exploration

    Even in his final months, Joseph continued pushing boundaries in ways that reflected his lifelong commitment to innovation. His recent exploration of artificial intelligence tools as potential aids to health work represented not disengagement from human learning but rather his latest attempt to incorporate emerging capabilities into community health practice—a continuation of the innovative thinking that had characterized his entire journey with the Foundation.

    For The Geneva Learning Foundation’s Executive Director Reda Sadki, Joseph was “a pioneer exploring the use of artificial intelligence” within global health contexts, demonstrating how practitioners could thoughtfully experiment with new technologies while maintaining focus on community needs.

    A voice that bridged worlds

    From November 2020 through August 2025, Joseph Ngugi completed an extraordinary progression through the Foundation’s most demanding programmes: the COVID-19 Peer Hub, WHO Scholar Level 1 certification, the Movement for Immunization Agenda 2030’s first Full Learning Cycle with distinction, Impact Accelerator certifications, and advanced collaborative work with the Nigeria Movement for Immunization Agenda 2030, which connected over 4,000 participants across Nigeria’s diverse health system.

    His Nigeria collaborative work, completed in July 2024, demonstrated his evolution into a mentor for colleagues in countries other than his own, facing similar challenges. Through structured peer review processes and collaborative root cause analyses, Joseph helped dozens of Nigerian health workers develop their own systematic approaches to immunization challenges—knowledge that will continue influencing practice long after his passing.

    “What I have learned from sharing photos and seeing photos from colleagues: we share common challenges, challenges are everywhere, love for human being is universal, health is wealth, immunization is the best investment in the world,” he wrote, capturing the spirit of global solidarity that sustained his work and connected him to practitioners worldwide.

    A legacy of networked learning

    Joseph Mbari Ngugi’s death leaves a profound void in a global learning network where his thoughtful analyses, generous mentorship, and systematic documentation created lasting value for thousands of colleagues. His comprehensive body of work—from detailed root cause analyses to innovative crisis responses, from equity advocacy to climate adaptation strategies—represents one of the most complete records of how a dedicated practitioner can evolve into a sophisticated analyst and effective advocate through structured peer learning.

    His progression from childhood dreams inspired by witnessing healthcare compassion to becoming a leader in global health networks demonstrates the transformative potential of connecting local practice with worldwide learning communities. In an era of unprecedented health challenges—from climate change to emerging diseases to persistent inequities—Joseph’s documented approach offers a roadmap for practitioners worldwide seeking to make systematic change while remaining deeply rooted in their communities.

    Joseph Ngugi’s voice may now be silent, but his contributions continue speaking through the colleagues he mentored, the frameworks he helped refine, and the thousands of health workers who will encounter his insights through the Foundation’s ongoing work. His legacy reminds us that the most effective global health leadership often emerges not from traditional hierarchies but from practitioners who combine deep local knowledge with the courage to share their experiences across borders, creating networks of learning that can respond to our world’s most pressing challenges with both precision and compassion.

    Photo credit: Matiba Eye and Dental Hospital, Murang’a County Kenya. Joseph Mbari Ngugi submitted this photo for World Immunization Week in 2023. Here is what he told us about the image: “This is me, and Grace M Kihara, nursing officer, on the 15th of March 2023 at the Kenneth Matiba Eye and Dental Hospital in Murang’a County, Kenya. My work includes explaining to clients the importance of measles immunization and other vaccines, and advocating for immunization.”

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  • Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries

    Climate change and health: a new peer learning programme by and for health workers from the most climate-vulnerable countries

    GENEVA, Switzerland, 23 July 2025 (The Geneva Learning Foundation) –Today, The Geneva Learning Foundation (TGLF) announces the launch of “Learning to lead change on the frontline of climate change and health,” the inaugural course in a new certificate programme designed by and for professionals facing climate change impacts on health.

    Enrollment is now open. The course will launch on 11 August 2025.

    Two years ago today, nearly 5,000 health professionals from across the developing world gathered online for an unprecedented conversation. They shared something most climate scientists had never heard: detailed, firsthand accounts of how rising temperatures, extreme weather, and environmental changes were already devastating the health of their communities.

    The stories were urgent and specific. A nurse in Ghana described managing surges of malaria after unprecedented flooding. A community health worker in Bangladesh explained how cholera outbreaks followed every major storm. A pharmacist in Nigeria watched children suffer malnutrition as crops failed during extended droughts.

    “I can hear the worry in your voices,” one global health partner told participants during those historic July 2023 events, “and I really respect the time that you are giving to tell us about what is happening to you directly.”

