A learning world for the Global Fund

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7355.55 (Published 13 July 2002) Cite this as: BMJ 2002;325:55

Decentralisation and a coordinated programme for learning is the way forward

  1. Donald M Berwick, president and chief executive officer (dberwick@ihi.org)
  1. Institute for Healthcare Improvement, Boston, MA 02215, USA

    Global investment may finally be surging in the fight against AIDS, tuberculosis, and malaria. With new resources in hand, people, programmes, and nations engaged in that struggle have a choice to make. They can act separately, doing their best for the communities they serve with a share of the fund, or commit themselves to working and learning together across boundaries.

    This is not a choice between decentralisation and centralisation. Decentralisation is the only way to fight these diseases effectively because their causes and treatment reach deeply into local communities. Without local action there can be no effective action.

    Nor is it a choice between grass roots and top down strategies. Multidrug treatment, social support, and prevention can work well only when local people adapt programmes to local conditions, using their intelligence at the point of care and service. What works in the streets of Nairobi may not work in the villages of Zimbabwe. The details matter, and people too far from the frontline cannot get the details right.

    But decentralised action need not be isolated action, and grass roots intelligence need not be a secret. In modern corporations, the best results come when a motivated, trained, and empowered workforce gets the right help from leaders so that people can …

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