Bill & Melinda Gates Foundation

Teach to Reach: Moving from theory to implementation and taking action in India

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October 08, 2018

The third global Teach to Reach Summit, “Innovative Methods for Immunization Training,”  was held on May 1-3, 2018 in Dar es Salaam, Tanzania. In many ways, the scene of this year's Teach to Reach was familiar.   As in years past, there was energy buzzing among participants eager to think out-of-the-box about ways to build workforce capacity; there was willingness to roll up sleeves and explore new ideas with subject matter experts from fields like instructional design, behavior change, and curriculum development; and there was enthusiasm to share experiences and learn from one another.

However, one thing was very different: the structure of the summit.  This year, attendees were invited to participate in a design-thinking workshop constructed to support them to move from the theoretical to the practical, and create action plans for performance improvement strategies unique to their contexts.  Some may shudder at the thought of a conference designed with a ratio of one part plenary session to two parts working group time.  However, this workshop took participants through a process to define the challenge they were seeking to address, brainstorm possible solutions, and define an action plan for implementing their solution in a way that was anything but boring.

“Hot Seat” was one of the most engaging sessions of the workshop. Participants pitched their solution ideas to one another and  received feedback from a diverse group of people with varying backgrounds – subject matter experts, representatives from ministries of health, implementing partners, and funders.  The summit was an opportunity for key stakeholders to problem-solve together, and for participants to share perspectives from different contexts and countries. And by the end of the workshop, each working group developed practical next steps for implementing their action plans, and pledged their commitment to working together in a new way.  

Kathleen Goodman – Deputy Director of Strategy and Innovation for Vaccine Delivery at the Bill & Melinda Gates Foundation – opened by comparing the learning journey of Teach to Reach participants to the journey an explorer might take in preparing to climb a mountain.  Before taking your first step on a climb, there are many things you do to prepare – you learn best practices, get equipment, and train for the big task ahead.  With the previous Teach to Reach summits, we laid the groundwork for our climb and at the 2018 summit, we planned our route.  With action plans in hand, groups returned home to set out on their journeys and put it all into practice.

Dr. MK Agarwal of the Ministry of Health & Family Welfare in India did just that.  At the summit he led the working group in its collaboration with peers and subject matter experts to develop a plan, which they then brought back to Delhi to put into action.

With the ultimate goal of improving immunization coverage, the India working group focused on improving service delivery by building the capacity of frontline health workers (FLWs) who are responsible for administering the immunization program.  To do this, they proposed increasing access to on-the-job training opportunities through a new mentorship program, having learned that more learning happens on the job and with peers than in a formal classroom setting.  Dr. Agarwal and his team designed this comprehensive mentorship program for FLWs within the framework of supportive supervision, leveraging an opportunity for capacity building that currently exists within the immunization system.

Like experienced mountaineers gathering information on their climb and studying their route, the India working group followed a systematic approach to developing the key outputs they hope to achieve with the program, including conducting an in-depth situation assessment, developing a theory of change, and designing a framework for the mentorship program.  The route to improved FLW capacity that they charted goes like this: