The article “Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030” is, according to the authors, “the first to showcase the positive inclusion of mainstreaming gender in a WHO capacity-building program.”

Context:

• The paper analyzes action plans developed and peer reviewed by participants in one cohort of the 2021 World Health Organization (WHO) Scholar Level 1 certification course on Immunization Agenda 2030 (IA2030), a course developed by The Geneva Learning Foundation (TGLF) with funding from the Bill & Melinda Gates Foundation (BMGF).
• WHO’s Scholar courses only utilize the knowledge creation component of TGLF’s learning-to-action model, whereas the full model supports implementation that leads to improved health outcomes.
• TGLF uses an innovative peer learning-to-action model, developed through over a decade of research and practice, focused on knowledge creation through dialogue, critique, and collaboration, with rubric-based peer feedback scaffolding the learning process.
• The course was facilitated by Charlotte Mbuh and Min Zha, two women learning leaders at The Geneva Learning Foundation (TGLF), who combine deep expertise in learning science and real-world knowledge of immunization in low- and middle-income countries (LMICs).

Key findings:

• The analysis included 111 action plans, a subset of the projects and insights shared, from participants across 31 countries working to improve immunization programs.
• It found that “all action plans in the 111 sample, except three, included gender considerations” showing the course was effective in raising awareness of gender barriers.

This is consistent with the known effectiveness of peer feedback, as the rubric followed by each learner included specific instructions to “describe how your action plan has considered and integrated gender dimensions in immunization.”

TGLF’s peer learning model focuses on generating and applying new knowledge. This appears to be conducive to raising awareness of issues like gender barriers to immunization. By giving and receiving feedback, participants build understanding.

Whereas only around ten percent of learners participated in expert-led presentations offered about gender and immunization, every learner had to think through and write up gender analysis. And every learner had to give feedback on the gender analyses of three colleagues.

The social nature of giving and received structured peer feedback, supported by expert-designed resources, creates accountability and motivation for integrating gender considerations. Participants educate one another on blindspots, helping embed attention to gender issues.

Compared to traditional expert-led capacity building, this peer-led approach empowered participants to learn from each other’s experience, situating gender in their real-world practice, rather than as an abstract concept that requires global experts to explain it. This participant-driven process with built-in feedback mechanisms is likely to have helped make the increased gender awareness actionable.

What we learned about gender barriers

• The most cited barrier was “low education and health literacy” affecting immunization uptake. As one plan stated, “lower educational levels of maternal caregivers are more commonly related to under-vaccination”.
• Other major barriers were difficulties accessing services due to “gender-related factors influencing mobility, location, availability, or quality of health services” and lack of male involvement in decisions, as “men make most of the household decisions while they often do not have sufficient information”.
• Proposed strategies focused on areas like “incentive schemes” and “on-the-job support” for female health workers, “community engagement” to improve literacy, and better “engagement of men” in immunization activities.

TGLF’s peer learning approach likely contributed to raising awareness of gender issues and ability to propose context-specific solutions, though some implicit biases may have affected peer evaluations.

Overall, the analysis shows mainstreaming gender was an effective part of this capacity building program, and the authors appear convinced of its potential to lead to more gender-equitable and effective immunization policies and services.

However, the authors’ claim that “gender inequality and harmful gender norms in many settings create barriers and are the main reasons for suboptimal immunization coverage” is not substantiated by the available data. The action plans do provide some contextual descriptions of gender barriers and describe an intent to take action. But descriptions shared by learners were not verified, and the course did not offer any support to learners in implementing their proposed actions.