    Connecting the dots from individual impact to systemic crisis

    While climate change dominates headlines for its environmental and economic impacts, a parallel health crisis has been quietly unfolding in clinics and hospitals across Africa, Asia, and Latin America. Health workers have become first-hand witnesses to climate change’s human toll.

    Dr. Seydou Mohamed Ouedraogo from Burkina Faso described devastating floods that “really marked the memory of the inhabitants” and led to cascading health impacts.

    Felix Kole from Gambia reported that “wells have turned to salty water” due to rising sea levels, while extreme heat meant “people are no longer sleeping inside their houses,” creating new security and health complications.

    Rebecca Akello, a public health nurse from Uganda, documented malnutrition impacts directly: “During dry spells where there is no food, children come and their growth monitoring shows they really score low weight for age.”

    Health professionals like Dr. Iktiyar Kandaker from Bangladesh already get that this is a systemic challenge: “Our health system is not prepared to actually address these situations. So this is a combined challenge… but it requires a lot of time to fix it.”

    These health workers serve as what TGLF calls “trusted advisors”—over half describe themselves as being like “members of the family” to the populations they serve. Yet until now, they have had no structured way to learn from each other’s experiences or develop coordinated responses to climate health challenges.

    Learning from those who know because they are there every day

    “It is something that all of us have to join hands to be able to do the most we can to educate our communities on what they can do,” said Monica Agu, a community pharmacist from Nigeria who participated in the founding 2023 events. Her words captured the collaborative spirit that has driven the programme’s development.

    The new certificate programme employs TGLF’s proven peer learning methodology, recognizing that health workers are already implementing life-saving climate adaptations with limited resources. During the 2023 events, participants shared examples of modified immunization schedules during heat waves, cholera outbreak management after flooding, and maintaining health services during extreme weather events.

    “We believe that investing in health workers is one of the best ways to accelerate and strengthen the response to climate change impacts on health,” explains TGLF Executive Director Reda Sadki.

    The programme has been developed from comprehensive analysis of health worker experiences documented since 2023. Most observations come from small and medium-sized communities in the most climate-vulnerable countries.

    For health, a different kind of climate action

    Unlike traditional climate programmes focused on policy or infrastructure, this initiative recognizes that effective climate health responses must be developed by those experiencing the impacts firsthand. The course enables health workers to share their own experiences, learn from colleagues facing similar challenges, and develop both individual and collective responses.

    Dr. Eme Ngeda from the Democratic Republic of Congo captured this approach during the 2023 events: “We are all responsible for these climate disruptions. We must sensitize our populations in waste management and sensitize how to reform our healthcare providers to face resilience, face disasters.”

    The programme connects leaders from more than 4,000 locally-led health organizations through TGLF’s REACH network, enabling them to become programme partners supporting their health workers in developing climate-health leadership skills.

    Building global solutions by connecting local, indigenous knowledge and expertise

    The inaugural course offers health professionals worldwide the opportunity to learn from documented experiences of colleagues who are facing unprecedented consequences of climate change on health. Rather than lectures or theoretical frameworks, the programme employs structured reflection and peer feedback cycles, enabling participants to develop actionable implementation plans informed by peer knowledge and global guidance.

    The course covers four key areas based on health worker experiences:

    • Climate and environmental changes: Recognizing connections between climate and health in local communities.
    • Health impacts on communities: Understanding direct health impacts, food security, and mental health effects.
    • Changing disease patterns: Managing infectious diseases, respiratory conditions, and healthcare access challenges.
    • Community responses and adaptations: Implementing local solutions and innovations from peer experiences.

    Participants earn verified certificates aligned to professional development competency frameworks. Upon completion, they join TGLF’s global community of health practitioners for ongoing peer support and collaboration.

    The urgency of now

    The programme launches at a critical moment. Climate change impacts on health are accelerating, particularly in low- and middle-income countries where health systems are least equipped to respond. Yet these same regions are producing innovative, resource-efficient solutions that could benefit communities worldwide.

    As one health worker reflected during the 2023 events: “Although climate change is a global phenomenon, it is affecting very, very locally people in very different ways.” The new programme acknowledges this reality while creating pathways for local solutions to inform global responses.

    The course is available in English and French, designed to work on mobile devices and basic internet connections. It is free for health workers in participating countries.

    For health workers who have been managing climate impacts in isolation, the programme offers something unprecedented: the chance to learn from colleagues who truly understand their challenges and to contribute their own expertise to a growing global knowledge base.

    As the climate health crisis deepens, the solutions may well come from those who have been living with its impacts longest—if we finally give them the platforms and recognition they deserve.

