For decades, learning in global health has depended on a conventional model premised on the scarcity of available knowledge and an emphasis on establishing mechanisms to transmit that knowledge from the center (capital city, headquarters) to the periphery (field, village, training room). With the Internet, scarcity disappeared. But the economy of high-cost, low-volume training has persisted, with little or no accountability.

Burck Smith wrote in 2012 what remains one of the clearest summaries of how accreditation is based primarily on a higher education institution’s inputs rather than its outcomes, and serves to create an “iron triangle” to maintain high prices, keep out new entrants, and resist change.

We are launching a new Scholar programme about environmental threats to health, with an initial focus on radiation. (I mapped out what this might look like in 2017.) As part of the launch, we are enlisting support of immunization colleagues. Our immunization programme is our largest and most advanced programme, and still growing fast since its inception in 2016.

Through research and broad sector collaboration, a consensus has emerged on the recognition that uneven quality of personnel is a major limiting factor in humanitarian response, and that serious effort is needed to address the global gap in skills and build capacity of countries and local communities.

Burck Smith describes how accreditation is based primarily on a higher education institution’s inputs rather than its outcomes, and creates an “iron triangle” to maintain high prices, keep out new entrants, and resist change. To be accredited, a college must meet a variety of criteria, but most of these deal with a college’s inputs rather than its outcomes [emphasis mine]. Furthermore, only providers of entire degree