The Geneva Learning Foundation runs peer learning for the people who deliver health care where it is hardest to deliver. Its courses ask participants not for opinions but for situations they lived through, with a place, a date, and numbers, then have colleagues read and reply. Teach to Reach is the Foundation’s bilingual network event, and its sixteenth edition, on 6 August 2026, brought participants from more than 50 countries into a livestream from Geneva, Switzerland and Ebolowa, Cameroon, to hear findings from the first peer learning course in TGLF’s Malaria: Turning the tide programme. This opens a series of five articles.
The parents were sent to buy the medicine.
That is the sentence at the centre of this story, and it is not a metaphor.
A child arrived at a health facility in the Republic of Guinea, sick enough that the clinicians knew what he needed.
They wrote the prescription.
Then they told his mother and father to go and buy it at a pharmacy, because the facility did not have it.
Thierno Abdoulaye Baldé recorded what happened next in nineteen words.
“Before they could return with it, the child got rapidly worse and died.”
Baldé is a senior technical adviser at national level in Guinea.
He wrote that sentence in early 2026, in the peer learning course called Malaria: turning the tide, where health workers were asked not for their opinions but for a situation they had lived through, with a place, a date, and numbers.
258 health professionals wrote 1,534 such accounts in the French-language version of the course.
(The numbers were smaller, but the stories just as significant, for the English-language version.)
Baldé’s is one line in a hundred-slide synthesis.
It carries a footnote.
The footnote says: this was his nephew.
Injectable artesunate was not available.
What makes the difference between the child who lives and the child who dies?
Baldé wrote something else in the same course, and reading the two together is the way to understand what he was doing.
His other account is procedural, almost clinical in its calm.
“Mamadou Bhoye Diallo, 7 years old, from Koula village, Diari sub-prefecture, Labé prefecture, Republic of Guinea, comes to the community health worker with his mother. He has fever, 38 degrees Celsius, no appetite, and feels weak. The community health worker listens carefully and does a rapid test.”
Nothing dramatic happens.
A boy with a name and an address meets a community health worker who listens and then tests.
That is the chain functioning exactly as designed, written down by a man at national level who had every professional reason to describe systems rather than children, and who instead gave the village, the sub-prefecture, and the temperature.
Set that beside the nephew, and the shape of Baldé’s contribution becomes clear.
He submitted the system working and the system killing, from the same country, in the same voice.
In the synthesis prepared for the cohort, the finding attached to his second account reads: “You can follow one person over time. The supervisor who carefully checks hospital numbers tells elsewhere what led him to start.”
He checks the numbers because of the pharmacy run.
He wrote both down so that strangers in 24 countries would know why.
A pattern rather than a tragedy: why learning from each other matters
The reason the pharmacy run is a pattern rather than a tragedy is the cohort’s first finding, and it rearranges the problem it describes.
In 217 of 258 stories, or 84 percent, the family had already seen one or more other health providers before reaching a health centre.
A street seller.
A private pharmacy.
A traditional healer.
A health hut.
The synthesis refuses the obvious framing.
“This is not unusual. This is how the care journey really begins.”
Rodriguez Madokoun, a health worker at operational level in Benin, gave the journey its distance.
“What struck me right away was that he did not come straight from his village,” he wrote.
“He came after a journey with three stops that took nearly a week. The mother told me that on the first day of fever, she went to a small private pharmacy in the village of Zè. The seller gave her a pack of paracetamol and two over-the-counter malaria pills without doing any test.”
Nearly a week.
Three stops.
Paracetamol and two pills, no test.
By the time this child became a data point in a district health information system, the disease had been running for days and had been treated three times by people who do not appear in any organogram.
Read the two findings against each other and Baldé’s nephew stops being an anomaly.
If four families in five pass through unofficial care before arriving, then the moment of arrival is late by design, and the stock of injectable artesunate needs to be sitting on the shelf at the exact moment a child arrives already deteriorating.
Guinea’s chain broke at the last link.
The 84 percent explains why that last link was carrying so much weight.
The street seller is not the enemy: how we work for health, together
What the cohort did with this finding is the part that should interest anyone who designs malaria programmes, because it is not what programmes usually do.
142 participants, 47 percent, described going to talk to the seller.
Face to face.
A pharmacy, a medicine depot, a traditional healer.
Not an inspection.
A conversation.
Tarcisse Kilara Kapene, a doctor at district level in the Democratic Republic of the Congo, quoted what the informal pharmacist said to him weeks afterwards.
“Doctor, since we talked, I now send all my customers with fever to the health centre for a test before I sell any medicine.”