    Image: The Geneva Learning Foundation Collection © 2025

  • WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action

    WHO Global Conference on Climate and Health: New pathways to overcome structural barriers blocking effective climate and health action

    After the World Health Assembly’s adoption of ambitious global plan of action for climate and health, global and country stakeholders are meeting in Brasilia for the Global Conference on Climate and Health, ahead of COP30. Three critical observations emerged that illuminate why conventional global health approaches may be structurally inadequate for the challenges resulting from climate change impacts on health.

    These observations carry particular significance for global health leaders who now possess a WHA-approved strategy and action plan, but lack proven mechanisms for rapid, community-led implementation in the face of an unprecedented set of challenges. They also matter for major funders whose substantial investments in policy and research have yet to be matched by commensurate support for the communities and health workers who will be the ones to translate better science and policy into action.

    Signal 1: When funding disappears and demand explodes

    Seventy percent of global health funding vanished, virtually overnight. This collapse comes precisely when the World Health Organization projects a shortage of 10 million health workers by 2030—six million in climate-vulnerable sub-Saharan Africa.

    The World Bank calculates that climate change will generate 4.1-5.2 billion disease cases and cost $8.6-20.8 trillion by 2050 in low- and middle-income countries alone. Health systems must simultaneously manage unprecedented demand with drastically reduced resources.

    Traditional technical assistance—flying experts to conduct workshops, cascade training through hierarchies—is more difficult to resource. By comparison, peer learning networks can reduce costs by 86 percent while achieving implementation rates seven times higher than conventional methods. Furthermore, 82 percent of participants in such networks continue independently after formal interventions end. Peer learning is especially well-suited to include health workers in conflict zones, refugee settings, and remote areas where climate vulnerability peaks—precisely the locations where traditional expert-led capacity building proves most difficult and expensive.

    The funding crisis makes it more of an imperative than ever before to examine which approaches can scale effectively when resources contract. Organizations that recognize this shift early could achieve breakthrough results as traditional approaches become unaffordable.

    Signal 2: Global expertise meets local reality

    The World Health Assembly continues producing comprehensive action plans backed by thousands of expert hours. The climate and health action plan represents the pinnacle of this approach—technically excellent, evidence-based, globally applicable.

    Yet the persistent implementation gap reflects deeper challenges about how knowledge flows between institutions and communities. Current theories of change assume that technical expertise, properly communicated, will lead to improved outcomes. Local knowledge gets framed as “barriers to implementation”, rather than recognized as essential intelligence for adaptation.

    This creates a paradox. The WHO recognizes that “community-led initiatives that harness local knowledge and practices” are “fundamental for creating interventions that are both culturally appropriate and effective.” Health workers possess sophisticated understanding of how global frameworks must adapt to local realities. But systematic mechanisms for capturing and integrating knowledge and action remain underdeveloped.

    Climate change manifests differently in each community—shifting disease patterns in Kenya differ from changing agricultural cycles in Bangladesh, which differ from altered water availability in Morocco. Health workers witness these changes daily, developing contextual responses that often remain invisible to global institutions. The question becomes whether global frameworks can evolve to recognize and systematically integrate this distributed intelligence rather than treating it as anecdotal evidence.

    Signal 3: The policy-people gap widens if field-building ignores communities and is disconnected from local action

    Substantial philanthropic funding is flowing toward climate and health policy and evidence generation. Some funders call this “field-building”. Research institutions develop sophisticated models. Policy frameworks become more comprehensive. Scientific understanding advances rapidly. These investments are producing genuinely better science and more effective policies—essential progress that must continue.

    Yet investment in communities and health workers—the people who must implement policies and apply evidence—remains disproportionately small. This disparity creates concerning dynamics where knowledge advances faster than the capacity to apply it meaningfully in communities.

    The risk extends beyond implementation gaps. When sophisticated policies and evidence develop without commensurate investment in community relationships, communities may reject even superior science and policies—not because they are irrational or too ignorant to recognize the benefits, but because the effort to accompany communities through change has been insufficient. Health workers, as trusted advisors within their communities, are uniquely positioned to bridge this gap by helping communities make sense of new evidence and adapt policies to local realities.

    Health workers serve as trusted advisors within communities facing climate impacts. When investment patterns overlook this relationship, sophisticated policies risk becoming irrelevant to the people they aim to help. The trust networks essential for translating evidence into community action – and ensuring that evidence is relevant and useful – receive less attention than the evidence itself.

    The pathway forward: Health workers as knowledge creators and leaders of change

    These three signals point toward a fundamental misalignment between how global institutions approach climate and health challenges and how communities experience them. The funding crisis makes traditional expert-led approaches unsustainable. Implementation gaps persist because local knowledge remains systematically undervalued. Investment patterns favor sophisticated frameworks over the human relationships needed to apply them effectively.

