Linking Local Knowledge with Global Action: Examining The Global Fund to Fight AIDS, Tuberculosis and Malaria through a Knowledg

Published in the Bulletin of the World Health Organization (v. 84, n. 8, pp. 629-635), this paper explores strategies for translating knowledge into action in the field of global public health by basing decisions explicitly on results, evidence, and best practice. The authors use a knowledge systems framework, which focuses on "a network of actors connected by social relationships, either formal or informal, who dynamically combine knowing, doing and learning to bring about specific actions for sustainable development." Guided by this framework, they undertook a study - involving 28 semi-structured interviews and analysis of relevant policy statements, websites, and written materials - of the broader knowledge system that underpins actions to fight HIV/AIDS, tuberculosis (TB), and malaria. They focus on the Global Fund to Fight AIDS, Tuberculosis and Malaria, investigating this organisation's process of deciding whether to fund an application as a means for understanding the collective ability to generate, mobilise, apply, and communicate high-quality knowledge about these diseases.

Having outlined the formal knowledge system embedded in current rules and practices associated with the Global Fund's application process (using a figure to illustrate this complex process), the authors provide 3 examples that illustrate the complexity of the system in action:

• HIV/AIDS policy in China - "The Global Fund application process became a major force in fostering the engagement of officials from health and other sectors with international best practice and experience from other countries. As a result, the policies in China became more outward-looking, and moved closer to best practice. This example illustrates that institutional innovations can encourage countries to engage with international knowledge and become more open to learning and adapting global-level knowledge to local conditions."
• Successful applications from Haiti - "The ability of applicants to apply local knowledge to a proposal, but simultaneously draw on the legitimacy conferred by participating in the broader, global-scale knowledge system (academic publication and panels advising international standards) gave the Haitian proposal strength beyond that which could be expected by examining the local resources alone....Yet the role of implementers as knowledge generators (as opposed to knowledge recipients) is not well supported by the existing knowledge system."
• Responses to changing research on malaria - "In January 2004, the Lancet published a Viewpoint article that vehemently criticized the Global Fund for funding malaria projects that used treatments in populations where the parasite had been shown to have developed significant resistance, and was therefore no longer effective....The Global Fund's response was rapid, and included consultation with the authors of the article...and other experts, and an independent review of the projects. The countries that had made the original decisions not to apply for funding for the new treatments were not formally consulted in this process..."

Reflecting on these examples, the authors conclude that the Global Fund could play an influential role in fostering much-needed learning from implementation, correcting the dominant one-way knowledge flow in supporting efforts to combat the 3 diseases. (The bulk of this complex knowledge system still characterises funding recipients as knowledge recipients, the authors claim, rather than active and important knowledge generators). They suggest that 3 initial steps are required to offset this tendency:

1. Recognising interdependence and acknowledging shared responsibility for learning across the knowledge system;
2. Analysing the Global Fund's existing data (and refining data collection over time) to cull out lessons from existing project successes and failures; and
3. Supporting recipients and technical partners to invest resources in linking implementation with best practice and research.