Knowledge is power
In business, knowledge is power, because it is the basis for competitive advantage. A telecom company that has developed a software that analyses big data to identify key customer segments will zealously guard the code from competitors. If a maker of food sauce knew how to put that special zing into the product—why would they tell the world? If a pharma company created a new molecule, it wouldn’t want to give that away in a hurry. Mostly, this is rational business thinking. And intellectual property rights need to be honoured.
The situation in the public health arena is similar, and yet, entirely different. There too, knowledge is power—it is the power to save lives. This knowledge must be captured and given away to others. That is rarely the case. This week’s column lays out the case for a knowledge exchange.
There are hundreds of excellent public health delivery programmes across the country. They deliver products and solutions that can save lives or prevent compromised health trajectories, on a large scale. It could be a programme run by a tiny non-governmental organization (NGO) working in a few villages or something as large as India’s polio programme. Big or small, all such programmes generate insights into the problem, and offer solutions.
I am not talking about scientific data coming from randomized control trials of new drugs or vaccines. I refer to the “dirt under the fingernails”, everyday knowledge that comes from delivering services at the grassroots. This is the know-how about methods to analyse data, improve facilities, involve communities, evaluate programmes, or organize better.
How wonderful if programmes across India, large and small, would share such knowledge in real time! Having visited hundreds of grassroots programmes, what I have seen is both exciting and frustrating. Recently we visited the Rajiv Gandhi Mahila Vikas Pariyojana, an organization in eastern Uttar Pradesh, doing innovative work with women’s groups focusing on health and savings—heard of it? Are the lessons from data use and community involvement from India’s amazing polio programme being systematically absorbed by others in the health sector —probably not. Visiting two maternal and child health programmes funded by a single donor in two states, I was asked by the managers in one what I had learnt from his colleagues across the border! I’ve seen brilliant innovations in tiny village programmes in the south that could inform much larger programmes thousands of miles to the north.
Instead, wheels are being reinvented everyday. Sometimes programmes say—“Yes, we do get visitors, and we do some training”. That’s good but misses the point. Saying “yes” to a visit request or training a batch of front-line workers for another small intervention is different from documenting methodologies and outcomes and making that information open source. Besides, how is anyone to even know that there is a programme worth visiting somewhere?
There are two sides. The first is that the very culture of data sharing is missing among many donors who fund implementation programmes. They insist on rigorous implementation but view the documentation and dissemination of methods as a frill, and not as a public health obligation. Conversely, many implementing NGOs lack the skills required to capture and disseminate their own programme’s knowledge. This is a specialized task that spans both quantitative and qualitative analysis, peer reviewed scientific publications, use of community voice, and leverage of social media.
There is need for a solution—call it the knowledge exchange. Envisage an ever-growing network of programmes, big and small, sharing knowledge, and working on a non-profit basis. That could be done digitally, through bilateral partnerships and benchmarking visits. The exchange would operate on a subscription basis—with the fee ranging from zero upwards, depending on the means of the participant.
Why would anyone subscribe to such a network? Self-interest. Donors would over time insist that any agency that submits a proposal be part of the knowledge exchange because that would bring best practices and partnerships. Implementing agencies would want to learn, make sure their programmes are both more efficient and effective. They would have the satisfaction of seeing their innovations travel widely. Government would know where to tap knowledge to in\form itself. There is every reason for this to become a global network.
A self-funding, organically expanding, virtuous, knowledge network—I’m excited at the prospect! As a first step, we are creating a collection of 50 programmes that look like they have plenty to share, making field visits to each of these exemplars. We are also looking at the work being done in this area by the UN system and others. Many can help. Business can bring network thinking to the design. Programmes could offer themselves for study.
In business, private knowledge controls markets. In public health delivery, shared knowledge can save lives.
Ashok Alexander is founder-director of Antara Foundation. His Twitter handle is @alexander_ashok.
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