The Know-Do Gap: We know what needs to happen, but now we need to scale up and do something

The Know-Do gap was a recurring theme in this afternoon’s session, Health Systems and Implementation Science, focused on universities and researchers going beyond identifying the issues in global heath to implementing solutions which can scale and be sustained. Getting from knowing what to do, to actually doing it is a tough challenge facing health systems worldwide.

Dr. David Peters, the director of the Health Systems Program at John Hopkins University, approached the challenge by outlining a system that programs can follow along with the principles that need to be followed for it to be successful. His guidance on the principles were to focus on the purpose of the system, build on interventions that have already proved to be successful, scrap the blueprint, engage the key stakeholders, incorporate incentives, and use data for systematic learning. He also noted there can be unintended consequences.

Later in the session, Dr. James Blanchard, director if the Center for Global Public Health at the University of Manitoba spoke, and reiterated the concern of unintended consequences which is an oversight on the lack of complexity these “systems” have.

A student from the audience who had just returned from Zambia wondered if government programs or NGO run programs were more effective at implementing systems. Dr. Peters answered saying it depends. “ Both can be successful, but in many ways both can fail,” said Dr. Peters. He explained that sometimes NGOs can deal with things governments may not want to deal with, but there are other things those NGOs are weaker at. More than any which type of organization doing the work, he said it’s important to “Do it, measure it, show it, revise it.”

Dr. Rashad Massoud, the director of USAID Health Care Improvement Project, talked about applying improvement science to strengthen health systems. He reminded the group of the adage that if we continue to do what we are doing, we’ll keep getting the results we are getting; if we want something different, we must do something different. “Change must happen, but you don’t necessarily need to change everything,” explained Dr. Massoud.

He told us about work done in Niger to reduce post-partum hemorrhage – they know that when a woman receives three specific elements, one of which is a drug, they are able to essentially stop the hemorrhages from occurring. The new procedure was implemented but the drug needs to be refrigerated. Well, how accessible are refrigerators in Niger? Not very. They tend to be locked after hours, when many women go into labor. So while the solution was identified, they weren’t able to implement it consistently. So the teams started brainstorming and came up with the ideas of keeping the medicine in coolers or keeping the syringes on hand and bringing them to the delivery center. This solution effectively curbed the hemorrhages.

Prepared by Erika Bitzer

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