Institutional Innovations for Linking Knowledge with Action in Global Health

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Overview

The Institutional Innovations for Linking Knowledge with Action in Global Health Project seeks to understand the revolution in unconventional public-private partnerships that has begun to link knowledge with action – linking what medical science knows with what health systems deliver – with regard to catastrophically deadly diseases of the developing world. 

What is the problem? Worldwide, perhaps 10 million children die each year from preventable diseases, principally diarrhea, pneumonia, measles, malaria, HIV/AIDS, and related malnutrition.  It is widely accepted that the Millennium Development Goal of reducing this childhood mortality by 2/3 by 2015 could be met if we were just able to deliver existing low cost, easy to distribute interventions against these diseases to the mothers and children who need them.  The Goal could be exceeded if a number of additional drugs that we know how to produce in principle, but don’t in practice, were actually developed and deployed.  The problem behind these tragic numbers is often referred to as the ‘gap between knowing and doing’ in global health. Indeed, in the recent World Health Organization’s (WHO) World Report on Knowledge for Better Health, WHO assistant director general Tim Evans summarized the problem as follows: “Why is the world so vulnerable to health problems that science is supposed to be able to solve?” 

Why is time important? “Acting in time” can be important to prevent spectacularly catastrophic acute events that haven’t happened yet.  But it can also be important to arrest mundane but chronic destruction that accumulates day by day. Accelerating by even one day the bridging of the know-do gap in global public health could save 27,000 lives on that day, and again every day thereafter.  A higher return on efforts to make technically feasible action more timely is difficult to imagine. 

What are the obstacles to action?  There are two related obstacles to closing the know-do gap in global public health, and thereby bringing affected populations in developing countries access to treatment. The first is availability, or the lack of development of needed drugs. The second problem is accessibility, or the failure to deliver existing treatments.  The challenge is increasingly recognized as one of simultaneously developing new drugs, delivering existing treatments, and mobilizing public or private resources to support the overall venture.  Most policy debates have looked at only one side of this problem. This project looks at what the Gates Foundation has recently taken to calling the whole ‘value chain’ or, to draw a term from our earlier work, the whole “knowledge system.” 

How can the obstacles to action be overcome? A variety of public private partnerships (PPP) have begun to show results in narrowing the gap.  In drug development, a number of new and unusual organizations appear to be having remarkable successes, e.g., Medicines for Malaria Venture, the Global Alliance for Tb Drug Development, Drugs for Neglected Diseases Initiative, Institute for One World Health.  This project compares and critically evaluates the impact of these PPP in linking knowledge with action and seeks to understand the institutional characteristics that have made those impacts possible. By characterizing the institutional nature of these new organizations, and assessing what they have and have not actually accomplished in linking knowledge with action in the global public health arena, we hope to extract lessons that will be valuable for replicating their successes on other diseases and in other regions.  More broadly, we seek to bring experience with bridging knowledge-action gaps in the global health sector into comparative alignment with experience in other sectors we have studied with the goal of developing broader generalizations of utility for science and development policy.

The Project is an evolving collaboration between several groups at Harvard and Boston Universities. It is led by Prof. William Clark and Dr. Nicole Szlezák of Harvard’s Center for International Development, and guided by a steering group that includes Profs. Barry Bloom (Dean, Harvard School of Public Health), Gerald Keusch (Associate Dean for Global Health, Boston University School of Public Health), and Dean Jamison (T. & G. Angelopolous Visiting Professor in Public Health and International Development at the Kennedy School and the Harvard School of Public Health).

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