By Kranthi Vysyaraju

In November 2021, I got the unique opportunity to facilitate a week-long Face to Face (F2F) training of the Emerging Voices for Global Health (EV4GH) 2020 program at the Mohammed bin Rashid School of Government (MBRSG), Dubai. I was attending the program as a substitute facilitator for my colleague, Dr. Tanya Seshadri – a longtime member of the EV4GH family. I cannot describe my excitement and nervousness to meet the ‘Emerging Voices’ (EVs) as I recognize some EVs from different phases of my own professional journey, and their positive influence on health policy and systems research, visibility and voice in their communities, and importantly their nature to ‘uplift’ and mentor others and build capacity. This post is based on personal observations and casual conversations with the EV2020 cohort and facilitators. It aims to highlight the value of such programs, especially in these pandemic times.

Preparing for the face-to-face EV4GH program

The EV4GH program is a blended training program mainly directed towards young and emerging researchers and activists from low- and middle-income countries. The skill- building program focuses on knowledge translation, networking and health policy and systems research (HPSR).

Under normal circumstances, EVs go through a virtual training phase followed by the 10–14-day F2F training which then typically culminates in a wrap-event where they showcase their posters and presentations, just ahead of a (pre-determined) global conference like the HSG (i.e., the ‘real deal’). The EV4GH program is usually linked with a major conference (usually the Health Systems Global Symposium usually, as a thematic working group of the HSG).

This year, the EV2020 was a unique “pandemic cohort” – with uncertainties and challenges of trying to bring together 30 people from all over the world during the COVID-19 pandemic –and the first cohort to be trained under a new secretariat and new governance board, and of course, EV2020 marked the 10-year anniversary of EV4GH!

Unlike previous editions though, this edition of the F2F program was put together at short notice. Much like the Dubai Expo 2020, the EV2020 also really took place in 2021. Facilitators tried to put together a comprehensive blended (virtual and in-person) program in a tightly packed 6-day schedule set from 8:30 am to 4pm with breaks for coffee, lunch and prayer. The typical flow of linking the EV F2F with the symposium as described above had to be altered since the ‘virtual stage’ of EV2020 took place in early autumn 2020 before the equally virtual HSG symposium, followed by the F2F in November 2021. The changed program and putting it together presented a few challenges for EVs and facilitators, and lessons from these would serve us well, especially while preparing for in-person meetings during these uncertain times.

Considering the long gap between virtual and F2F phases, it’s only fair that the ideas and interests for presentations evolved for a significant number of participants since the beginning of the program. One of our biggest challenges as facilitators was to try and fit in all that a longer F2F has into this shorter 6-day edition! The 6-day edition aimed to capture the key skills-building components of the F2F, yet the shortage of time didn’t allow us to make space for the post-work hours coaching and support that facilitators usually offer EVs on their work and presentation. This meant the EVs had to be quick on their feet and adapt to the circumstances.

A program outline is a baseline document that describes the overarching purpose of the program and its learning outcomes (static components based on vision and mission), guiding integration, continuity and flow of learning activities (more dynamic components). As always, it is essential for all members of the program including coordinators and EVs to have access to this anchoring instrument to envision the learning in the beginning planning stages, during the actual program as well as a reflecting tool at the end of the program. Deliberate attention and frequent reference to this existing document can better help to prepare for the intricacies of the program.

Mode of delivery and technology

‘Zoom fatigue’ and ‘Death by PowerPoint’ have spread on par with COVID-19 and everything should be done to prevent them in a F2F session, maximizing the time spent for in-person discussions and activities.

Since various speakers and resource persons (including 2 EV2020s who were joining us online from Australia) were from diverse time zones, the agenda on each day varied to accommodate both virtual and physical sessions. While this was not a major problem; a suggestion for the future is to have more active sessions that require talking, walking and working in groups (e.g. role plays) in the afternoon when many people tend to go into ‘snooze’ mode, and having more “one-way” sessions (with EVs mainly in listening mode) for earlier during the day when people are usually more alert.

The biggest learning moment for the program coordinators was on managing technological challenges for the final webinar which had about 20 presentations of about 15 minutes each to be delivered in a little over two hours. To replicate a real-life conference, Zoom breakout rooms were set up for the virtual experience. However, a glitch in setting up Zoom breakout rooms led to chaos at the last minute. While this was immediately resolved, it sure did raise the anxiety levels of facilitators and presenters. Oh! Well… what is a conference without technological glitches, lost luggage and travel delays. Further support needs to be identified and extended to EVs that need to develop digital skills (e.g. in data presentation) by connecting them to other EVs within or across cohorts – this can be done through deliberately setting some time aside in the agenda for such activities, and I will never underestimate the effort and skill in coordinating virtual meetings anymore!

