Global health continues to grapple with a persistent tension between standardized, evidence-based interventions developed by international experts and the contextual, experiential local knowledge held by local health workers. This dichotomy – between global expertise and local knowledge – has become increasingly problematic as health systems face unprecedented complexity in addressing challenges from climate change to emerging diseases. The limitations of current approaches The dominant approach privileges global technical expertise, viewing local knowledge primarily through the lens of “implementation barriers” to be overcome. This framework assumes that if only local practitioners would correctly apply global guidance, health outcomes would improve. This assumption falls short in several critical ways: The hidden costs of privileging global expertise When we examine actual practice, we find that privileging global over local knowledge can actively harm health system performance: Evidence from practice Recent experiences from the COVID-19 pandemic provide compelling evidence for the importance of local …
