Implementation science for planetary health

Remarks about implementation science for planetary health by Reda Sadki, Executive Director, The Geneva Learning Foundation at the Centre for Planetary Health’s research corner meeting, London School of Hygiene & Tropical Medicine (LSHTM) on December 17, 2025.

Pauline Paterson (LSHTM): We are really delighted to welcome Reda Sadki. Reda is the Executive Director of the Geneva Learning Foundation, a non-profit research organization developing new epistemological and methodological approaches for complex global health challenges. Welcome, Reda.

Reda Sadki (TGLF): Warm greetings from Geneva, Switzerland. I am very pleased to share with you what we have been learning about climate change and health – in particular, how we can move from ground truth to local action on a global scale.

Since 2021, we have been running an initiative called Teach to Reach, led by community-based health professionals from all over the world. It connects people across countries and job roles, supporting the journey from local insight to global health initiative.

The scale of this network has grown significantly. In March 2021, we started with 2,604 participants. By December 2024, at the eleventh meeting of Teach to Reach, we had 24,610 health workers participating.

Who are they? Most work in health facilities and districts. Half work for government and half for civil society organizations.

Where are they? They serve in the most fragile contexts: 62% work in remote rural areas; 47% with the urban poor; 25% with refugees or internally displaced populations. And one in five work in areas of active armed conflict.

Alongside these individuals, we are nurturing the REACH Network, a coalition of more than 4,000 locally-led organizations. This is the backdrop for how we think about leadership as the key to driving change in climate and health.

The “dark matter” of implementation science

As a community working on climate change and health, we are strong – and getting stronger – on diagnosis. But we must be candid: we are weak on delivery. The science keeps getting better, but there is a gap when it comes to translating science into action.

When it comes to formal research, we see what I call the ”dark matter”, a blind spot around hyperlocal adaptation and how implementation actually happens at the local level.

This dark matter includes environmental, behavioral, and systemic signals that formal research might miss: social and economic disruption, hidden mental health burdens in communities with no formal services, community coping mechanisms, and subtle changes in vector behaviors.

Now, I know that for many of you trained in epidemiology, the word “anecdote” sets off alarm bells. We are taught to devalue it for good reason: it is prone to recall bias, selection bias, and lacks denominators. A nurse in Bangladesh noticing “more heatstroke” is a signal, not a prevalence study. We are not claiming it is.

However, we have two ways to answer the questions these signals raise. We can carry out long-term, rigorous academic studies over decades. Or – given that we are past several climate tipping points – we can recognize that aggregate patterns formed by thousands of these signals offer a speed and granularity that traditional studies cannot match. This functions as a massive, distributed sentinel surveillance system. It may be “imperfect” compared to a controlled trial, but is it riskier than the alternative? The alternative is often waiting years for definitive answers while communities suffer damage that may make those findings moot.

This requires a new epistemology. Our hypothesis is that we can build a system where an anecdote becomes an eyewitness report. A health worker, traditionally seen as a “knowledge recipient” presumed ignorant of climate science, becomes a “knowledge creator”. They know things about local impacts that no one else knows, simply because they are there every day.

In July 2023, Charlotte Mbuh, TGLF’s director who started over a decade ago as a sub-national health worker from Cameroon, stood at COP28 and said:

”What we know, we know because we are here every day. We are already managing the impacts of climate change on health. We are doing the best we can, but we need your support.”

Read Charlotte Mbuh’s full statement at COP28: Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

Turning experience into evidence: the global climate change and health survey

To operationalize this, we built a living laboratory powered by a global human sensor network.

In 2025, in partnership with Grand Challenges Canada and a group of 50 global funders (including Gates, Wellcome, and Rockefeller), we conducted what I have been told is the largest-ever climate and health survey, and the one with the highest level of responses from local communities in the most climate-vulnerable regions

We received responses from 6,436 health workers, primarily from the sub-national level. Because of the trust we have built over years, the Teach to Reach network contributed over 60% of these responses, ensuring we heard from the most climate-vulnerable regions.

https://www.youtube.com/watch?v=C67nYqq-hP0

Most importantly for funders, we asked about barriers to action. The top barriers were not just resource shortages, but structural issues.