Reference: Nyasulu, B.J., Heidari, S., Manna, M., Bahl, J., Goodman, T., 2023. Gender analysis of the World Health Organization online learning program on Immunization Agenda 2030. Frontiers in Global Women’s Health 4, 1230109. https://doi.org/10.3389/fgwh.2023.1230109

Illustration: The Geneva Learning Foundation Collection © 2024

https://redasadki.me/2024/02/21/gender-analysis-of-the-world-health-organization-online-learning-program-on-immunization-agenda-2030/

In the article “Towards reimagined technical assistance: the current policy options and opportunities for change”, Alexandra Nastase and her colleagues argues that technical assistance should be framed as a policy option for governments. It outlines different models of technical assistance:

1. Capacity substitution: Technical advisers perform government functions due to urgent needs or lack of in-house expertise. This can fill gaps but has “clear limitations in building state capability.”
2. Capacity supplementation: Technical advisers provide specific expertise to complement government efforts in challenging areas. This can “fill essential gaps at critical moments” but has limitations for building sustainable capacity.  
3. Capacity development: Technical advisers play a facilitator role focused on enabling change and strengthening government capacity over the long term. This takes time but “there is a higher chance that these [results] will be sustainable.”

Governments may choose from this spectrum of roles for technical advisers in designing assistance programs based on the objectives, limitations, and tradeoffs involved with each approach: “The most common fallacy is to expect every type of technical assistance to lead to capacity development. We do not believe that is the case. Suppose governments choose to use externals to do the work and replace government functions. In that case, it is not realistic to expect that it will build a capability to do the work independently of consultants.”

Furthermore, technical assistance should be designed through “meaningful and equal dialogue between governments and funders” to ensure it focuses on core issues and builds sustainable capacity. Considerations that need to be highlighted include balancing short-term needs with long-term capacity building and shifting power to local experts.

However, this requires reframing technical assistance as a policy option through transparent dialogue between government and funders.

What key assumptions about technical assistance does this challenge?

The article challenges some key assumptions and orthodox views about technical assistance in global health:

1. It frames technical assistance not as aid provided by donors, but as a policy option and domestic choice that governments make to meet their objectives. This contrasts with the common donor-centric view.
2. It critiques the assumption that all technical assistance inherently builds sustainable government capacity and questions this expected linear relationship. The article argues different types of technical assistance have fundamentally different aims – gap-filling versus long-term capacity building.
3. The article challenges the idealistic principles often promoted for technical assistance, like localization, government ownership, and adaptability. It suggests the evidence is lacking on if these principles effectively lead to better development outcomes on the ground.  
4. The article argues that technical assistance decisions involve real dilemmas, tradeoffs and tensions in practice rather than being clear cut. It challenges the notion of win-win solutions and highlights risks like unintended consequences.
5. By outlining limitations of different technical assistance approaches, the article pushes back against a one-size-fits-all mindset. The appropriate approach depends on contextual factors and clarity of purpose.
6. The article questions typical measures of success for technical assistance based on fast results and output delivery. It advocates for greater focus on processes that enable long-term capacity development even if slower.

How does The Geneva Learning Foundation’s work fit into such a model?

At The Geneva Learning Foundation (TGLF), we realized that our own model to support locally-led leadership to drive change could be described as a new type of technical assistance that does not fit into any of the existing three categories, because:

1. TGLF’s model is grounded in principles of localization and decolonization that shift power dynamics by empowering government health workers from all levels of the health system – not only the national authorities – to recognize what change is needed, to lead this change where they work. We have observed that, even in fragile contexts, this accelerates progress toward country goals, and strengthens or can help rebuild civil society fabric.
2. It focuses on nurturing intrinsic motivation and peer accountability rather than imposing top-down directives or extrinsic incentives. 
3. It utilizes lateral feedback loops and informal, self-organized networks that cut across hierarchies and geographic boundaries.
4. It emphasizes flexibility, adaptation to local contexts, and problem-driven iteration rather than pre-defined solutions.
5. It builds sustainable capacity and self-organized learning cultures that reduce dependency on external support.

Reference: Nastase, A., Rajan, A., French, B., Bhattacharya, D., 2020. Towards reimagined technical assistance: the current policy options and opportunities for change. Gates Open Res 4, 180. https://doi.org/10.12688/gatesopenres.13204.1

Illustration: The Geneva Learning Foundation Collection © 2024

https://redasadki.me/2024/02/13/towards-reimagined-technical-assistance-thinking-beyond-the-current-policy-options/