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InnovationSome plausible causes of the know-do gapLimited access to information, technology and medicines (digital divide,intellectual property rights, patents)Ignorance of evidence-based problem-solving and learning approaches inhealth (including lack of learning from development projects due tostructure of aid process)Lack of need-driven research, particularly in developing countriesLack of ownership of knowledge by potential “users”/“adopters”Lack of creation/exploitation of knowledge from practice (evaluation,continuous improvement)Slow diffusion of innovation or scale upSome ongoing efforts to address the causesMedline, Health InterNetwork Access to Research Initiative (HINARI), Healthinformation network (HifNet), Iowa University, Global Health Library,specialized libraries & portals (Maternal and Child Health (MCH), AIDS),Google scholar, virtual health libraries and other country initiatives, DigitalSolidarity FundInternational Network of Clinical Epidemiology (INCLEN), Cochranecollaboration, Cambell collaboration, UK NICE, guidelines and courses byprofessional associations, Health Evidence Network, EVIPNETs, etc.National Institutes of Health (country priorities), Council on Health Researchfor Development (COHRED), Global Forum for Health Research, WHO SpecialProgramme on Research and Tropical Diseases (TDR), specializedinitiatives, including new Public-Private Partnerships in Research &Development for diseases of povertySuccessful immunization campaigns, tobacco-free inititatives, socialentrepreneurship, knowledge brokering (Canada, Netherlands)Institute for Health Care Improvement (IHI), Bangladesh RehabilitationAssistance Committee (BRAC), Management Sciences for Health (MSH),Tanzania Essential Health Interventions Project (TEHIP)Strategic advocacy (Médecins Sans Frontières), social marketing (Greenstar-Pakistan-based social marketing organization), social entrepreneurship(BRAC, Ashoka Fellows)Table 1: Some causes of the know-do gap and ongoing efforts to address themFrequent sources of knowledge✜ Scientific and informal research (new or not)✜ Surveillance systems✜ Project monitoring and evaluation✜ Practical experience✜ Historical or news facts✜ OthersLayers for knowledge-based activities in health✜ Policy work✜ Institutional management✜ Technology/R&D✜ Clinical service provision✜ Community enterprises✜ Individual behaviour(healthy lifestyle, adherence)✜ OthersSelect mechanisms or “schools” for KT✜ Utilization research✜ Operational & action research✜ Evidence-based guidelines✜ Knowledge brokers, sages✜ Implementation science✜ Strategic planning & management✜ Continuous improvement✜ Social entrepreneurshipTable 2: Frequent sources and types of knowledge and select mechanisms for KTKnowledge TranslationThe importance of Knowledge Translation (KT) is its potentialto bridge the know-do gap, the gap between what is knownand what gets done in practice. This gap between knowledgeand its application is not new, but today systematicapproaches to address it are urgently needed 13 .KT is being developed at a time when unprecedentedglobal investments in health research have generated a vastpool of knowledge that is underused and not translatedrapidly enough into new or improved health policies,products, services and outcomes. KT comes at a time wherethe gap between what is known and what gets done (theknow-do gap) is highlighted by shortfalls in equity (e.g.Millennium Development Goals) and quality (e.g. patientsafety movement) in health services 14 . However, we witnessa limited interpretation of KT as a linear transaction betweenresearch “producers” and “users” trading knowledge as acommodity. Knowledge can be created without science andKT is not research; it moves from responding to curiosity tofocusing on purpose and problem-solving. It is defined as “thesynthesis, exchange and application of knowledge by relevantstakeholders to accelerate the benefits of global and localinnovation in strengthening health systems and improvingpeople’s health” 15 . More concretely, KT is about creating,transferring and transforming knowledge from one social ororganizational unit to another in a value-creating chain – acomplex interactive process that depends on human beingsand their context.Knowledge Translation is a cross-cutting, non-linearprocess that involves not only recent research findings butalso knowledge that is created from the dynamic interactionof people who come together to solve public health problems,to learn and ultimately to drive productive change. Attentionshould be given to the knowledge itself, but even more so tothe purpose, people and processes involved. The processesfrom knowledge generation to application are complex andinfluenced by factors including local context (where practicetakes place), and the perceived relevance of knowledge thatis enhanced when owned by relevant stakeholders.Translating knowledge into new or improved healthpolicies, services and outcomes requires a clearunderstanding of the characteristics of this process, the waysit can be used, the conditions governing it, and criteria toassess its impact.When addressing issues related to KT, technical expertshave the inclination to depend almost exclusively on encodedGlobal Forum Update on Research for Health Volume 4 ✜ 105