Pending their formal publications, I am not yet able to share results.

These findings are signals. They generate hypotheses. Here are three examples of hypotheses grounded in health worker experirences:

• Geh Raphaela Agwa, a midwife from Cameroon, told us: “During this unfavourable weather period, people who can paddle canoes come in and help…”. Could community-led transport solutions improve maternal health access during floods?
• Solace Jewel Morgan, a disease control officer in Ghana, told us: “The dry season… results in dust particles known as harmatan. This leads to a high incidence of respiratory illnesses… encourage… free distribution of personal protective masks.” Could prophylactic mask distribution reduces respiratory morbidity during the harmatan season?
• Victoire Odia, a nurse from the Democratic Republic of Congo (DRC), told us that during extreme weather events, maternity “stays were paid for by the women’s group solidarity fund.” Could micro-financing networks increase facility-based deliveries in climate-vulnerable areas?

Of course, we must distinguish between generating a hypothesis and validating an intervention. We do not claim every local idea is safe or effective immediately. But we do claim that listening is the prerequisite to testing them.

From insight to impact: the Accelerator model for implementation science

We do not just extract data. We give it back to the community to prompt action. Since 2016, we have developed an “Accelerator” system that moves from listening to implementation. It works on a simple rhythm: participants set a specific, practical goal on Monday, and on Friday, they report on what happened, receiving feedback from peers.

This brings us to a critical tension: the balance between context and content. Critics might argue that prioritizing “context over content” carries risks. What if health workers implement unproven or suboptimal strategies? That is a valid concern. However, we see this mechanism not as a way to bypass evidence, but as the most effective tool to operationalize it.

In The Geneva Learning Foundation’s Accelerator, every participant commits to work toward their countries’ goals, and to do so by using the best available global knowledge.

Learn more: What is The Geneva Learning Foundation’s Impact Accelerator?

This actually supports effective adoption and use of global guidelines, which otherwise may linger on shelves.

In fact, we have shown in the past that this mechanism increases adherence to proven protocols (e.g., WHO guidelines on heat stress or malaria control). That is one important reason why it is a powerful implementation science tool. It transforms adherence from a wish expressed in the capital city into a reality in local communities.

Furthermore, if national planners and international experts are willing to listen, they may hear back ways to improve and strengthen the global standards, as well as gain new insights into the “how” of local implementation that defies easy generalization.

When we compared this model to conventional technical assistance or “cascade training,” the results were stark :

These results give us confidence. We are not starting from zero. We are building on prior work in immunization and other areas of work where supporting implementation led to exactly these kinds of validated outcomes.

Here are two examples of local solutions in action.

• Côte d’Ivoire: Communities identified stagnant water as a malaria risk and organized youth-led cleanup committees to clear gutters. This resulted in a drastic, locally measured drop in malaria cases.
• Cameroon: In response to frequent floods, communities voluntarily cleaned gutters to ensure water did not stagnate, directly impacting disease vectors.

No one in the capital city – and certainly no one in Geneva or Seattle – knew about these initiatives.

This leads to our most ambitious projection. If we can grow this network from 80,000 to 1 million health workers by 2030, we estimate we could save 7 million lives through simple, locally resourced projects, at a cost of less than $2 per life.

I acknowledge this is an aggressive claim. It is a “back-of-the-envelope” calculation based on our pilot data. It assumes that local projects remain effective at scale and that we can attribute outcomes to the network. But I ask you: if there is even a glimmer of a chance that this is true – that we can save lives at a fraction of the cost of traditional interventions – isn’t it worth investing in the rigorous research to find out?

Discussion

Do you think MOOCs (Massive Open Online Courses) are dead?

Reda Sadki: MOOCs have become primarily marketing tools for higher education. From a pedagogical perspective, they remain transmissive, expert to learner. I do not see how that model can deliver against complex problems. We need a two-way street. We need new ways to organize the production and circulation of knowledge.

