Translating Implementation Experiences and Lessons Learned From Polio Eradication Into a Global Health Course: Insights From an International Consortium

The knowledge amassed in the process of implementing a global health initiative can enhance frameworks for prevention, care, and treatment for a broader range of health conditions. Lessons learned from one program can profoundly shape the response to the challenges faced in other programs. For example, lessons learned from the HIV/AIDS epidemic have been leveraged to address noncommunicable diseases and Ebola-related stigma. However, widespread uptake of key public health lessons (both positive and negative) does not occur passively; the knowledge gained from one initiative will not automatically transfer to another without active strategies. Public health practitioners tend to produce narratives that validate their work, but more complex accounts that integrate an understanding of

The STRIPE consortium (8 institutions across Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, and the United States) undertook a collaborative process to develop an international course translating polio eradication lessons into broader global health implementation science education. Team development: At an initial meeting (April 2019), researchers completed a survey to indicate topical expertise and interest. Based on survey results, cross-country “teaching teams” were formed for each knowledge domain, ensuring gender and geographic representation. Each team had a Johns Hopkins University (JHU) facilitator experienced in the learning domain and curriculum development. Regional meetings: Three in-person regional meetings supported curriculum development. Dhaka, Bangladesh (June 2019) aligned with a global implementation science conference; teams refined course design, outputs, timelines, lecture outlines, and brainstormed case studies. Ibadan, Nigeria (early August 2019) focused on feedback on draft lectures and a pilot case study, with revisions and new deadlines set. Yogyakarta, Indonesia (late August 2019) addressed case-based learning approaches and peer review of lecture drafts, revisions, and data gaps; attendees included partners from Afghanistan, Bangladesh, India, Indonesia, and the United States. Validation: By September 2019, teams finalized lecture materials, teaching notes, and case studies for review by a Technical Advisory Committee (TAC) comprising global polio partners (WHO, UNICEF, Gates Foundation, CDC, Rotary), faculty, and Ministry of Health and NGO representatives from diverse income settings. TAC provided feedback on lessons emphasized, framing for diverse audiences, and reviewed materials in their areas of expertise. Training of trainers and production: A final meeting in Baltimore (March 2020) included collaborators from Afghanistan, Bangladesh, DRC, Ethiopia, Nigeria, and the United States; Indian partners joined remotely. The group finalized course structure, assignments, teaching strategies, and recorded lectures and discussions for MOOCs with the support of JHU’s Center for Teaching and Learning (CTL). CTL and JHU standardized and packaged all materials (slides, recordings, case studies) for online distribution and in-country in-person delivery. Curriculum design: For each topic area, two lectures were created: a basic lecture introducing key concepts using polio examples for learners with limited background, and an advanced lecture exploring complex, transferable lessons with opportunities for reflection and application to other programs. All lectures were aligned with implementation science core competencies. Open-access readings accompanied MOOCs; broader readings accompanied in-person courses. Case studies for each topic allowed deeper exploration of implementation challenges from multiple perspectives (global policymakers to frontline workers). Three MOOCs covered planning/management and equity; alliances and engagement; and data for decision-making and outbreak response, each mapped to implementation research competencies. Collaborative learning integration: In-person meetings facilitated rich exchanges on governance, policy engagement, corruption, aid dynamics, community opposition, and operating in contexts of violence. Short video discussions capturing these dialogues were integrated into MOOCs and made available for classroom use. Project coordination: The collaboration addressed logistical hurdles (time zones, connectivity, scheduling, COVID-19 disruptions). Hierarchies across and within countries and within the subcontracting structure (JHU-centered management) influenced workflow and required active mitigation. Standardization across diverse teaching styles and materials required substantial editorial and design support.

- International, cross-context collaborations are effective for developing educational materials, yielding diverse information, perspectives, and context, and fostering local and global ownership and uptake. - Such collaborations pose challenges in curriculum design, content development, team coordination, and cohesion; in-person meetings and early recognition and planning for institutional and inter-country hierarchies can mitigate challenges and enhance team strengths. - Designing adaptable curricula (basic and advanced tracks) aligned with implementation science competencies enables relevance across diverse learner backgrounds and contexts. - Technical and logistical supports (e.g., instructional design infrastructure) help standardize and package materials for both MOOCs and in-person delivery.

The collaborative, multi-country approach directly addressed the goal of translating polio eradication implementation lessons into broadly applicable global health education. Diverse team composition enriched course content with multiple perspectives and contextual nuances, increasing relevance across LMIC settings and beyond. The two-tiered lecture design and integration of implementation science competencies made the curriculum adaptable to varying learner backgrounds. In-person regional meetings were crucial in building rapport, aligning expectations, and resolving differences in pedagogy and content, thereby overcoming limitations of remote coordination. However, hierarchical dynamics within and between institutions, subcontracting structures, and uneven availability of personnel time affected workflow and required explicit management strategies. Access to robust instructional design resources facilitated quality and coherence but also underscored North-South power asymmetries when centralized at a high-income institution. Overall, the findings support that intentional design, early planning for hierarchies, equitable workload distribution, and dedicated in-person engagement are key to successful international curriculum co-development.

International collaborations to develop educational materials provide substantial benefits by incorporating diverse experiences and contexts, which is especially valuable in implementation science. Maintaining cohesion across teams and contexts requires in-person meetings and proactive planning for hierarchical dynamics within countries and across consortium members, potentially necessitating adjustments in expectations and workload distribution. The collaboration produced rich course materials and catalyzed new cross-continental partnerships likely to inform future work. Future efforts should anticipate hierarchies, ensure adequate staffing to execute senior faculty insights, and invest in relationship-building and in-person engagement to enhance cohesion and depth.

- Most consortium members held academic positions and were not full-time polio program staff, potentially limiting familiarity with day-to-day operational details; practitioner input via the TAC helped address this gap. - Logistical constraints included time zone differences, poor internet connectivity, and the onset of COVID-19, complicating scheduling, remote participation, and cohesiveness. - Hierarchical structures within countries (senior-junior dynamics) and between institutions (primary vs. subawardee, JHU-centered management) affected decision-making, content production responsibilities, and cross-country teamwork. - Variability in teaching styles and experience with case-based methods complicated standardization; achieving cohesion required significant editorial and design effort. - Limited availability of personnel with time for content production (vs. idea generation) created bottlenecks; additional staffing would have facilitated execution of revisions and content development.