Kapene drew the conclusion himself: “This showed me that talking directly with informal providers can really change how they work.”
Abdoulaye Alassane Mahamidou, a physician at operational level in Niger, described the same decision as a choice between two postures.
“The medicine seller in my neighbourhood plays a real role in first care, even without training. Instead of fighting him, I chose to talk with him to help improve what he does.”
Dyna Lufungula, a community health worker in the Pweto health zone of Haut-Katanga in the Democratic Republic of the Congo, went further and described the reasoning that led her there.
“I knew the manager of a small private pharmacy. People with fever often went there before coming to the health centre. I wanted to improve our partnership so we could strengthen early malaria care.”
Nobody instructed her to do this.
She worked out where the sick went first, and went there.
Mortimer Papy Mohele Bosalo, a doctor at a district hospital in the Central African Republic, supplied the detail that makes the practice real rather than aspirational.
He went after a second child arrived in shock from severe malaria following wrong treatment at a particular pharmacy.
“We met in the back room of the pharmacy after the busy hours.”
The back room, after the rush.
That is diplomacy conducted on the seller’s terms, in the seller’s premises, at a time that does not cost the seller money.
It is also entirely unfunded, which the cohort noticed.
Why the malaria conversation sometimes fails
The cohort did not romanticise these negotiations, and this is where its evidence becomes genuinely useful to policy rather than merely encouraging.
Jean-Hubert Mwabi Mbala, a public health worker at operational level in the Democratic Republic of the Congo, recorded the refusal in one line of reported speech.
“He told me he was afraid of losing customers if everyone got referred directly.”
The synthesis draws the conclusion without softening it.
“When a seller refuses to cooperate, it is not about refusing to learn. It is about money. A policy that ignores this will hit the same wall everywhere.”
That sentence should be read twice by anyone who has ever funded a sensitisation campaign aimed at informal providers.
The barrier is a revenue model, and a training workshop does not touch a revenue model.
Ibrahima Touré, a public health worker at district level in Guinea, found the one adjustment that does move it, and it is a change in his own stance rather than in the seller’s knowledge.
“I changed how I approach informal medicine sellers in my area. I went from an inspection stance to an ongoing training stance. This has improved how well they refer serious cases.”
Tilado Marie Nicolas Tamolgo, a doctor at operational level in Ouagadougou, Burkina Faso, measured the result in the modest terms it deserves.
“In the weeks that followed, we saw a small increase in patients sent to us early by that pharmacy.”
A small increase.
Sent early.
From one pharmacy.
This is what functioning looks like at the scale where malaria is actually decided, and it happened because a doctor walked into a shop and did not threaten anybody.
The cohort was also blunt about who is paying for it.
Nearly half the stories describe relationship work of this kind conducted on the worker’s own time.
The synthesis states the consequence plainly: “This work gets no funding, no tools, and no recognition.”
One participant in Senegal, whose identity was protected at his request, described an agreement reached with a named individual.
“I negotiated with an informal medicine seller in my area, Mr. Diallo, so he would send fever cases to the health centre instead of treating them himself without a diagnosis.”
That agreement exists because one person chose to make it.
It will not survive his transfer without a policy change.
Data quality and use: the numbers that lied
If four families in five pass through unofficial care, and if the last link is a stockout, the question becomes why nobody upstream saw either problem.
The cohort answered that question with an example that cold be taught in every health information systems course.
Adrienne Vanessa Kouatchouang, a physician at district level in Cameroon, was reviewing weekly figures in the middle of the rainy season.
A health centre reported a sharp drop in confirmed malaria cases from one week to the next, at peak transmission.
On a dashboard, that is good news.
“I dug deeper and called the head nurse directly,” she wrote.
“They had been out of rapid diagnostic tests for several days. The number did not reflect a real drop in cases. It was a stockout disguised as an epidemiological improvement.”
A stockout disguised as an epidemiological improvement.
There is no aggregate indicator that catches this, because the indicator behaves exactly as it should when the input disappears.
Confirmed cases fall when you stop confirming cases.
Somewhere above that district, a chart improved.
Mohele Bosalo found the same distortion pointing the other way.
“The monthly report said we treated 142 cases of clinical malaria, but we only recorded 12 positive rapid tests. That is a very low confirmation rate of 8.4 percent. At the same time, the children’s ward was full of kids with fever.”
The report was complete.
It was punctual.
It complied with every rule.
It described a different hospital from the one he was standing in.
Jean Paul Kanda Ndibualonji, a doctor in the Lomami health district of the Democratic Republic of the Congo, found a gap between suspected and confirmed cases large enough that he stopped analysing and started travelling.
