A learning world for the Global Fund

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 learn from and teach each other, measure progress, share lessons and good and bad news openly, and celebrate together. Modern management theorists call such a place a learning organisation.

Can we have learning nations or even a learning world?

The Global Fund to Fight AIDS, Tuberculosis, and Malaria¹ can multiply its chances of success and impact by establishing a global system for learning, measurement, exchange, and training among the people who tackle these diseases at the national, regional, district, and local level. Investors in the global fund have a right to expect results and a programme for worldwide learning would improve the odds.

The mission of such a programme would be to multiply the effectiveness of the global fund by creating and supporting a learning world, in which skills, information, and designs for the continual improvement of the prevention and treatment of these diseases are freely exchanged and actively spread within and among all nations.

A programme for worldwide learning would have four elements.

Building capability

The programme would continually increase the skills and knowledge of national, regional, and local leaders to foster change and innovation.

A global fund fellows programme would be established with about 100 fellows per year, both clinicians and non-clinicians. They would be chosen from national officials (for example, the ministry) and regional leaders (for example, district medical officers) who have responsibility at their level for fostering the programmes. Fellows would meet for three weeks twice a year and remain connected thereafter as alumni to exchange ideas through the internet and by convening side sessions at appropriate meetings.

In addition, the programme would collect, republish, and supplement existing training manuals and other educational materials for local health workers, establish and support national and multinational training workshops, and identify and make available tools for measurement and improvement, such as database systems and registries. In all cases, the primary methods of the programme would not be to invent resources de novo but rather to identify, collect, and spread existing training models and resources from field programmes and academic settings throughout the world.

Supporting action

The programme would establish and support an expanding series of collaborative action projects, involving improvement teams from within and among nations, to help them encourage and learn from each other, and to identify and share best practices and promising new models.

To accomplish this, the programme would maintain a portfolio of multinational improvement collaboratives, initially 15 per year, each with about 50 improvement teams—10 teams from five nations in a specific geographic area. These collaboratives, adapted from successful models in the United States,² the United Kingdom, and elsewhere³ would last for a year, meet twice in face to face conferences, and remain connected through the internet and telephone calls. Collaboratives would provide access to experts and social support for improvement and learning and would involve people at the frontline of care focusing on measurement and results. Within three years, over 1000 improvement teams would have participated in such collaborative action. To ensure that improvement efforts would spread faster, the programme would establish and maintain a collaborative college, to train national and regional leaders to support local collaborative projects.

Documenting and improving system designs

The programme would establish and maintain a design centre for concepts and processes for combating AIDS, tuberculosis, and malaria, especially in local settings.

The design centre would gather ideas from local settings with the help of local leaders and develop models based on what it found. A tight international network of design teams would identify, study, and document a wide array of local models of best practice for care and prevention of the three diseases from throughout the world. The design teams would find such models by visiting local programmes, assembling experts from non-governmental organisations and governments, and linking to the collaborative improvement projects sponsored by the programme.

Spreading knowledge

The programmes would spread knowledge among people taking action at local, regional, and national levels at no cost to the user, with full transparency and by many means.

The main mechanism of spread would be through the internet, with options suitable to many existing levels of technology and band width. Resources available would be online learning options, ways to participate in virtual collaborative projects, and the carefully archived findings of the design centre. Internet based systems to spread knowledge would complement conferences, publications, and other established vehicles for exchange.

The potential target audience to participate in the programme could comprise thousands of people, initially in over two dozen nations. Among them might be ministry officials and national clinical and public health leaders; clinical and public health leaders at the regional and district levels within countries; clinicians and programme leaders in local communities.

An effective programme for worldwide learning would give the world a way to capture and spread the skills and ideas that the global fund will help to generate, valuable resources that otherwise may well remain local or be lost. Its purpose, in a sense, would be to avoid waste—of talent, imagination, and hard won experience of several thousand people struggling together to achieve the aims for which the global fund was established.