Thank you, Reda. I noticed in your results that food security is a major concern. Have you identified local actions focusing on food, given the challenges of working with healthcare workers who might not see this as their primary remit?

Reda Sadki: That is a critical question. Food insecurity is one of the most worrying consequences we are tracking. We often see a mismatch where local actors tasked with, say, immunization, do not see nutrition as their lane. However, at the community level, the approach is naturally integrated – the health worker knows the vet, who knows the farmers. Those connections exist.

We are currently preparing a major insights report that includes a specific chapter on food security. We are also designing an accelerator specifically around this topic to bring together the right set of partners, because the consequences we are documenting are dire.

You mentioned that 78% of participants eventually said “no thank you” to further support. Ideally, shouldn’t these peer networks become self-sustaining, bypassing Geneva or London entirely?

Reda Sadki: That is the goal. We have shown that more than half of each cohort stays in touch to continue leading local action. However, as long as resources and decision-making power remain concentrated in global centers, we cannot just “flip a switch”. We need to build bridges that facilitate that transformation. The goal is autonomy, but the reality requires us to actively dismantle the dependencies that current funding structures create.

Are there new capabilities that we in academia need to develop urgently to support this?

Reda Sadki: It is about moving away from being the “sage on the stage” to a “guide on the side”. For example, in our recent work, global partners and experts joined Teach to Reach sessions not to present the latest guidelines, but to listen to the challenges local practitioners faced. They then had to figure out how their expertise could be useful in response to those specific needs.

For researchers inside academic institutions, this can be difficult. It requires starting not with a research question, but with a willingness to listen to the needs of local actors and let the research questions emerge from that reality. We know this challenges the incentive structures of academia, but we are open to partnering with researchers willing to work in this emergent, demand-driven way.

It is a fascinating dilemma – we want to be guided by needs, but funding requires pre-set hypotheses. Reda, this has been truly impressive. Thank you for sharing these refreshing perspectives.

Reda Sadki: Thank you. We look forward to exploring how we can collaborate. Best wishes for the holidays and the new year.

References

Images: The Geneva Learning Foundation Collection © 2025

What learning science underpins peer learning for Global Health?

Watch Reda Sadki’s presentation about peer learning for global health at the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH) Symposium on 19 October 2023

https://www.youtube.com/watch?v=Q08dbbzUzzc

Most significant learning that contributes to improved performance takes place outside of formal training.

It occurs through informal and incidental forms of learning between peers.

This is called peer learning or peer-to-peer learning.

Effective use of peer learning requires realizing how much we can learn from each other (peer learning), experiencing the power of defying distance to solve problems together (remote learning), and feeling a growing sense of belonging to a community (social learning), emergent across country borders and health system levels (networked learning).

At the ASTMH annual meeting Symposium organized by Julie Jacobson, two TGLF Alumnae, María Monzón from Argentina and Ruth Allotey from Ghana, will be sharing their analyses and reflections of how they turned peer learning into action, results, and impact.

In his presentation, Reda Sadki, president of The Geneva Learning Foundation (TGLF), will explore:

Join this #TropMed23 Peer Learning symposium on Day 2 of the Annual Meeting of the American Society for Tropical Medicine and Hygiene (ASTMH).

Experience-sharing sessions in the Movement for Immunization Agenda 2030: A novel approach to localize global health collaboration

As immunization programs worldwide struggle to recover from pandemic disruptions, the Movement for Immunization Agenda 2030 (IA2030) offers a novel, practitioner-led approach to accelerate progress towards global vaccination goals.

From March to June 2022, the Geneva Learning Foundation (TGLF) conducted the first Full Learning Cycle (FLC) of the Movement for IA2030, engaging 6,185 health professionals from low- and middle-income countries.

A cornerstone of this programme was a series of 44 experience-sharing sessions held between 7 March and 13 June 2022. These sessions brought together between 20 and 400 practitioners per session to discuss and solve real-world immunization challenges.