    When a community health worker in Nigeria notices malaria cases appearing earlier each season, or a nurse in Bangladesh observes heat-related illness patterns in specific neighborhoods, they are detecting signals that epidemiological studies might take years to document formally. This represents a form of “early warning system” that current approaches tend to overlook.

    Recent innovations demonstrate different possibilities. Networks connecting health practitioners across countries through digital platforms treat health workers as knowledge creators rather than knowledge recipients. Such approaches have achieved, in other fields, implementation rates seven times higher than conventional technical assistance while reducing costs by 86 percent. There is no reason why applying these approaches would not result in similar results. 

    For the World Health Organization, such approaches could offer pathways to operationalize the Global Plan of Action through the very health workers the organization recognizes as “uniquely positioned” to champion climate action while building essential community trust.

    For major funders, these models represent opportunities to complement policy and research investments with approaches that strengthen community capacity to apply sophisticated knowledge to local realities.

    The evidence suggests that failure to bridge these gaps could prove more costly than the investment required to close them. But the returns—measured in communities reached, knowledge applied, and trust maintained—justify treating health worker networks as essential infrastructure for climate and health response rather than optional additions.

    Three questions for leaders

    As leaders prepare for the Global Climate Change and Health conference in Brasilia and begin work to implement climate and health commitments, three questions emerge from the World Health Assembly observations:

    • For institutions with comprehensive plans: How will technical excellence translate into community-level implementation when traditional capacity building approaches have become economically unsustainable?
    • For funders investing in research and policy: How can sophisticated evidence and frameworks reach the health workers and communities who must apply them to local realities?
    • For all climate and health leaders: What happens when policies advance faster than the trust relationships and implementation capacity needed to apply them effectively?

    The signals from the World Health Assembly suggest that conventional approaches face structural constraints that incremental improvements cannot address. The funding crisis, implementation gaps, and investment disparities require responses that recognize health workers as partners in creating climate and health solutions rather than merely implementing plans created elsewhere.

    The choice is not whether to transform approaches—resource constraints and community realities make transformation inevitable. The choice is whether leaders will direct that transformation toward approaches that strengthen both global knowledge and local capacity, or risk watching sophisticated frameworks fail for lack of community connection and trust.

    References

    Miller, J., Howard, C., Alqodmani, L., 2024. Advocating for a Healthy Response to Climate Change — COP28 and the Health Community. N Engl J Med 390, 1354–1356. https://doi.org/10.1056/NEJMp2314835

    Sanchez, J.J., Gitau, E., Sadki, R., Mbuh, C., Silver, K., Berry, P., Bhutta, Z., Bogard, K., Collman, G., Dey, S., Dinku, T., Dwipayanti, N.M.U., Ebi, K., Felts La Roca Soares, M., Gudoshava, M., Hashizume, M., Lichtveld, M., Lowe, R., Mateen, B., Muchangi, M., Ndiaye, O., Omay, P., Pinheiro Dos Santos, W., Ruiz-Carrascal, D., Shumake-Guillemot, J., Stewart-Ibarra, A., Tiwari, S., 2025. The climate crisis and human health: identifying grand challenges through participatory research. The Lancet Global Health. https://doi.org/10.1016/S2214-109X(25)00003-8

    Sadki, R., 2024. Health at COP29: Workforce crisis meets climate crisis. https://doi.org/10.59350/sdmgt-ptt98

    Sadki, R., 2024. Strengthening primary health care in a changing climate. https://doi.org/10.59350/5s2zf-s6879

    Sadki, R., 2024. The cost of inaction: Quantifying the impact of climate change on health. https://doi.org/10.59350/gn95w-jpt34

    Image: The Geneva Learning Foundation Collection © 2025

  • 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”.

  • The funding crisis solution hiding in plain sight

    The funding crisis solution hiding in plain sight

    “I did not realize how much I could do with what we already have.”

    A Nigerian health worker’s revelation captures what may be the most significant breakthrough in global health implementation during the current funding crisis. While organizations worldwide slash programs and lay off staff, a small Swiss non-profit, The Geneva Learning Foundation (TGLF), is demonstrating how to achieve seven times greater likelihood of improved health outcomes while cutting costs by 90 percent.

    The secret lies not in new technology or additional resources, but in something deceptively simple: health workers learning from and supporting each other.

    Nigeria: Two weeks to connect thousands, four weeks to change, and six weeks to outcomes

    On June 26, 2025, representatives from 153 global health and humanitarian organizations gathered for a closed-door briefing seeking proven solutions to implementation challenges they knew all too well. TGLF presented evidence from the Nigeria Immunization Agenda 2030 Collaborative that sounds almost too good be true to senior leaders who have to make difficult decisions given the funding cuts: documented results at unprecedented speed and scale – and at lower cost.