Innovationknowledge – the “know what”. The realm of biotechnologyresearchers and evidence-based medicine is dominated bythe intensive use of encoded knowledge. By comparison,practitioners in the health professions, policy-makers andmanagers of health service organizations rely on the use ofcomplementary types of knowledge in a context whereencoded research knowledge does not usually dominate. Weacknowledge that scientifically generated knowledge enjoysthe highest degree of generalizability and potential for radicalinnovations 16 , however, some phenomena do not lendthemselves well to systematic research.The lesson to derive from the examination of the types ofknowledge is that sound decisions and sound professionalpractices must be based on multiple types and pieces ofknowledge that bring complementary contributions toproblem-solving in a progressive, Bayesian way 17 . Varioussources of knowledge, besides that from research, are neededby various users who range from policy-makers, topractitioners, to managers and communities. The processesfrom generation to utilization of knowledge (value chains) istherefore dependent on the purpose and on who thestakeholders might be.Different types of knowledge are especially important toperform a particular task and solve problems and managechange in unique, complex or uncertain circumstances.Moving from KT conceptual framework to theknowledge value chainKnowledge should be used as a resource adding value intothe activities undertaken in the production and deliveryprocesses of health service organizations. In the managementliterature, this idea of value creation is often approachedthrough the concept of knowledge value chain (KVC) fromstrategic planning to implementation.From an organizational perspective, the KVC is the set ofknowledge creating activities to move from concept up to theproduction of new or improved products and servicesdelivering added value for clients. While some variation isexpected for different problems or settings, we propose thatthe knowledge value chain consists of five activitiesinterrelated by multiple feedback loops from knowledgeexploration to exploitation: acquisition, creation, sharing/dissemination, utilization/application, and performanceassessment/innovations 18 . In turn, each activity is supportedby specific tools and specific tactics. The mission, vision,goals and strategies of an organization or social enterprisedrive the KVC. The higher the knowledge performance relatedto acquisition, creation, sharing, and use, the higher the valuegenerated for key stakeholders along the value chain. Value iscreated by managing interactions between the strategic,operational and tactical levels of the KVC as well as betweenthe different activities of the KVC. This dynamic processgenerates feedback loops that amplify or attenuate theknowledge conversion flows depending on key drivers(motivation and incentives) and local context and largerhistorical forces.Value chains start and end with a purpose, to solve aproblem and create value through the delivery of key servicesand products by orchestrating and navigating social andorganizational processes involving motivation, strategy andincentives. The research to policy value chain (transferexchange-utilization)is complex but there is someexperimentation. Diffusion of innovation in clinical practice iswell established although there is room for improvement. Thepharmaceutical R&D value chain is one of the most evolvedand one to learn from. Community interventions, on the otherhand, require major development. Paradoxically, this is thearea where private sector has valuable experience inmarketing a product or service. Nonprofit, socialentrepreneurship thus has lots of potential where governmentservices and market alone fall short.Research needsKnowledge Translation has the potential to bridge the knowdogap. The field is a growing one with scarce literature,although a new journal of implementation science has beenlaunched recently. WHO, countries and the global communitycould be further engaged in efforts to address the know-dogap through research on KT. There is yet no agreedconceptual framework and a lack of a general learningplatform to develop and spread good practices. Fundingsystems are not supportive and evaluation and accountabilitysystems are not aligned.The following are among the research topics/questions thatwill contribute to development of KT.✜ Evidence on impact of evidence-based approaches.✜ Evidence on impact of interactive approaches, includingdemand-driven models.✜ Increase general knowledge of what works and how –what key factors contribute to success stories (aforthcoming issue of the Bulletin is devoted to KT andshould contribute to this issue).✜ Increase understanding of the processes, includingdiffusion of innovation from knowledge generation to itsapplication-value chains.✜ National and global assessments of the knowledgeenterprise for health.There is no clear picture of the knowledge systems inhealth in countries, and thus, a global assessment ofknowledge for health is needed in order to landscape the stateof KT in countries and the international space. Suchassessment could highlight the importance of KT in countries,identify and engage new partners, identify needs andpriorities for action in Member States, draw comparativelessons and derive best practices, and inform a baseline tomonitor impact and progress over time. ❏Ariel Pablos-Méndez joined the Rockefeller Foundation asManaging Director in April 2007. He is an Associate Professor ofMedicine and Public Health at Columbia University in New York.Previously, Dr Pablos-Méndez served as the Director ofKnowledge Management & Sharing at the World HealthOrganization (WHO) in Geneva, working to help bridge the knowdogap in public health and advancing the field of e-health.Dr Pablos-Méndez has returned to the Rockefeller Foundation,106 ✜ Global Forum Update on Research for Health Volume 4
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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Access to healthintegrating individ
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