IA2030 case study 16, by Charlotte Mbuh and François Gasse, offers valuable insights from these experience-sharing session:

Download the full case study: IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation.

For every challenge shared during the experience sharing sessions, there was always at least one member who had encountered or was encountering the same challenge and had carried out measures to resolve it.

These sessions provided a space to share practical stories that are making a difference – and supported participants in considering their relevance to their own situations.

Experience sharing also helped build confidence and motivation.

Members were able to identify with experiences shared, realizing they were not alone in facing similar challenges.

The sessions covered a wide range of critical immunization topics.

For instance, a participant from Nigeria discussed strategies for reaching zero-dose children in Borno state.

Facing the challenge of reaching approximately 600,000 unvaccinated children, the presenter received practical suggestions from peers, including developing a zero-dose reduction operational plan, leveraging new vaccine introductions, and partnering with the private sector for evening vaccination services.

In another session, a subnational Ministry of Health staff member from Côte d’Ivoire presented challenges related to cross-border immunization campaigns.

Peers shared experiences of organizing cross-border meetings to identify unvaccinated children, synchronize efforts, and involve community representatives in the process.

Such context-specific, experience-based advice exemplifies the unique value of peer learning in addressing complex health system challenges.

The case study of 44 sessions highlights how these sessions fostered multiple types of learning simultaneously.

Participants reported learning from each other’s experiences, experiencing the power of solving problems together across distances, feeling a growing sense of belonging to a community, and connecting across country borders and health system levels.

A district-level Ministry of Health staff member from Ghana encapsulated the impact: “I have linked up with expert vaccinators worldwide through experience sharing and twinning. I have become more competent and knowledgeable in the area of immunization, and work confidently.”

This sentiment was echoed by many participants who found value not only in acquiring new knowledge but also in expanding their professional networks and gaining confidence in their problem-solving abilities.

The case study also reveals the adaptability of the approach in responding to unique contexts.

This resilience underscores the potential of digital platforms to democratize access to expertise and foster global collaboration.

However, the study also identifies areas for improvement.

• Participants expressed a desire for more follow-up support and opportunities to continue their peer learning groups beyond the initial sessions.
• Additionally, the need for better integration of community engagement strategies was identified as a key area for future development.

To contextualize these findings, we can turn to a 2022 study by Watkins et al., which evaluated a prototype of these experience-sharing sessions known as Immunization Training Challenge Hackathons (ITCH), conducted in 2020.

The ITCH methodology, developed by The Geneva Learning Foundation (TGLF), informed the design of the 2022 IA2030 Movement sessions.

Watkins et al. found that the ITCH approach fostered four simultaneous types of learning: peer, remote, social, and networked.

These four types of learning operate simultaneously during ITCH sessions, creating a synergistic effect. 

For instance, a participant might learn a new cold chain management technique (peer learning) from a colleague in another country (remote learning), feel supported by the global community in implementing this new technique (social learning), and then share their adaptation of this technique with others across various levels of the health system (networked learning).

From an epidemiological perspective, this approach to learning could be compared to how we understand disease transmission and intervention effectiveness.

Just as multiple factors contribute to disease spread and control, these multiple learning types contribute to knowledge dissemination and capacity building in the immunization field.

The value of this approach lies in its potential to rapidly disseminate practical, context-specific knowledge and solutions across a global network of immunization professionals.

This can lead to faster adoption of best practices, more innovative problem-solving, and ultimately, improvements in immunization program performance that could contribute to better disease control outcomes.

While this approach may seem unconventional compared to traditional training methods in the immunization field, the evidence presented by Watkins et al. suggests that it can be a powerful complement to existing capacity-building efforts, particularly in resource-constrained settings where access to formal training opportunities may be limited.

This multifaceted approach allowed participants to not only acquire new knowledge but also to expand their professional networks and gain confidence in their problem-solving abilities—findings that align closely with the outcomes observed in the 2022 IA2030 Movement sessions.

