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Innovationcapacities. It is indeed weak health care systems that preventhigh vaccination coverage and the reduction of maternalmortality. Effective innovative skills are necessary to bringabout the creation of health care systems that are closer andaccessible to the client.In addition, effective ways of disseminating knowledge forbehavioural change requires research capacities for support.To accelerate the pace of current achievements, create greatercertainty that new knowledge becomes a public goodaccessible to all, and ensure that new and improved tools areutilized effectively by those that need them most, we mustencourage real partnership in the process of knowledgegeneration. This can be the case only if deliberate efforts aremade to support research capacity development in diseaseendemiccountries.Achieving the Millennium Development Goals should gohand in hand with developing capacities to sustainachievements and make even greater progress in future.Health and development are achievable. They must belinked to the capacity to generate and utilize effectivelygenerated knowledge 9 . The role of research in beinghealthy is unquestionable. Hence, capacity for researchand development is a prerequisite for empoweringcountries to participate actively in solving their priorityproblems, and contribute effectively to making a healthyglobal community. ❏Andrew Y Kitua is a medical doctor and epidemiologist. He iscurrently Director General of the National Institute for MedicalResearch in Tanzania. Dr Kitua was previously Director of theIfakara Health Research and Development Centre from 1993 to1997. He has vast experience in health research and publichealth, especially in malaria epidemiology, vaccine and clinicaltrials and health systems. He is a member of the TDR TechnicalAdvisory Committee, the Netherlands (WOTRO); DevelopingCountries Coordinating Committee of EDCTP; member of theBoard of Directors of three research institutions in Tanzania.Initiator and Secretary, Tanzanian National Health Research Forum(TANHER Forum) and Chairperson of the Tanzanian NationalMalaria Advisory Committee.References1.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 GlobalEpidemics: three growing threats. Geneva, World Health Organization,2003.3.Report of the Working Group 5 of the Commission on Macroeconomicsand Health 2002. Improving health outcomes of the poor. World HealthOrganization, Geneva, 2002.4.Report of the Commission on Macroeconomics and Health. 2001.Macroeconomics and Health: Investing in health for economicaldevelopment. World Health Organization, Geneva, 2001.5.Bazin H. The eradication of smallpox: Edward Jenner and the first andonly eradication of a human infectious disease, 2000. Academic Press.6.One disease down – Eradication of river blindness offers hope in fightagainst AIDS. Sarasota Herald Tribune. 13 December 2002.7.Onchocerchiasis elimination program for the Americas (OEPA). Updates:2005 www.cartercentre.org8.Matola YG and Magayuka SA. Malaria in the Pare area of Tanzania: V.malaria 20 years after the end of residual spraying. Transactions of theRoyal Society of Tropical Medicine and Hygiene 75, 1981, 811-813.9.Kitua AY. Building capacity for public health research. Global ForumUpdates on Research for Health, 2005, pp. 037-040.Global Forum Update on Research for Health Volume 4 ✜ 103
InnovationThe role of KnowledgeTranslation in bridgingthe “know-do gap”Article by Ariel Pablos-Méndez (pictured) and Ramesh ShademaniDuring the 20th century, knowledge in all its formscontributed to unprecedented global health gains 2 . Yetill-health and premature deaths from preventablecauses persist, especially among poor children and women,in spite of available cost-effective interventions 2,3 . Studiesshow that more than half of the deaths to children under fiveyears old can be prevented by the use of availableinterventions 2,3,4 . Such studies indicate that most of theburden of premature death and illness among the poor is dueto problems for which solutions are known and prevention ispossible. Even in war-ravaged countries, most deaths arefrom easily preventable and treatable illness rather thanviolence 5 . The achievement of the health MillenniumDevelopment Goals (MDGs) in many developing countries isquestionable. The obvious “know-do gap” was recognized bythe Mexico Ministerial Summit on Health Research inNovember 2004 6 and by the 58th World Health Assembly inMay 2005 as a major obstacle to the attainment of theMillennium Development Goals.Bridging the know-do gap is the foremost challenge andopportunity for public health in the 21st century. Newinitiatives and platforms to strengthen specific aspects of thehealth systems such as health information systems, humanresources, and equitable access and coverage have emerged.Knowledge and its links to action is another platform forhealth system strengthening.Evidence and knowledge for problemsolvingThere is widespread agreement that policy and practiceshould be informed by the best available evidence that isapplicable in a given setting. However, there is debate onwhat constitutes evidence and how to harness it in practice,and whether it is sufficient to bring about sustainable changein complex social settings. The goal of traditional researchers,conditioned by funding and tenure systems, is often to getpublished in a respected medical journal – assuming theirfindings will be translated into practice by somebody else atsome point. In addition, learning about effective developmentprojects taking place in poor countries is sometimes hinderedby the lack of general knowledge of what works and how 8 . Ashift from “moving” evidence to solving problems is overdue.The contribution of knowledge to health gains has beendominated by consideration of benefits of science andtechnology, neglecting to exploit and use other valid sourcesof knowledge: knowledge from practice and the sharing andreplication of people’s experience. The tacit dimension ofknowledge, the social context of knowledge, and the variousknowledge-creating mechanisms in practice are gainingimportance, paradoxically, following the ICT revolution whichmainly handles increasing volumes of disembodied explicit(i.e. codified) information 9 . A strategic approach to creatingand promoting evidence from practice in priority areas shouldcontribute to bridging the know-do gap.Knowledge has been recognized by economists as the mostimportant factor of production in the new economy. Aknowledge economy (including health sector) is “one inwhich the generation and exploitation of knowledge has cometo play a predominant part in the creation of wealth. It is notsimply about pushing back the frontiers of knowledge; it isalso about the more effective use and exploitation of all typesof knowledge” 10 .The golden era of modern research, which started after theSecond World War, was a period in which research findingsoutside strategic government projects were published 11 andpassive diffusion followed. The 1970s saw the birth ofevidence-based medicine which took a push strategy withboth active dissemination of practice guidelines andeducation for their local interpretation and adaptation;technology assessment also emerged at a time when privateindustry took over most product R&D. Conceptualframeworks derived from the social theory of diffusion ofinnovation at the time included Research Transfer andResearch Utilization; the private sector developed value chainmodels, and marketing strategies. The success of evidencebasedmedicine, however, plateaued in the 1990s and thenew millennium dawned with fresh thinking on this oldfrontier. In Canada, for example, institutions were reorganizedor created, crafting the term Knowledge Translation andemphasizing linkage and exchange models 12 .104 ✜ Global Forum Update on Research for Health Volume 4
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IntroductionResearch contributions
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Decision-makingReferences1.Hawes H.
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