EVs engaged in multiple activities alongside preparing their posters and presentations for the final webinar. These included “Big Talks” – presentations and panel discussions by seasoned public health professionals on ‘governance’, ‘economic forces in health’, ‘corruption’, ’climate resilient and sustainable health systems’, ‘activism’, ‘fragile health systems’ and skill building sessions on ‘social media’, ‘stakeholder engagement’, ‘elevator pitch’, ‘thinking intersectionality.’ What stood out for me was the pedagogy. Collaborative and participatory activities/tools such as role play, privilege walk, and fishbowl discussions worked really well, and should be further leveraged.

The richness of the EV4GH program is its diversity, networking, feedback and discussion. Only about half of the EVs were able to attend the F2F session, and the virtual format especially during the final webinar, being on a Saturday meant a smaller audience. Further, ‘art-based approaches’ including music, poetry, animation etc. need to be explored for better inclusivity of both EVs and audience. The EV4GH program has historically been largely in English, and special efforts are being made hereon to include participants from non-anglophone countries.

Building upon opportunities

The EV program also aims to include field trips – for exposure to the local health system, and also leisure. In Dubai, a visit to the International Humanitarian City was organized. The visit was insightful and led to reflective and eye-opening discussions of judicious usage of humanitarian aid, limited human resources to run the center, etc.). Given the pandemic situation, there were limited options of further exploring the host country’s health systems. Future cohorts should leverage this usually unique opportunity to visit and further experience local health systems of host countries.

The time for EVs to discuss the ongoing COVID-19 pandemic was limited. But then there is never enough time to fit in all discussions! The fishbowl session (a new activity for most) generated important insights in a nutshell highlighting similarities and differences across country contexts including access to healthcare, health financing, ethics, etc. The disconnect between evidence and policy making and the iterative processes involved could have been further explored via formats such as debates so that the EV voices could have been more pronounced. Given this is a unique opportunity where EVs are physically present together, maximizing the time to efficiently work together and freely express their voices and opinions in the time available while minimizing distractions will have to be a priority for coordinators. Deliberate attention to seating arrangements, breaks for stretches and water breaks need to be incorporated in the planning of sessions. A template developed by one of the facilitators gave attention to such details which encouraged all facilitators to think through details of their session and the plan flow for each day.

Building bonds

The ‘pandemic cohort’ charged through the uncertainties of travel restrictions (including a civil war in Ethiopia, and COVID-19 Delta and Omicron variant induced travel bans), multiple-swabs up their noses, making it to Dubai and back home. The duration of the F2F training session seemed too short (shortened from 10 days in 2010 to 6 days in 2021) and the facilitators struggled to provide the desired time to give feedback and further support those who needed it.

The experience of EV4GH is beyond professional; an equal amount of learning happened off hours while dining, walking to and back from the venue, while exploring Dubai, etc. Facilitators and EVs immediately formed tight bonds in the limited time together as is the nature of the program, paving way for life-long friendships and collaborations across borders and cultures. Many EVs met people from different countries for the first time, leading to awareness and getting over preconceived notions of other countries from the media. Among other feedback on the last day, what stood out is how transformed many of them felt to see that ‘other’ people are more similar to themselves than they had imagined, as they tried WhatsApp calls/ Google Meet/ Zoom to reach their loved ones back home (among other ‘important’ agenda items like strengthening health systems). A community feeling quickly bloomed within and across cohorts – it is said that sharing meals brings people and cultures together and with the limited time together, this time was invaluable where discussions at the dining table ranged from how each one faced the nervousness to travel in these uncertain pandemic times leaving their family/ young ones behind, to what ideas can be adapted across countries to strengthen health systems.

Lingering questions

This edition also marked 10 years of EV4GH. It was held at a time when we are reflecting on the program and taking it forward. It has led to questions on the EV “identity”; What do EVs want to achieve with their voice? What is the responsibility? What are the pros and cons of having a voice? What is the reach of the EV network?’ Some of these questions have been tackled in the external evaluation from last year and remain a work in progress for the EV governance team and new secretariat.

I feel honored to have had the opportunity to be a part of the program as a facilitator, and am grateful for the friends I made, and most importantly finding my own purpose in capacity building.

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Kranthi Vysyaraju is a Program Coordinator in the Institute of Public Health, Bengaluru. She has been part of capacity building programs such as the India HPSR Fellowships Programme. She holds a Masters degree in Molecular Microbiology and Immunology from Johns Hopkins Bloomberg School of Public Health and in Biotechnology from Manipal University. She is interested in leveraging >10 years of basic science and clinical research experience towards capacity building for public health and primary care.