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Innovation capacities. It is indeed weak health care systems that prevent high vaccination coverage and the reduction of maternal mortality. Effective innovative skills are necessary to bring about the creation of health care systems that are closer and accessible to the client. In addition, effective ways of disseminating knowledge for behavioural change requires research capacities for support. To accelerate the pace of current achievements, create greater certainty that new knowledge becomes a public good accessible to all, and ensure that new and improved tools are utilized effectively by those that need them most, we must encourage real partnership in the process of knowledge generation. This can be the case only if deliberate efforts are made to support research capacity development in diseaseendemic countries. Achieving the Millennium Development Goals should go hand in hand with developing capacities to sustain achievements and make even greater progress in future. Health and development are achievable. They must be linked to the capacity to generate and utilize effectively generated knowledge 9 . The role of research in being healthy is unquestionable. Hence, capacity for research and development is a prerequisite for empowering countries to participate actively in solving their priority problems, and contribute effectively to making a healthy global community. ❏ Andrew Y Kitua is a medical doctor and epidemiologist. He is currently Director General of the National Institute for Medical Research in Tanzania. Dr Kitua was previously Director of the Ifakara Health Research and Development Centre from 1993 to 1997. He has vast experience in health research and public health, especially in malaria epidemiology, vaccine and clinical trials and health systems. He is a member of the TDR Technical Advisory Committee, the Netherlands (WOTRO); Developing Countries Coordinating Committee of EDCTP; member of the Board of Directors of three research institutions in Tanzania. Initiator and Secretary, Tanzanian National Health Research Forum (TANHER Forum) and Chairperson of the Tanzanian National Malaria Advisory Committee. References 1. The World Health Report 2002 – Reducing risks, promoting healthy life, Geneva, World Health Organization, 2002. 2. The World Health Report 2003 – Shaping the future. Neglected Global Epidemics: three growing threats. Geneva, World Health Organization, 2003. 3. Report of the Working Group 5 of the Commission on Macroeconomics and Health 2002. Improving health outcomes of the poor. World Health Organization, Geneva, 2002. 4. Report of the Commission on Macroeconomics and Health. 2001. Macroeconomics and Health: Investing in health for economical development. World Health Organization, Geneva, 2001. 5. Bazin H. The eradication of smallpox: Edward Jenner and the first and only eradication of a human infectious disease, 2000. Academic Press. 6. One disease down – Eradication of river blindness offers hope in fight against AIDS. Sarasota Herald Tribune. 13 December 2002. 7. Onchocerchiasis elimination program for the Americas (OEPA). Updates: 2005 www.cartercentre.org 8. Matola YG and Magayuka SA. Malaria in the Pare area of Tanzania: V. malaria 20 years after the end of residual spraying. Transactions of the Royal Society of Tropical Medicine and Hygiene 75, 1981, 811-813. 9. Kitua AY. Building capacity for public health research. Global Forum Updates on Research for Health, 2005, pp. 037-040. Global Forum Update on Research for Health Volume 4 ✜ 103
Innovation The role of Knowledge Translation in bridging the “know-do gap” Article by Ariel Pablos-Méndez (pictured) and Ramesh Shademani During the 20th century, knowledge in all its forms contributed to unprecedented global health gains 2 . Yet ill-health and premature deaths from preventable causes persist, especially among poor children and women, in spite of available cost-effective interventions 2,3 . Studies show that more than half of the deaths to children under five years old can be prevented by the use of available interventions 2,3,4 . Such studies indicate that most of the burden of premature death and illness among the poor is due to problems for which solutions are known and prevention is possible. Even in war-ravaged countries, most deaths are from easily preventable and treatable illness rather than violence 5 . The achievement of the health Millennium Development Goals (MDGs) in many developing countries is questionable. The obvious “know-do gap” was recognized by the Mexico Ministerial Summit on Health Research in November 2004 6 and by the 58th World Health Assembly in May 2005 as a major obstacle to the attainment of the Millennium Development Goals. Bridging the know-do gap is the foremost challenge and opportunity for public health in the 21st century. New initiatives and platforms to strengthen specific aspects of the health systems such as health information systems, human resources, and equitable access and coverage have emerged. Knowledge and its links to action is another platform for health system strengthening. Evidence and knowledge for problemsolving There is widespread agreement that policy and practice should be informed by the best available evidence that is applicable in a given setting. However, there is debate on what constitutes evidence and how to harness it in practice, and whether it is sufficient to bring about sustainable change in complex social settings. The goal of traditional researchers, conditioned by funding and tenure systems, is often to get published in a respected medical journal – assuming their findings will be translated into practice by somebody else at some point. In addition, learning about effective development projects taking place in poor countries is sometimes hindered by the lack of general knowledge of what works and how 8 . A shift from “moving” evidence to solving problems is overdue. The contribution of knowledge to health gains has been dominated by consideration of benefits of science and