8 Strategic Opportunities for Gavi

Specific initiatives have been mapped and assessed against criteria of scalability, agility to adapt to rapid developments, potential for measurable impact, and country ownership and sustainability. The results of this exercise are provided in Annex 4

WHO provided a useful summary of the big picture outlook, specifically on digital education for health workers, which is reproduced below:59

In taking forward support for strategies which accelerate health provider competency development and performance, Gavi should consider its unique role in supporting solutions to achieve scale and gain traction at country level and globally. The following actions are suggested:

1. Join forces with other multilateral organisations such as WHO, UNICEF, the World Bank and The Global Fund using their platforms to support improved global and in-country coordination of frontline health worker interventions. This could include: o Advocating for more internationally recognised, nationally accredited, usercentric learning experiences including via the WHO Academy in collaboration with local ministries, professional councils and associations; o Investing in courses for vaccination managers and further language translations of successful courses; o Supporting ministries of health in fragile settings establish databases for health provider training to avoid duplication; o Running coordinated live simulation exercises with in-country partners e.g. for pandemic preparedness / vaccine roll out

2. In relation to digital learning and performance solutions, build on what exists and invest in further language translations, local adaptation and contextualisation, supporting interoperability and sustainable funding mechanisms for existing proven technological solutions; in particular, o Using blended, multi-faceted approaches rather than a single approach – opting for integrated digital solutions which address competency building, performance feedback, and accountability measures such as digital vaccination tracking; o Supporting initiatives such as Digital Classroom which can rapidly update, translate and roll out materials o Encouraging more partnerships between platforms such as CommCare and Community Health Toolkit in support of interoperability.

3. Ensure rollout of solutions for provider education / performance is country driven and aligned with wider support (through HSS grants) to address health workforce and other health systems constraints. This might include: o Providing technical assistance to countries to address staff turnover by developing career ladders for frontline health workers, with performance reward and recognition strategies, and investment cases for approaches to reduce wasteful turnover; o Ensuring in-service training strategies have MoH buy-in and there is a clear link to career development; investment in a network of local partners for sustainability; o Fostering greater links with pre-service training institutions, and providing technical support to digitise elements of pre-service curricula; o Consolidating and leveraging more value from existing platforms within countries, for greater economies of scale and to build familiarity with common platforms

4. Ensure that all innovative/digital investments are aligned to the country digital health plan if one exists, digital development principles and country cMYPs and ensuring investments are aligned with and communicated to other development partners o Encourage co-financing from country government for implementation of digital technologies, and build up capacities of local Digitech companies through northsouth business partnerships

5. Channel support to district level capacity building for quality improvement initiatives This could include: o Identifying lagging behind districts and agreeing collaborative quality improvement initiatives - identification of the problem, root cause analysis, action planning, agreement on focused indicators, data collection and rapid feedback cycles; o Deploying a cadre of technically savvy graduates to be embedded within district teams to support digital elements within above initiatives, particularly troubleshooting use of digital data systems and producing data visualisations; o Building capacity of governments for in-house data analytics and use of data; o Supporting district-level management training, to build exposure to less hierarchical, problem-solving / coaching approaches.

6. Seek to measure impact in relation to the original problem that is being addressed using better, fewer, metrics that reflect quality of service delivery. This might include: o Ensuring regular monitoring of a limited number of indicators, rapid feedback cycles and two-way data flow that allows adaptation, layering and continual improvement of interventions; o Using mobile phone surveys for collecting rapid feedback from health service users on quality of care, missed opportunities for integrated care etc.

7. Ensure better alignment of funding and incentives and consider innovative payment for performance mechanisms to replace training per diems, based on empirical evidence of service improvement.

8. Allow disruptive bottom up strategies that challenge traditional power dynamics, but explore the feasibility of pushing similar models down to lower tiers where non-

English/French speaking participants can engage in their own language. This might include: o Exploring learning laboratory approaches to distil and continually refine such approaches; o Considering a financial mechanism to support “bottom-up” action plans developed through this route via HSS grants, for example micro grants which alumni of such networks could apply for (with involvement of district health teams) for small scale collaborative quality improvement initiatives.