The Watkins study emphasized the importance of building confidence and motivation through peer learning experiences, a theme strongly echoed in the Mbuh case study.

Furthermore, Watkins et al. highlighted the potential of this approach to create a “space of possibility” for innovation and problem-solving, which is evident in the diverse and creative solutions shared during the 2022 sessions.

Both studies underscore the significance of peer-led, digital learning experiences in accelerating progress towards global health goals.

By fostering peer learning and digital collaboration, these approaches empower health workers to turn global strategies into effective local action.

References

Mbuh, C., Gasse, F., Jones, I., Sadki, R., Brooks, A., Zha, M., Steed, I., Sequeira, J., Churchill, S., Kovanovic, V., 2022. IA2030 Case study 16. Continuum from knowledge to performance. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.7014392

Watkins, K.E., Sandmann, L.R., Dailey, C.A., Li, B., Yang, S.-E., Galen, R.S., Sadki, R., 2022. Accelerating problem-solving capacities of sub-national public health professionals: an evaluation of a digital immunization training intervention. BMC Health Serv Res 22, 736. https://doi.org/10.1186/s12913-022-08138-4

Image: The Geneva Learning Foundation Collection © 2024

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#CharlotteMbuh #continuousLearning #FrançoisGasse #FullLearningCycle #IA2030 #IA2030CaseStudies #ImmunizationAgenda2030 #ITCH #KarenEWatkins #learningCulture #MovementForImmunizationAgenda2030 #networkedLearning #peerLearning #remoteLearning #TheGenevaLearningFoundation

Climate change and health: perspectives from developing countries

Today, the Geneva Learning Foundation’s Charlotte Mbuh delivered a scientific presentation titled “On the frontline of climate change and health: A health worker eyewitness report” at the University of Hamburg’s Online Expert Seminar on Climate Change and Health: Perspectives from Developing Countries.

https://www.youtube.com/watch?v=7cR-mFCj2xk

Mbuh shared insights from a report based on observations from frontline health workers on the impact of climate change on health in their communities.

Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline

Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

The Geneva Learning Foundation, a Swiss non-profit, facilitated a special event “From community to planet: Health professionals on the frontlines of climate change” on 28 July 2023, engaging 4,700 health practitioners from 68 countries who shared 1,260 observations.

“93% of respondents believed that there was a link between climate change and health, and they reported a direct local experience of a wide range of climatic and environmental impacts,” Mbuh stated.

The most commonly reported impacts were on farming and farmland, the distribution of disease-carrying insects, and urban areas becoming hotter.

Health impacts linked to these climatic and environmental changes included increased malnutrition and/or undernutrition, increased waterborne diseases, and changes to the incidence and distribution of vector-borne diseases.

Mbuh emphasized that these impacts were particularly prevalent in smaller communities or mid-sized towns.

Mbuh highlighted the unique role of frontline health workers as trusted advisors to their communities: “Frontline health workers are trusted advisors of the communities that they serve, and they have unique insights to local realities and are strategically positioned to bring about change,” she said.

The Geneva Learning Foundation aims to leverage its digitally-enabled peer learning network of health workers to drive change across different levels of the health system and geographical boundaries.

Mbuh concluded : “These experiences demonstrate the importance of community engagement, sustainable practices, and support from relevant stakeholders in addressing the climate health nexus and building resilience in the face of a changing climate.”

The presentation underscored the urgent need to invest in frontline health workers at the local level to build resilience against the impacts of climate change on health, particularly in vulnerable communities in developing countries.

The event was organized by the International Expert Centre of Climate Change and Health (IECCCH) at the Research and Transfer Centre Sustainable Development and Climate Change Management, Hamburg University of Applied Sciences, in collaboration with the European School of Sustainability Science and Research (ESSSR), the UK Consortium on Sustainability Research (UK-CSR), and the Inter-University Sustainable Development Research Programme (IUSDRP).

