Bill & Melinda Gates Foundation

Teach to Reach: A Story of Immunization Training

February 16, 2017

In, “Nine Secrets to Inspire Learning,” presented at the Teach to Reach Summit in Barcelona, Matthew Richter shared the importance of telling stories – stories that can engage a person, create perspective, and make a personal connection with the subject being taught. As Matt explained, the most engaging stories have what playwright Kenn Adams refers to as ‘the story spine’: a series of prompts that set the stage for a drama to unfold.

At Teach to Reach—a summit designed to inspire innovation in the way we train and foster continuous learning for immunization staff—facilitator Robin Schofield of Linksbridge built on the theme of the meeting by translating theory into action. Using Adams’ ‘story spine,’ he outlined how the story of the summit and its impact might unfold:

“Once upon a time, people carried out immunization training in a very formulaic way.

Every day, healthcare workers and managers headed to trainings to listen to boring lectures, drink their tea, and collect their per diems.

But one day, a better way to help people learn and subsequently improve their performance came to light. 

Because of that, many committed people gathered together for Teach to Reach, a conference to share new ideas in learning science.

And then, colleagues from national governments, CSOs, multilaterals and other partner organizations began to discuss ways to disrupt the current paradigm and define a new way forward.

Until finally, the community had a shared global framework, clear organizational strategies, and a set of best practices to guide interactive, impactful immunization trainings.

And ever since then, training has been more engaging, more cost-effective, and has contributed to increased routine immunization of the world’s children.”

Why do we care about turning this story into reality?  We care because as a community we are falling short of the goals outlined in the Global Vaccine Action Plan. If we expect to immunize 90% of the world’s children by 2020 and reach the most vulnerable and systemically overlooked, we need to start doing things differently. 

In recognition of the increased volume, price and complexity of new vaccines, we are already investing in the sub-systems that drive national health systems – finance, data, and supply. And that itself is a good story. To realistically meet the challenge of equitably extending vaccine coverage, however, we need to start paying more attention to the people who deliver vaccines.  They include the managers juggling multiple priorities as they plan and budget, the logisticians who help get the right vaccines to in the right place at the right time, and the healthcare workers who make sure each child is recognized and receives the vaccines that he or she needs. These individuals require investment, and not just through a singular training event, but through continuous learning and performance support.

Do we need to invest more as a global community? Maybe. Maybe not. At a minimum, we need to start investing differently. We need to pay more attention to measurement, and we need to employ innovative instructional and delivery methods.

Today, global organizations, development partners, and national governments still spend millions of dollars annually to support trainings utilizing an outdated, didactic ‘cascade style’ model – the same one we have been using since the Expanded Programme on Immunization began in 1974.  Yet, there is no evidence to suggest that this model is working. 

The evidence we do have suggests that one-way, lecture-style trainings have only a minor effect on learning outcomes—at best—compared to more interactive training models. And we rely on output measures like number of trainings held or number of attendees to evaluate the success of our training programs, rather than measuring against learning outcomes.

This brings us back to our story.  The inaugural Teach to Reach Summit, held at the Bill & Melinda Gates Foundation in Seattle in 2015, brought development practitioners together with learning scientists to begin the discussion on the “art of the possible,” thinking through how we could approach training differently. With new research, new tools, and stronger collaboration, we set about to utilize and measure the effectiveness of newer, more adaptive approaches to training and learning. 

A year later in Barcelona, partners met again, this time to think through taking “theory to action.” An integral part of this discussion was centered around Conrad Gottfredson’s discussion of the 70-20-10 rule, whereby 70% of learning happens on the job while performing and meeting the everyday challenges of work, 20% happens on the job working collaboratively with others, and 10% happens in the classroom.  While the percentages may vary depending on context, the idea is the same.  To put theory into action, it is not just about training in a new way – an important first step – but it’s also about providing on-the-job support, mentoring, and opportunities for continued learning in the workplace.

Today, we, the global community, are at the “and because of that…” part of our story. We have the opportunity to shape the future of immunization training and performance improvement, and in turn to improve point-of-service delivery and reach more children with life-saving vaccines.

For more information and resources from both summits, please visit the Teach to Reach website.

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