“I had to go check with the health facilities to find out why.”
And Christelle Bosulu, a health professional at operational level in the Democratic Republic of the Congo, tested the coverage figures against households, roughly three hundred of them, for her thesis.
“Some data made it look like several families had nets. But what I saw in the field told a different story. Actual use was much lower than the reported number suggested.”
Owning a net and using a net are different variables.
Papy Wembo, a doctor at health area level in the Democratic Republic of the Congo, identified the mechanism, and it is not misuse.
“Many families put them away to use later instead of hanging them up.”
The most common obstacle to net effectiveness, on this evidence, is a closet, and no information system in the world has a field for it.
Ali Toilibou, a health professional at national level in the Comoros, turned the whole problem into a request rather than a complaint.
“Data must allow us to make the right decisions on time. The big problem is that many people do not understand how critical good-quality data is. How can we strengthen malaria data collection and management to support an elimination programme?”
How does data triangulatio become deliberate practice?
Set against these failures is the cohort’s least expected finding, and it is a finding about cognition rather than about systems.
50 of the 258 stories describe a decision made from a number the writer collected personally.
98 discuss data quality directly, with exact figures.
And 36 describe the same three-step reflex, independently arrived at: notice the oddity, look for a possible cause, then check against a second source.
Marcelin Mukonkole, a doctor at operational level in the Democratic Republic of the Congo, supplies step one in a single clause.
“In November, I saw a sudden, unusual 45 percent jump in severe malaria cases with anemia.”
Kimpiobe Kikwate Kim supplies steps two and three, and does so as a community health worker, which is the level at which this behaviour is least expected and most valuable.
“To check this oddity, I compared the clinic register with the lab data, where rapid test results are recorded. I also talked with the other community health workers to see if they had noticed more fever cases in the community.”
Three sources.
A register, a laboratory, and colleagues.
That is triangulation, performed by someone whose job description almost certainly does not use the word.
Two participants then stated the principle that follows.
Sama Sarki Moussa, a doctor at operational level in Niger, put it as a claim about authority.
“Local data should not just fill reports. They can let field workers detect problems quickly and act before new national directives even exist.”
Aguérégna Abou-Kerim, a public health worker at operational level in Benin, put it in the second person, as advice. “Local data are not just paperwork for your supervisors. They are your first early warning system.”
Chetoui Ahmed, a health professional at operational level in Morocco, converted it into a rule that fits on a wall.
“When a number looks unusual, never ignore it. Check it, talk about it with your team, and understand it before you make any decision.”
Read alongside Kouatchouang’s stockout, these accounts describe an inversion of how surveillance is usually imagined.
The people best placed to detect that a number is lying are the people who watched it being generated.
They are also the people whose observations are least likely to reach anyone with the authority to act.
The man who stood up in Fon
Then there is the finding the cohort was never asked to produce, which arrived anyway, in 52 of 258 stories, in nearly identical words, in the Democratic Republic of the Congo, in Burkina Faso, and in Benin.
Rodriguez Madokoun recorded it as a scene.
He was addressing a community session in Benin about bed nets when a man interrupted him.
Madokoun noticed everything about how it happened.
“A man in his fifties spoke up without warning. He was a father and a respected farmer in the village. He stood up calmly and looked around to make sure people were listening. Then he said to me in Fon, in a calm but firm voice: ‘Young man, you come here to tell us how to protect our children. But who decided this is the net we will hand out? Who decided it should be treated with this product? Not us. People sitting in offices in Cotonou or Geneva decided.’”
He looked around to make sure people were listening.
That detail is the whole story.
This was a deliberate public act by a man who had thought about it, chose his moment, chose his language, and named both the national capital and the international one.
Madokoun did not have an answer, because there is not one available to him.
Amani Kahunga, a physician at district level in the Democratic Republic of the Congo, described the professional position this creates.
“Decisions about where to work are often made at national and regional level, far from local reality. This limits how much field health workers can negotiate when communities ask legitimate questions.”
Field workers are required to defend, in a language they share with their neighbours, procurement decisions they did not make, cannot explain, and are not permitted to contest.
The synthesis identifies this as the single strongest theme in the entire dataset, and notes that nobody prompted it.
Tamba Dissy Millimouno, a physician at district level in Guinea, showed what happens downstream when the reasoning stays hidden.
“Trust in the net distribution campaign depends largely on transparency about targeting criteria. When communities do not understand why certain households are a priority, suspicion sets in fast.”
Free distribution, on this evidence, does not reassure anybody.
Explaining the rule does.
