Global organizations, development partners, and national governments spend millions of dollars annually to support health care worker trainings around the world, utilizing an outdated, didactic, ‘cascading’ model in which small groups are trained on a topic, train other small groups, and so on until information is cascaded to all levels. The evidence suggests that these one-way, lecture-style trainings have only a minor effect on improving learning outcomes compared with more interactive training approaches. It is difficult to maintain training quality and integrity throughout each level of the cascade and limits innovation by reinforcing entrenched attitudes and approaches (e.g., ‘this is just the way it is done’). Under this model, determining whether a training was ‘successful’ often involves simply measuring outputs such as the number of trainings held or the number of people in attendance. This does not sufficiently measure, of course, whether training resulted in demonstrable knowledge and skill acquisition and performance improvement.
Since 2016, Linksbridge has helped to address some of these challenges through Teach to Reach (T2R), an initiative sponsored and led by the Bill & Melinda Gates Foundation to transform immunization worker training by incorporating learning science principles on how people actually think and learn. Teach to Reach has organized global summits to bring together country-level, regional, global, and implementing partners to develop actionable solutions to real-world challenges in immunization training, along with subject matter experts from fields like instructional design, behavior change, and curriculum development.
At the 2018 summit in Dar es Salaam, the working group for India decided to focus on improving service delivery by building the capacity of the frontline health workers (FLWs) responsible for administering the immunization program. The Bill & Melinda Gates Foundation’s Impatient Optimists blog recently featured Teach to Reach and the India working group’s progress following the summit.