    Working with Gavi, Nigeria’s Primary Health Care Development Agency, and UNICEF, they facilitated connections among 4,300 health workers and more than 600 local organizations across all Nigerian states, in just two weeks. Not fleeting digital clicks, but what Executive Director Reda Sadki calls “deep, meaningful engagement, sharing of experience, problem solving together.”

    The challenge was reaching zero-dose children in fragile areas affected by armed conflict. The timeline was impossible by traditional standards. The results transformed many skeptics into advocates – including those who initially said it sounded too good to be true.

    A civil society organization (CSO) volunteer reported that government staff initially dismissed the initiative: “They heard about this, thought it was just another CSO initiative. Two weeks in, they came back asking how to join.”

    Funding crisis: How does sharing experience lead to better outcomes?

    What happened next addresses the most critical question about peer learning approaches: do health workers learning from each other actually improve health outcomes?

    TGLF’s comparative research demonstrated that groups using structured peer learning are seven times more likely to achieve measurable health improvements versus conventional approaches.

    In Nigeria, health workers learned the “five whys” root cause analysis from each other. Many said no one had ever asked them: “What do you think we should do?” or “Why do you think that is?” The transformation was both rapid and measurable.

    For example, at the program start, only 25 percent knew their basic health indicators for local areas. “I collect these numbers and pass them on, but I never realized I could use them in my work,” participants reported.

    Four weeks in, they had produced 409 root cause analyses. Many realized that their existing activities were missing these root causes. After six weeks, health workers began credibly reporting attribution of new activities that led to finding and vaccinating zero-dose children.

    Given limited budget, TGLF had to halt development. But here is the key point: more than half of participating have maintained and continued the peer support network independently, addressing sustainability concerns that plague traditional capacity-building efforts.

    The snowball effect at scale

    The breakthrough emerged from what Sadki describes as reaching “critical mass” where motivated participants pull others along. “This requires clearing the rubble of all the legacy of top-down command and control systems, figure out how to negotiate hierarchies, especially because government integration is systematically our goal.”

    Nigeria represents one of four large-scale implementations demonstrating consistent results. In Côte d’Ivoire, 501 health workers from 96 districts mapped out 3.5 million additional vaccinations in four weeks. Global initiatives are likely to cost no more than a single country-specific program: the global Teach to Reach network has engaged 24,610 participants across more than 60 countries. The global Movement for Immunization Agenda 2030, launched in March 2022, grew from 6,186 to more than 15,000 members in less than four months.

    The foundation tracks what they call a “complete measurement chain” from individual motivation through implementation actions to health outcomes. Cost efficiency stems from scale and sustainability, with back-of-envelope calculations suggesting 90 percent cost reduction compared to traditional methods.

    Solving the abundance paradox

    “You touched upon an important issue that I am struggling with—the abundance of guidance that my own organization produces and also guidance that comes from elsewhere,” noted a senior manager from an international humanitarian network during the briefing. “It really feels intriguing to put all that material into a course and look at what I am going to do with this. It is a precious process and really memorable and makes the policies and materials relevant.”

    This captures a central challenge facing global health organizations: not lack of knowledge, but failure to translate knowledge into action. The peer learning model transforms existing policies and guidelines into peer learning experiences where practitioners study materials to determine specific actions they will take.

    “Learning happens not simply by acquiring knowledge, but by actually doing something with it,” Sadki explained.

    For example, a collaboration with Save the Children converted a climate change policy brief into a peer learning course accessed by more than 70,000 health workers, developed and deployed in three days with initial results expected within six weeks.

    Networks that outlast the funding crisis

    The foundation’s global network now includes more than 70,000 practitioners across 137 countries, with geographic focus on nations with highest climate vulnerability and disease burden. More than 50 percent are government staff. More than 80 percent work at district and community levels.

    Tom Newton-Lewis, a leading health systems researcher and consultant who attended the briefing, captured what makes this approach distinctive: “I am always inspired by the work of TGLF. There are very few initiatives that work at scale that walk the talk on supporting local problem solving, and mobilize systems to strengthen themselves.”

    This composition ensures that peer learning initiatives operate within rather than parallel to official health systems. More than 1,000 national policy planners connect directly with field practitioners, creating feedback loops between strategy development and implementation reality.

    Networks continue functioning when external support changes. The foundation has documented continued peer connections through network analysis, confirming that established relationships maintain over time.

    Three pathways forward

    The foundation outlined entry points for organizations seeking proven implementation approaches. First, organizations can become program partners, providing their staff access to existing global programs while co-developing new initiatives. Available programs include measles, climate change and health, mental health, non-communicable diseases, neglected tropical diseases, immunization, and women’s leadership.