technology, neglecting to exploit and use other valid sources of knowledge: knowledge from practice and the sharing and replication of people’s experience. The tacit dimension of knowledge, the social context of knowledge, and the various knowledge-creating mechanisms in practice are gaining importance, paradoxically, following the ICT revolution which mainly handles increasing volumes of disembodied explicit (i.e. codified) information 9 . A strategic approach to creating and promoting evidence from practice in priority areas should contribute to bridging the know-do gap. Knowledge has been recognized by economists as the most important factor of production in the new economy. A knowledge economy (including health sector) is “one in which the generation and exploitation of knowledge has come to play a predominant part in the creation of wealth. It is not simply about pushing back the frontiers of knowledge; it is also about the more effective use and exploitation of all types of knowledge” 10 . The golden era of modern research, which started after the Second World War, was a period in which research findings outside strategic government projects were published 11 and passive diffusion followed. The 1970s saw the birth of evidence-based medicine which took a push strategy with both active dissemination of practice guidelines and education for their local interpretation and adaptation; technology assessment also emerged at a time when private industry took over most product R&D. Conceptual frameworks derived from the social theory of diffusion of innovation at the time included Research Transfer and Research Utilization; the private sector developed value chain models, and marketing strategies. The success of evidencebased medicine, however, plateaued in the 1990s and the new millennium dawned with fresh thinking on this old frontier. In Canada, for example, institutions were reorganized or created, crafting the term Knowledge Translation and emphasizing linkage and exchange models 12 . 104 ✜ Global Forum Update on Research for Health Volume 4
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Global Forum Update on Research for
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Editorial Advisory Board: Luis Gabr
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Contents 096 Child immunization: ac
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Introduction Research contributions
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Introduction Type I Type II Type II
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Introduction making), takes account
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Access to health Strengthening heal
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Access to health raising public awa
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Access to health Recent trends in r
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Access to health districts with a p
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Access to health Understanding heal
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Access to health This study investi
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Access to health References continu
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Access to health combining particip
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Access to health 2002 2005 Diff. SU
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Access to health References continu
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Access to health Americans think th
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Access to health threatening and se
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Access to health References 1. Worl
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Page 43 and 44: Access to health national and globa
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Page 51 and 52: Access to health Inequality, margin
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Page 59 and 60: Access to health The diverse pathwa
Page 61 and 62: Access to health 2001, WTO ruled th
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Page 67 and 68: Innovation 076 Towards the developm
Page 69 and 70: Innovation ✜ Creating a viable va
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Page 73 and 74: Innovation References 1. Morel C et
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Page 85 and 86: Innovation Health system strengthen
Page 87 and 88: Innovation Being healthy: the role
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Page 95 and 96: Research resources 110 Research imp
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Page 103 and 104: Research resources Nursing research
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Page 107 and 108: Research resources The need to deve
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Page 131 and 132: Decision-making Delivering evidence
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Decision-making References 1. Haine
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Decision-making reviews in this fie
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Decision-making Inequities in healt
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Decision-making Deaths Crude death
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Decision-making Group I Group II Gr
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Decision-making Low- and middle-inc
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Decision-making Europe and Central
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Decision-making Europe and Central
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Decision-making References 1. Banni
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Decision-making irresponsible-to be
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Decision-making Several strategies
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To achieve better health, particula
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