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The knowledge translation Problem

GLOBAL FORUM FOR HEALTH RESEARCHsVision: "Aworld in which the potential of research and innovationis fully utilized to address the health problems of the

poor.

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know-do gap & innovation cycle problems

failing innovation cycles in biomedical R&D in lowincome countries discovery development delivery

(CIPIH report , Dreifuss et al 2006)

Case: improved vaccines for the infectious diseasemeningitis (Roberts, 2008) exposes the many hurdles incombating "southern" diseases.

it takes too long for science & innovations to inform

clinical practice

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Current plans and missions

Who? Global Strategy and plan of action on publichealth, innovation and intellectual propertywasendorsed at the 61st World Health Assembly, onMay 24, 2008 (WHA61.21)

CODATAs Mission: "to strengthen international

science for the benefit of society by promotingimproved scientific and technical datamanagement and use."

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What? How? Bring knowledge to those who can benefit from it! The media for bridging know-do gaps:

by word of mouth

by printing press

by radio and television

by computer

by internet

by mobile internet

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Can we do better with ICT? .. !

Internet

Mobile phones

One laptop per child Telemedicine

Electronic patient record

.

How effective do we deploy it?

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The complexity is overwhelming

Grewal (2007)UK NHS

&Science

data

not yet in

NHS

OtherGovernment

DeptsExternalSupportServices

Direct ServiceDelivery Links

LocalAuthorityServices

DCAfMOD

DoH

LogisticsEstatesManagement

AuditCommission

Other NHSOrganistiaons

Connectingfor Health

PublicHealth

EducationDepartments

Housing

SocialServices

HomeOffice

v

Courts

Police

YoungOffenders

Teams

NPSA

HealthcareCommission

Schools

Higher /Further

Education

EducationPsychology

DomicillaryCare

MentalHealth& LD

AdultServices

OlderPeople

Services

Childrens

Services

PPA

DrugCompanies

Prosthetics /ApplianceSuppliers

PrisonService

DFES

ManagementServices

Non-StatutoryOrganisations

IndependentService

Providers

Charities

Patients

Relatives& Carers

SpecialEducationNeeds

Research

PrivateHospitals

ForcesHealthcare

NICE

NHS - includes:Primary Care

Acute CareMental Health

& AmbulanceServices

TribunalsService

Dentists

Opticians

InformationCentre

Chiropodists

Physio-therapists

Other HealthServices

Pharmacies

DeFRA

PrisonHealthcare

DWP

Home OfficeService

Contacts

NHS ServiceContactsHigh-level Map

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Collective action challengese.g. Stakeholders in vaccine introduction

(Mexico; Conway) International :

GAVI Alliance, Pan Americal Health Organization (PAHO) UNICEF, WHO

National: Ministry of Health Mexican Insitute of Social Security Insitute of Social Security and Services for Civil Servants Finance and legislature

Local local medical and research experts

Medical private sector Vaccine producer

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work-system

change

methodology

Real site work system:

Health care systemAfrica

site specificreference model

s

ProblemIdentification

Analysis anddiagnosis

InterventionImplementation

Plan of actionDesign

Evaluation/ Monitoring

reference model

Translation

SiteSpecific

PRM

Peer Intelligence

(Market, Science,Roadmap,

Benchmarking,..)

Problem

/GapRegister

PRM

- Pico level- Micro level- Meso level- Macro level

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needa

socio-

technicaltransition

HC Monitoring &Evaluation

Currently FragmentedGoals & Initiatives

HC ChangeSystem:

CurrentlyChangeProjects arePerformedSingly &Severally

HC Operations Currently Under

Performing

Low ProductivityHealth Workers

Lack of HealthWorkers

Poor RelationKnowledge Base &Clinical Practice

As is withPressurepoints

HC Monitoring &Evaluation

Align Goal & Initativesin SociotechnicalLandscape

HC ChangeSystem

EstablishProgrammEnabledapproach forchangeprojects

HC Operations Performing Increased Productivity

Healthworkers Reduce cost and time

of healthcareeducation

Improved KnowledgeTranslation

To Be

Transition

Scorecards

Contribution:Guidelines for scorecards

Contribution:Roadmap & Option Exploration

Contribution:Stakeholder Awareness

Contribution:Case Test of Openarchitechture&Methodology

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Who is

involved?