    Second, using the model to connect policy and implementation at scale and lower cost. Timeline: three days to build, four to six weeks for initial results. Organizations gain direct access to field innovations while receiving evidence-based feedback on what actually works in practice.

    Third, testing the model on current problems where policy exists but implementation remains inconsistent. Organizations can connect their staff to practitioners who have solved similar problems without additional funding. Timeline: six to eight weeks from start to documented results.

    The foundation operates through co-funding partnerships rather than grant-making, with flexible arrangements tailored to partner capacity and project scope. What they call “economy of effort” often delivers initiatives spanning more than 50 countries for the cost of single-country projects.

    Adaptability across contexts

    The model has demonstrated remarkable versatility across different contexts and challenges. The foundation has successfully adapted the approach to new geographic areas like Ukraine and thematic areas like mental health and psychosocial support. Each adaptation requires understanding specific contexts, needs, and goals, but the fundamental peer learning principles remain consistent.

    An Indian NGO raised a fundamental challenge: “Where we struggle with program implementation post-funding is without remuneration frontline workers. Although they want to bring change in the community, are motivated, and have enough data, cannot continue.”

    Sadki’s response: “By recognizing the capabilities for analysis, for adaptation, for carrying out more effective implementation because of what they know, because they are there every day, that should contribute to a growing movement for recognition that CHWs in particular should be paid for the work that they do.”

    The path forward

    The Nigerian health worker’s realization—discovering untapped potential in existing resources—represents more than individual transformation. It demonstrates how peer learning unlocks collective intelligence already present within communities and health systems.

    In two weeks, health workers connected with each other across Nigeria’s most challenging regions, facilitated by the foundation’s proven methodology. By the sixth week, they had begun reporting credible, measurable health improvements. The model works because it values local knowledge, creates peer support systems, and integrates with government structures rather than bypassing them.

    With funding cuts forcing difficult choices across global health, this model offers documented evidence that better health outcomes can cost less, sustainable networks continue without external support, and local solutions scale globally. For organizations seeking proven implementation approaches during resource constraints, the question is not whether they can afford to try peer learning, but whether they can afford not to.

    Image: The Geneva Learning Foundation Collection © 2025

  • When funding shrinks, impact must grow: the economic case for peer learning networks

    When funding shrinks, impact must grow: the economic case for peer learning networks

    Humanitarian, global health, and development organizations confront an unprecedented crisis. Donor funding is in a downward spiral, while needs intensify across every sector. Organizations face stark choices: reduce programs, cut staff, or fundamentally transform how they deliver results.

    Traditional capacity building models have become economically unsustainable. Technical assistance, expert-led workshops, international travel, and venue-based training are examples of high-cost, low-volume activities that organizations may no longer be able to afford.

    Yet the need for learning, coordination, and adaptive capacity has never been greater.

    The opportunity cost of inaction

    Organizations that fail to adapt face systematic disadvantage. Traditional approaches cannot survive current funding constraints while maintaining effectiveness. Meanwhile, global challenges intensify: climate change drives new disease patterns; conflict disrupts health systems; demographic transitions strain capacity.

    These complex, interconnected challenges require adaptive systems that respond at the speed and scale of emerging threats. Organizations continuing expensive, ineffective approaches will face programmatic obsolescence.

    Working with governments and trusted partners that include UNICEF, WHO, Gates Foundation, Wellcome Trust, and Gavi (as part of the Zero-Dose Learning Hub), the Geneva Learning Foundation’s peer learning networks have consistently demonstrated they can deliver measurably superior outcomes while reducing costs by up to 86% compared to conventional approaches.

    Peer learning networks offer both immediate financial relief and strategic positioning for long-term sustainability. The evidence spans nine years, 137 countries, and collaborations with the most credible institutions in global health, humanitarian response, and research.

    The unsustainable economics of traditional capacity building

    A comprehensive analysis reveals the structural inefficiencies of conventional approaches. Expert consultants command daily rates of $800 or more, plus travel expenses. International workshops may require $15,000-30,000 for venues alone. Participant travel and accommodation averages $2,000 per person. A standard 50-participant workshop costs upward of $200,000.

    When factoring limited sustainability, the economics become even more problematic. Traditional approaches achieve measurable implementation by only 15-20% of participants within six months. This translates to effective costs of $10,000-20,000 per participant who actually implements new practices.

    A rudimentary cost-benefit analysis demonstrates how peer learning networks restructure these economics fundamentally.

