What are the consequences of the false dichotomy between global and local knowledge in health systems

Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems

Global health

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 …

Brevity’s burden The executive summary trap in global health

Brevity’s burden: The executive summary trap in global health

Global health, Learning strategy

It was James Gleick who noted in his book “Faster: The Acceleration of Just About Everything” the societal shift towards valuing speed over depth: “We have become a quick-reflexed, multitasking, channel-flipping, fast-forwarding species. We don’t completely understand it, and we’re not altogether happy about it.” In global health, there’s a growing tendency to demand ever-shorter summaries of complex information. “Can you condense this into four pages?” “Is there an executive summary?” These requests, while stemming from real time constraints, reveal fundamental misunderstandings about the nature of knowledge and learning. Worse, they contribute to perpetuating existing global health inequities. Here is why – and a few ideas of what we can do about it. We lose more than time in the race to brevity The push for shortened summaries is understandable on the surface. Some clinical researchers, for example, undeniably face increasing time pressures. Many are swamped due to underlying structural issues, …

Civil society organisations and global health initiatives Problems of legitimacy

Do Civil Society Organizations (CSOs) actually help global health?

Global health

This summary analyzes two important articles examining the role of civil society organizations (CSOs) in global health: “Civil society organisations and global health initiatives: Problems of legitimacy” by Doyle and Patel (2008), and “Civil society in global health policymaking: a critical review” by Gómez (2018). While both articles challenge dominant assumptions about CSOs in global health, Doyle and Patel focus more on issues of legitimacy, representation and effects on democracy. Gómez focuses more on the lack of theoretical and empirical evidence for CSOs’ influence across all stages of the policy process.  Doyle and Patel (2008) challenge the assumption that CSOs automatically enhance representation and democracy in global health governance. Gómez (2018) similarly critiques the lack of evidence for CSOs’ assumed comparative advantage in health program delivery. Doyle and Patel conclude that failure by advocates to respond to the sceptical arguments put forward here may weaken the legitimacy of CSO involvement …

Towards reimagined technical assistance Thinking beyond the current policy options

Towards reimagined technical assistance: thinking beyond the current policy options

Global health, Leadership

In the article “Towards reimagined technical assistance: the current policy options and opportunities for change”, Alexandra Nastase and her colleagues argues that technical assistance should be framed as a policy option for governments. It outlines different models of technical assistance: Governments may choose from this spectrum of roles for technical advisers in designing assistance programs based on the objectives, limitations, and tradeoffs involved with each approach: “The most common fallacy is to expect every type of technical assistance to lead to capacity development. We do not believe that is the case. Suppose governments choose to use externals to do the work and replace government functions. In that case, it is not realistic to expect that it will build a capability to do the work independently of consultants.” Furthermore, technical assistance should be designed through “meaningful and equal dialogue between governments and funders” to ensure it focuses on core issues and …