And Anthony Apanzoa, a physician at health zone level in the Democratic Republic of the Congo, described what the absence of that explanation looked like in practice, from inside the distribution team.
“During a distribution campaign, I had a conflict with the distribution team about targeting priority households. Some non-priority households got multiple bed nets while others got none.”
Refusal, read correctly
The farmer in Benin questioned the decision.
Other communities answer it with their hands, and the cohort’s most-quoted reframing is about learning to read that correctly.
Sékou Oumar Traore, a public health worker at operational level in Burkina Faso, wrote the sentence that travelled furthest.
“What hit me hardest was seeing bed nets used for fishing. This is not necessarily ignorance. It is a smart choice when people are hungry. One lesson to remember: work with trusted community health workers to adapt your message to local needs.”
A bed net in a river is usually filed as a health education failure.
Traore filed it as a household calculation between eating today and being protected tonight, made by people who understood both options.
Once that is accepted, the intervention changes.
You are no longer correcting a misunderstanding.
You are competing with hunger, which requires either a different offer or an admission that you do not have one.
Marlène Kapinga Mulumba, director of nursing at a referral health centre in Mont Ngafula, Kinshasa, reached the same conclusion from the opposite direction and made it the title of her submitted work: building acceptance of insecticide-treated bed nets, an experience that taught her trust is as important as innovation.
André Mukeba, a community health worker in the Democratic Republic of the Congo, located where that trust is actually produced, and it is not during the campaign.
“In my area, I found that people trust public health campaigns when community health workers are there between campaigns, not just during them.”
Between campaigns.
The period nobody counts, nobody funds as a deliverable, and nobody reports.
What happened at Teach to Reach 16, and why you should care
On 6 August 2026, findings like these were read aloud to the people who had written them, over a livestream from Geneva, at the sixteenth edition of Teach to Reach.
Reda Sadki and Charlotte Mbuh presented them to participants in more than 50 countries.
Reda was explicit about whose words were on the screen.
“These are health workers who work where malaria is part of everyday life,” he said.
“Each one shared a real situation they lived through, not an opinion, a fact, something that happened with a place, a date, and numbers. Each one also read what three colleagues wrote and replied to them and then received help in turn. Every quote here uses their exact words.”
Then he asked what surprised them.
Acha Achi, who works at regional level in government in Cameroon, went straight to the sellers, and described a professional habit he was abandoning in public.
“The way those who have been classically trained always behave is like either apology or trying to fight, or to make them know that they have no place, no constitution in the fight against malaria,” he said.
“But getting to know that if you fight against them you will shut them down, whereas you will instead be opening a pathway to the referrals if you actually work with them, train them, and make them improve their practices by testing.”
He then named where he stood.
“Where I am, I have always experienced that they have always been fought against. But now I think it is preferable to try to see how you could educate them and make them useful in the system to make referrals and to make proper treatment. I think that is why the quality needs to be integrated in my own practice, and I could advocate for that too with others.”
Maria Charlote Kemirembe, who works at district level in Uganda, had not taken the course.
She had come because, as she had said before the session began, “I am much interested in the resistance to anti-malarial drugs,” which she called “one of our biggest problems here in Uganda.”
What struck her instead was the size of the effective interventions.
“I have seen how people have done very small, they look like small interventions, but impactful,” she said.
Asked for an example, she chose the net demonstration and extended it into a critique of her own reporting.
“One has given an example: before the treatment, demonstrate how to spread the net, like how someone is supposed to spread the net on the bed. And that is where most of the people get malaria from, and would think they have a mosquito net, and we tick and say mosquito net, yes, tick, in the hospital, and yet when they go back home it is the use of the net that actually exposes them to malaria.”
We tick and say mosquito net, yes, tick.
She had found, in under an hour, the same gap Christelle Bosulu found across 300 households.
She said she would take the course shortly after the session ended.
Simms Ofosu teaches at a health facility in Ghana’s Ashanti region.
He prepares nurses and midwives, and what he heard changed his syllabus rather than his clinic.
“What surprised me is looking at how malaria is going to be influenced not fully by clinical factors, but with community beliefs also, and environmental conditions, and people’s willingness to seek early treatment.”
His conclusion was specific to his work: the findings would “update my knowledge so that teaching reflects current evidence.”
Peter, who works at regional level in government in South Sudan and was attending for the third time, was struck by what the cohort had shown could go wrong.
“You can give an intervention without talking to somebody,” he said, naming the failure precisely.
“So the engagement that they are giving to the people is something that I have admired, and in future that I can also would want to use as an intervention to my practice, and also to help others who are even suffering from malaria.”