    ComponentTraditional approachPeer learning networksEfficiency gain
    Cost per participant$1,850$26786% reduction
    Implementation rate15-20%70-80%4x higher success
    Duration of engagement2-3 days90+ days30x longer
    Post-training supportNoneContinuous networkSustained capacity

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

    Evidence of measurable impact at scale

    Value for money requires clear attribution between investments and outcomes.

    In January 2020, we compared outcomes between two groups. Both had intent to take action to achieve results. Health workers using structured peer learning were seven times more likely to implement effective strategies resulting in improved outcomes, compared to the other group that relied on conventional approaches.

    What about speed and scale?

    In July 2024, working with Nigeria’s National Primary Health Care Development Agency (NPHCDA) and UNICEF, we connected 4,300 health workers across all states and 300+ local government areas within two weeks. Over 600 local organizations including government facilities, civil society, faith-based groups, and private sector actors joined this Immunization Collaborative.

    With two more weeks, participants produced 409 peer-reviewed root cause analyses. By Week 6, we began to receive credible vaccination coverage improvements after six weeks, especially in conflict-affected northern regions where conventional approaches had consistently failed. The total programme cost was equivalent to 1.5 traditional workshops for 75 participants. Follow-up has shown that more than half of the participants are staying connected long after TGLF’s “jumpstarting” activities, driven by intrinsic motivation.

    Côte d’Ivoire demonstrates crisis response capability. Working with Gavi and the Ministry of Health, we recruited 501 health workers from 96 districts (85% of the country) in nine days ahead of the country’s COVID-19 vaccination campaign in November 2021. Connected to each other, they shared local solutions and supported each other, contributing to vaccination of an additional 3.5 million additional people at $0.26 per vaccination delivered.

    TGLF’s model empowers health workers to share knowledge, solve local challenges, and implement solutions via a digital platform. Unlike top-down training and technical assistance, it fosters collective intelligence, enabling rapid adaptation to crises. Since 2016, TGLF has mobilized networks for immunization, COVID-19 response, neglected tropical diseases (NTDs), mental health and psychosocial support, noncommunicable diseases, and climate-health resilience.

    These cases illustrate the ability of TGLF’s model to address strategic global priorities—equity, resilience, and crisis response—while maximizing efficiency. This model offers a scalable, low-cost alternative that delivers measurable impact across diverse priorities.

    Our mission is to share such breakthroughs with other organizations and networks that are willing to try new approaches.

    Resource allocation for maximum efficiency

    Our partnership analysis reveals optimal resource allocation patterns that maximize impact while minimizing cost:

    • Human resources (85%): Action-focused approach leveraging human facilitation to foster trust, grow leadership capabilties, and nurture networks with a single-minded goal of supporting implementation to rapidly and sustainably achieve tangible outcomes.
    • Digital infrastructure (10%): Scalable platform development enabling unlimited concurrent participants across multiple countries.
    • Travel (5%): Minimal compared to 45% in traditional approaches, limited to essential coordination where social norms require face-to-face meetings, for example in partnership engagement with governments.

    This structure enables remarkable economies of scale. While traditional approaches face increasing per-participant costs, peer learning networks demonstrate decreasing unit costs with growth. Global initiatives reaching 20,000+ participants across 60+ countries operate with per-participant costs under $10.

    Sustainability through combined government and civil society ownership

    Sustainability is critical amidst funding cuts. TGLF’s networks embed organically within government systems, involving both central planners in the capital as well as implementers across the country, at all levels of the health system.

    Country ownership: Programs work within existing health system structures and national plans. Networks include 50% government staff and 80% district/community-level practitioners—the people who actually deliver services. In Nigeria, 600+ local organizations – both private and public – collaborated, embedding learning in both civil society and government structures.

    Sustainability: In Côte d’Ivoire, 82% sustained engagement without incentives, fostering self-reliant networks. 78% said they no longer needed any assistance from TGLF to continue.

    This approach enhances aid effectiveness, reducing dependency on external funding.

    Aid effectiveness: Rather than bypassing systems, peer learning strengthens existing infrastructure. Networks continue functioning when external funding decreases because they operate through established government channels linked to civil society networks.

    Transparency: Digital platforms create comprehensive audit trails providing unprecedented visibility into program implementation and results for donor oversight.

    Implementation pathways for resource-constrained organizations

    Organizations can adopt peer learning approaches through flexible pathways designed for immediate deployment.

    1. Rapid response initiatives (2-6 weeks to results): Address critical challenges requiring immediate mobilization. Suitable for disease outbreaks, humanitarian emergencies, or longer-term policy implementation.
    2. Program transformation (3-6 months): Convert existing technical assistance programs to peer learning models, typically reducing costs by 80-90% while expanding reach, inclusion, and outcomes.
    3. Cross-portfolio integration: Single platform investments serve multiple technical areas and geographic regions simultaneously, maximizing efficiency across donor portfolios with marginal costs approaching zero for additional countries or topics.

