K4D AS AN ORGANIZING PRINCIPAL FOR SECTOR PROJECTS

In several past postings I have been musing about the World Bank view of Knowledge for Development, and specifically how the ideas related to the project cycle. I suggested that K4D works well as an analytic framework, and that related project work is done in ICT infrastructure development, higher education, and science and technology.

I would like to suggest here that K4D also might work well as a project level approach in specific sectors. That analysis might also suggest ways that the K4D conceptual framework might be improved. Consider the health sector. Below I address some of the key issues defined in the Development Gateway, Knowledge Economy Topic Page:
(http://www.developmentgateway.org/node/130667/) and how they might be utilized in a health sector context.

Knowledge Strategies: One might consider both
· “health sector strategies for knowledge”: The issue is what kinds of strategies in the health sector would encourage strengthening of knowledge systems within the sector. These might include professionalization strategies for health professions, strategies that encouraged ICT utilization within the sector, etc.
· “knowledge based strategies for health”: Thus one might emphasize the importance of improving the bases for health policy from epidemiology, health economics, medical sociology, etc.
Project activities could include training, technical assistance, and other institution building activities to strengthen knowledge strategies in the sector.

The approach could also be extended, perhaps in less common areas. In developing countries, pharmaceutical distribution is often done through direct purchase from unregulated pharmaceutical retailers. While in the U.S., perhaps one-third of people use “alternative medicine” some of the time, while many more people utilize the services of curers, traditional birth attendants, bone setters, and other non-physician practitioners in developing nations. A “knowledge strategy” for the sector might focus on how to reduce the amounts of these practices based on bad, or unvalidated information. Thus one might seek ways to improve the information available to consumers about pharmaceuticals bought without prescriptions, or one might find ways to diagnose erroneous information held by traditional practitioners and to correct the dangerous errors. I predict that there could be rich approaches to project development using such approaches.

ICT Infrastructure: Telemedicine, improved applications of ICTs health planning and administration, electronic media applications in health communications all come into play, and could be the focus of project activities.

I think improvement of health information systems might be a broader and more useful concept than ICT infrastructure. These information systems include epidemiological information systems that provide nations with pictures of the distribution of diseases; systems for the reporting of the amount and nature of hospital and outpatient service in the nation; financial data systems dealing with health service expenditures, etc. Projectizing improvement of health information systems would fit very well within a health K4D approach.

Intellectual Property Rights: IPR concerns are important in the area of pharmaceuticals and perhaps to a lesser degree, medical equipment and medical devices, and so could be included in a Health K4D project.

I would suggest that there are a number of related knowledge institutions that might also be considered. One would be drug licensing, and strengthening of food and drug administrations might be considered in a K4D health project. Another would be standards, and improving the ability of developing nations to measure pharmaceutical quality, and to define standards for pharmaceutical products. In the health sector, one faces problems of assuring that materials maintain their potency through the factory to patient chain, such as the problem of assuring that vaccines have in fact been protected by the cold chain, and not degraded by being overheated during transport to the location in which they are to be used. There are similar concerns for assuring that clinical laboratories are up to standards, and that diagnostic devices such as x-ray machines are properly calibrated. A health sector K4D project might profitably deal with a variety of such issues, and indeed it could deal with the capital investment needed to build the infrastructure needed for these aspects of the health system.

Innovation policy: I suggest that policies that encourage innovation in health service delivery are in many ways analogous to those that encourage innovation in the private sector. Indeed, there are aspects of the health sector that are often private sector, such as private medical practice, pharmaceuticals, medical equipment, traditional health practitioners, and health insurance. Moreover, all the information on innovations in the public sector can be brought to bear. (See in this respect the Development Gateway Portal’s Innovations for Development page: http://www.developmentgateway.org/node/135268/)

Lifelong Learning and Higher Education: Education of health practitioners (doctors, dentists, nurses, pharmacists, public health officials, etc.) is of critical importance in the health sector, and could benefit from the thinking being done about restructuring higher education and continuing education programs utilizing K4D concepts. I would place special emphasis on the role of distance education in these activities. Again, this would be a rich area to explore for project components in a health K4D project.

In the health sector, there are important educational functions carried out by the professional associations, such as medical and nursing associations. Project activities could focus on improving the institutionalization of such functions. Similarly, licensing plays an important institutional role in assuring that professionals maintain up-to-date technical knowledge and skills, and a health K4D project could help improve such systems. I would also note that there is a great deal of technical information transferred within the material supply systems in the health sector. Thus, “detail men” and other functionaries in the pharmaceutical industry provide considerable information on new drugs as part of the marketing of their products to pharmacists and physicians. A focus on the knowledge systems in the health sector might well help to identify project activities that could improve the knowledge flows through a variety of relatively novel mechanisms to improve human capital in the sector.

Science and Technology: Biomedical research, epidemiological research, health service research, and other areas of health science could be supported within a K4D health sector project approach. Focus on technology in the health sector has traditionally been limited to concern for medical and clinical devices. Indeed, there are important economic issues in terms of the appropriate imaging technology to different epidemiological, economic and clinical circumstances. I would suggest however, that much of the area of medical quality assurance deals with issues of whether the appropriate technology is embodied in the health practitioners, equipment, facilities and supplies brought to bear on patients with specific needs. Again, a K4D health project focus might suggest interesting and useful S&T activities to improve health care.

K4D approaches should of course deal with direct empowerment of the people, and especially the poor, with knowledge – not just with knowledge in bureaucratic and market systems. In the case of the health sector, one might look at the way in which radio and other media are used to provide better health information to the general public, as well as to health education in such locals as the schools, clinics, pharmacies, and practitioners’ offices.

I think that in the health sector, a K4D project development approach would be quite novel, and might result in implementable projects with unusual impact and cost-effectiveness.