Chinyelu Ekwunife, of Nnamdi Azikiwe University in Awka, Nigeria, asked the only interrogative of the session.
A colleague had described introducing rapid diagnostic tests.
Did he move from family to family, or work in the clinics?
“Please, I would like to know if he moves from family to family to teach them how to use it.”
Charlotte Mbuh restored the context rather than answering directly.
In some settings rapid tests are still being introduced as new tools.
“So the context of that comment was that before just going down or using RDTs, first of all, go and listen to the community, hear their questions, come back before he prepares the message for sensitisation.”
Listen first, then prepare the message.
That is the cohort’s second instruction, delivered to a professor who intended to use it.
The volunteer who became a mentor
Two contributions from that hour describe something the findings cannot, which is what participating in this kind of enquiry does to the person doing it.
Joshua Kofi Nnanchom is a community health volunteer in Ghana.
He began by naming his position without euphemism.
“My case is that I am just a mere volunteer. Unfortunately, I could not get a chance to enrol into any institution to learn professional health courses.”
Then he described what changed.
“Now [this course] has made me know the right processes that I can take to fight against malaria accordingly. Moreover, now I can speak in public confidently, because the main aspect of the programme was also done anonymously. So that aspect has boosted my confidence level, because I see myself as a mentor now.”
He explained why.
“I got the opportunity to interact with the diaspora and then people from different regions. And in fact, it was so amazing to me, because as I stated earlier, I am a person without any good background from the health aspect, and now I am able to interact with health expertise.”
The anonymity mattered.
In a course where work is reviewed by peers who do not know your credentials, a volunteer’s analysis is judged as analysis.
Nnanchom reported that learning for him was about acquiring standing.
Louise Nkusu Lusangu, a nurse and midwife working at a health facility in South Africa, described the same effect as a professional widening.
“One of the most important things I learned was how to work and communicate effectively with different health professionals, including health care workers, pharmacies, laboratory staff, and other public health practitioners.”
Note that pharmacies are on her list, alongside laboratories.
“What surprised me the most was how much we can learn from one another, even though we come from different countries and work in different approaches to solve them. I saw that everyone has valuable knowledge to share, regardless of their role or where they work.”
Her conclusion reads as a summary for the cohort.
Fighting malaria “is not only about treating patients. It is also about preventing disease, educating communities, working as a team, using data to guide our actions, and continuously learning from others.”
Balkhisa Bashir asked the question that tested the boundary.
She works with a relief organisation serving indigenous and marginalised communities in the semi-arid and arid regions of Kenya, and she wanted to know whether this was only for people inside the health sector.
“I do not know whether the engagement is only for those people who are working within the sector of health, but also inclusivity of NGOs and others.”
Charlotte answered by handing her the job.
“Everyone is welcome, Balkhisa. And you are even in the right position to start inviting them, because you have the links, you have experienced it. And so you also have even the message to share with them.”
Getting ready for new tools to turn the tide
The next course, Malaria: new tools to turn the tide, covers vaccines, medicines, antibodies, nets, and tools that target mosquitoes.
Most are arriving now.
On this cohort’s evidence, the technical content will be the easier half.
The harder half was posed by a farmer in his fifties who stood up in a village in Benin, looked around to make sure people were listening, and asked in Fon who chose the net and who chose the product.
Nobody in the room could tell him.
Nobody in the room was permitted to find out.
Emmanuel Kibambe, a doctor at health zone level in the Democratic Republic of the Congo, showed what the answer looks like when it is available.
Some parents in his zone thought the malaria vaccine was experimental.
“What made the difference was working with community health workers and a neighbourhood leader who had his own grandson vaccinated in front of everyone.”
Not an argument.
Not a poster.
A respected man putting his own grandchild first, in public, where everyone could see.
Excellent Kininga Bolia, a physician at operational level in the Democratic Republic of the Congo, wrote the sentence that describes what all of this depends on.
“Every success in malaria control does not come from one person alone. It comes from a chain of collaboration between community workers, health staff, and technical partners. This chain must be maintained constantly.”
Maintained constantly.
Between campaigns.
In the dry season.
On somebody’s own airtime.
Thierno Abdoulaye Baldé is still checking hospital numbers in Guinea.
He described a boy named Mamadou Bhoye Diallo, from Koula village in the Diari sub-prefecture, arriving with a fever of 38 degrees and meeting a community health worker who listened carefully and did a rapid test.
He also described a child whose parents were sent out to buy a medicine that should have been on the shelf.
He put both accounts into the same course, for strangers to read.