United Nations WHO

A_Gov A_NPHI

Human

Patient

HealthWorker MedicalTrainerParaMedWorker Physician

Trainer

Company

C_educ_est

C_hospital CM_educ_est C_med_research

Researcher

Agency

A_educ_min

C_risk_pool

Unesco

pico (Pi)

micro (Mi)

meso (Me)macro (Ma)

http://www.pragmetaknowledgeclout.be/picohttp://www.pragmetaknowledgeclout.be/microhttp://www.pragmetaknowledgeclout.be/mesohttp://www.pragmetaknowledgeclout.be/macrohttp://www.pragmetaknowledgeclout.be/macrohttp://www.pragmetaknowledgeclout.be/mesohttp://www.pragmetaknowledgeclout.be/mesohttp://www.pragmetaknowledgeclout.be/mesohttp://www.pragmetaknowledgeclout.be/microhttp://www.pragmetaknowledgeclout.be/picohttp://www.pragmetaknowledgeclout.be/picohttp://www.pragmetaknowledgeclout.be/pico

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Facilitate: Scan Globally

Reinvent Locally

(ref. J. Stiglitz)

Pi_life_S

United Nations

MeM_MedicalKnowledg

eProvision

Pi_TreatmentDeliveryPi_HealthyLivingLea

rning

Macro-Nation

uses

Pi_TreatmentDeliveryLearning

MaG_GlobalPublicGoodsProvision

Pi_healthwork_S

MaN_NationalPublicGoodsProvision

Pi_TreatmentParticipation

Mi_Edu_S

Mi_HealthyLivingTeaching

Mi_MedResearch_S

Mi_TreatmentServices

Mi_Hospital_SMi_MedicalResearch

Mi_MedEdu_S

MiPMEL_CareCureDeliveryEducation

Me_Nat_KnowledgeStreaming

Me_Nation_Edu_S

Me_MakeResAwareGuidelines

Me_Nation_Medical_S

Me_ProvideTreatmentDefs

Me_Globe_Medical_S

Macro-Global

TreatmentPathRepository

MedicalGuidelineRepository

MedicalKnowledgeRepository

RAGuidelineRepository

*

*

usesuses

*

*

**

*

*

usesusesuses

**

uses uses

Pi_research_S

Pi_Research

GuidelineRecommendations

NatEduProg

uses

Me_Globe_Edu_S

GlobEduProg

Me_GlobKnowledgeStreaming

uses

A_Gov

- the pathways from

science data tohealth outcomes?

-bi-directional

interactions as foundationfor improved

health outcomes

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Further work inform/support WHA61.21 strategic plan

contribute to collaborative diagnostics and

collaborative therapeutics for related literature see: http://www.citeulike.org/group/4365

on Integrative Expertise for Global Health

on health in the society-wide architecture context:

http://www.pragmetaknowledgeclout.be/global-health

http://www.pragmetaknowledgeclout.be/collaborative-diagnosticshttp://www.pragmetaknowledgeclout.be/collaborative-therapeuticshttp://www.citeulike.org/group/4365http://www.pragmetaknowledgeclout.be/global-healthhttp://www.pragmetaknowledgeclout.be/global-healthhttp://www.pragmetaknowledgeclout.be/global-healthhttp://www.pragmetaknowledgeclout.be/global-healthhttp://www.citeulike.org/group/4365http://www.citeulike.org/group/4365http://www.pragmetaknowledgeclout.be/collaborative-therapeuticshttp://www.pragmetaknowledgeclout.be/collaborative-therapeuticshttp://www.pragmetaknowledgeclout.be/collaborative-therapeuticshttp://www.pragmetaknowledgeclout.be/collaborative-diagnosticshttp://www.pragmetaknowledgeclout.be/collaborative-diagnosticshttp://www.pragmetaknowledgeclout.be/collaborative-diagnosticshttp://www.pragmetaknowledgeclout.be/collaborative-diagnostics