    The strategic choice

    The funding environment will not improve. Economic uncertainty in traditional donor countries, competing domestic priorities, and growing skepticism about aid effectiveness create permanent pressure for better value for money.

    Organizations face a fundamental choice: continue expensive approaches with limited impact, or transition to emergent models that have already shown they can achieve superior results at dramatically lower cost while building lasting capability.

    The question is not whether to change—budget constraints mandate adaptation. The question is whether organizations will choose approaches that thrive under resource constraints or continue hoping that some donors will fill the gaping holes left by funding cuts.

    The evidence demonstrates that peer learning networks achieve 86% cost reduction while delivering 4x implementation rates and 30x longer engagement. These gains are not theoretical—they represent verified outcomes from active partnerships with leading global institutions.

    In an era of permanent resource constraints and intensifying challenges, organizations that embrace this transformation will maximize their mission impact. Those that do not will find themselves increasingly unable to serve the communities that depend on their work.

    Image: The Geneva Learning Foundation Collection © 2025

  • The business of artificial intelligence and the equity challenge

    The business of artificial intelligence and the equity challenge

    Since 2019, when The Geneva Learning Foundation (TGLF) launched its first AI pilot project, we have been exploring how the Second Machine Age is reshaping learning. Ahead of the release of the first framework for AI in global health, I had a chance to sit down with a group of Swiss business leaders at the PanoramAI conference in Lausanne on 5 June 2025 to share TGLF’s insights about the significance and potential of artificial intelligence for global health and humanitarian response. Here is the article posted by the conference to recap a few of the take-aways.

    The Global Equity Challenger

    At the Panoramai AI Summit, Reda Sadki, leader of The Geneva Learning Foundation, delivered provocative insights about AI’s impact on global equity and the future of human work. Drawing from humanitarian emergency response and global health networks, he challenged comfortable assumptions about AI’s societal implications.

    The job displacement reality

    Reda directly confronted panel optimism about job preservation: “One of the things I’ve heard from fellow panelists is this idea that we can tell employees AI is not coming for your job. And I struggle to see that as anything other than deceitful or misleading at best. ”

    Eliminating knowledge worker positions in education

    “In one of our programmes, after six months we were able to use AI to replace key functions initially performed by humans. Humans helped us figure out how to do it. We then refocused a smaller team on tasks that we cannot or do not want to automate. We tried to do this openly.”

    What’s left for humans to do?

    “These machines are already learning faster and better than us, and they are doing so exponentially. Right now, what’s left for humans currently is the facilitation, facilitating connections in a peer learning system. We do not yet have agents that can facilitate, that can read the room, that can help humans understand.”

    Global access inequities

    Reda highlighted three critical equity challenges: geographic access restrictions (‘geolocking’), transparency expectations around AI usage, and punitive accountability systems that discourage innovation in humanitarian contexts. “Somebody who uses AI in that context is more likely to be punished than rewarded, even if the outcomes are better and the costs are lower. ”

    Emerging markets disconnect

    “Even though that’s where the future markets are likely to be for AI, ” Reda observed limited engagement with Africa, Asia, and Latin America among attendees, highlighting a strategic blindness to global AI market evolution.

    Organizational evolution question

    Reda posed fundamental questions about future organizational structures, questioning whether traditional hierarchical models with management layers will remain dominant “two years or five years down the line. ”

    Network-based innovation vision

    “We’ve nurtured the emergence of a global network of health workers sharing their observations of climate change impacts on the health of communities they serve. This is already powerful for preparedness and response, but we’re trying to find ways to weave in and embed AI as co-workers and co-thinkers to help health workers harness messy, complex, large-volume climate data.”

    Exponential learning challenge

    “These machines are already learning faster and better than us and that, and they’re doing so exponentially better than us. It’s pretty clear what, you know, what keeps me awake at night is what what’s left for humans. ”

    Key Achievement: Reda demonstrated how honest assessment of AI’s transformative impact requires abandoning comfortable narratives about job preservation, positioning global leaders to address equity challenges while identifying uniquely human capabilities in an AI-augmented world.

    Reda Sadki serves as Executive Director of The Geneva Learning Foundation (TGLF), a Swiss non-profit. Concurrently, he maintains his position as Chief Learning Officer at Learning Strategies International (LSi) since 2013, where he helps international organizations improve their change execution capabilities. TGLF, under his guidance, catalyzes large-scale peer networks of frontline actors across 137 countries, developing learning experiences that transform local expertise into innovation and measurable results.

    Image: PanoramAI (Raphaël Briner).