Photo: The Geneva Learning Foundation Collection © 2024

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#CharlotteMbuh #climateChange #developingCountries #ExpertCentreOfClimateChangeAndHealth #globalHealth #HamburgUniversityOfAppliedSciences #health

Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

The Geneva Learning Foundation’s Charlotte Mbuh spoke today at the COP28 Health Pavilion in Dubai, United Arab Emirates (UAE). Watch the speech at COP28…

https://www.youtube.com/watch?v=gMTMaMBOq-E

Good afternoon. I am Charlotte Mbuh. I have worked for the health of children and families in Cameroon for over 15 years.

I am one of more than 5,500 health workers from 68 countries who have connected to share our observations of how climate is affecting the health of those we serve. 

“Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow so that you can easily walk through a river you required a boat to cross in years past.”

These are the words of Samuel Chukwuemeka Obasi, a health worker from Nigeria.

Dr Kumbha Gopi, a health worker from India said: “The use of motor vehicles has led to an increase in air pollution and we see respiratory problems and skin diseases”.

Climate change is hurting the health of those we serve. And it is getting worse.

Few here would deny that health workers are an essential voice to listen to in order to understand climate impacts on health.

Yet, a man named Jacob on social media snapped: “Since when are health workers the authority on air pollution?”

Here are the words of Bie Lilian Mbando, a health worker from my country: “Where I live in Buea, the flood from Mount Cameroon took away all belongings of people in my neighborhood and killed a secondary school student who was playing football with his friends.”

Climate change is killing communities.

Cecilia Nabwirwa, a nurse in Nairobi, Kenya: “I remember my grand-son getting sick after eating vegetables grown along areas flooded by sewage. Since then I resolved to growing my own vegetables to ensure healthy eating.”

And yet, another man on social media, Robert, found this “ridiculous. As if my friend who sells fish at his fish stall comes as an expert on water quality.”

I wondered: why such brutal responses?

Well, unlike scientists or global agencies, we cannot be dismissed as “experts from on-high”.

What we know, we know because we are here every day.

We are part of the community.

And we know that climate change is a threat to the health of the communities we serve.

We are already having to manage the impacts of climate change on health.

We are doing the best that we can.

But we need your support.

The global community is investing in building a new scientific field around climate and health.

Massive investments are also being made in policy.

Are we making a commensurate investment in people and communities?

That should mean investing in health workers.

What will happen if this investment is neglected?

What if big global donors say: “it’s important, but it’s not part of our strategy?”

Well, in 5, 10, or 15 years, we will certainly have much improved science and, hopefully, policy.

Yet, some communities might reject better science and policy.

Will the global community then wonder: “Why don’t they know what’s good for them?” 

I am an immunization worker. For over 15 years, I have worked for my country’s ministry of health.

Like my colleagues from all over the world, I know more than a little about what it takes to establish and maintain trust.

Trust in vaccination, trust in public health.

Trust that by standing together in the face of critical threats to our societies, we all stand to do better.

Local communities in the poorest countries are already bearing the brunt of climate change effects on health.

Local solutions are needed.

Health workers are trusted advisors to the communities we serve.

With every challenge, there is an opportunity.

On 28 July 2023, 4,700 health workers began learning from each other through the Geneva Learning Foundation’s platform, community, and network.

Thousands more are connecting with each other, because they choose to.

And because they want to take action.

It is our duty to support them.

In March 2024, we will hold the tenth Teach to Reach conference.

The last edition reached over 17,000 health workers from more than 80 countries.

This time, our focus will be on climate and health.

We invite global partners to join, to listen and to learn.

We invite you to consider how you, your organization, your government might support action by health workers on the frontline.

Because we will rise.

As health workers, with or without your support, we will continue to stand up with courage, compassion and commitment, working to lift up our communities.

Our perseverance calls us all to press forward towards climate justice and health equity.

I wish to challenge us, as a global community, to rise together, so that  the voices of those on the frontline of climate change will be at the next Conference of Parties.

By standing together, we all stand to do better.

Thank you.

#CharlotteMbuh #climate #climateCrisis #COP28 #Dubai #health #healthWorkforce #HRH