Rebecca Weintraub is executive director of the Global Health Delivery Project, an associate physician in the division of social medicine and health inequalities at Brigham and Women’s Hospital, and an instructor in medicine at Harvard Medical School. Co-founder of Jumpstart, the largest part-time AmeriCorps program in the nation, she currently serves as a technical advisor to Ashoka, promoting the work of health entrepreneurs.

Q: In your view, what are the major obstacles to the uptake of new tools, strategies and interventions for the control of diseases of poverty?¨

A: Implementers in resource-poor settings struggle amidst critical workforce shortages and deficient infrastructures to provide the best care possible under extreme conditions. Poor access to new learning in medical knowledge – either from lack of access to the Internet or lack of access to subscription-based medical journals – are just a few of the major obstacles to the uptake of new tools, strategies and interventions that would improve health outcomes in resource-poor settings.

Implementers in developing regions often have limited access to the palette of information resources that most medical practitioners rely upon. In addition to traditional resources such as medical grand rounds and textbooks, we now check our emails for listserv messages, search the literature (e.g., PubMed), and read open-access and or subscription-based journals. We even join dedicated networks, the largest in North America arguably being UpToDate, boasting more than 385,000 users. UpToDate® is an online evidence-based, peer-reviewed information resource that synthesizes the latest medical literature and recommendations for patient care, covering more than 7,700 topics in 15 medical specialties. Of course, this kind of information comes with a pricetag, but the potential benefits to patients is undeniable.

The lack of a systematized, evidence-based approach to designing, implementing, and improving health care delivery programs in resource-constrained settings is an additional impediment to getting proven tools and knowledge to implementers.

Q: How do you see implementation research contributing to minimizing the barriers related to access and delivery of new tools, strategies and interventions for the control of diseases of poverty?

A: Although there has been an influx in global health investments over the past decade, little funding has been allocated to health delivery research. There have been tremendous advancements in clinical tools and new treatments that could save millions of lives around the world, but a stark discrepancy exists between developing these tools and getting them to the implementers and patients who need them most. The reasons for this “implementation gap” are manifold, mostly related to the economic, social, and political contexts of low resource communities.

The Global Health Delivery (GHD) Project (www.globalhealthdelivery.org) was created in 2007 to help bridge this implementation gap by laying the groundwork for a robust field in the study and practice of global health delivery. GHD takes a multidisciplinary approach to minimizing barriers to quality health care through three core work streams: multidisciplinary case-based research; curriculum development and education; and knowledge dissemination through GHDonline.org.

Central to GHD’s mission is the development of curriculum and courseware to educate future global health leaders. GHD cases provide a strategic understanding of the factors, decisions and inputs that influence success of global health service delivery models. In teaching, cases enliven and deepen class sessions and they expose students to core principles of strategy, management, and operations. In combination with their professional studies, students can leverage this database of cases to conceptualize or build effective health delivery systems.

GHD’s innovating collaboration platform, GHDonline.org, links professionals working to improve the delivery of health services in resource-limited settings. Each of the site’s eight public communities focuses on a critical clinical challenge and is guided by a team of expert moderators. GHDonline also hosts more than 25 private communities for specific organizations and collaborative initiatives, such as the Clinical Exchange community, which links physicians in Rwanda to Boston-based specialists. GHDonline.org has also formed a partnership with UpToDate, which allows organizations providing medical services in resource-limited settings to apply for free subscriptions to UpToDate through GHDonline.

The dialogue and resources posted to GHDonline are integral to our efforts to generate new knowledge about implementation. Our vision is to gather together and build upon the practical know-how and knowledge that we all exchange, but that never gets published, archived, or updated, and to provide a hub for professional content by partnering with leaders in the field. The site so far has 3,000 members representing 1,000 countries in over 125 countries. It is my hope that such a dedicated, free and non-partisan initiative, built and maintained by implementers, will pave the way to more knowledge transfer and collaboration on a global scale.

Q: This effort is about to bring together stakeholders around implementation research for access and delivery of new tools, strategies and interventions for the control of diseases of poverty. What can you say about that?

A: Gaining access to new tools, strategies and interventions in global health is just the starting point to improving delivery mechanisms on local and national levels. Because practitioners and program implementers – Ministries of Health, NGOs, multilateral organizations, for example – are often scattered and uncoordinated in developing regions, the need is still very great for aligning these actors and integrating best practices to form a strategic approach. Bringing together stakeholders around implementation challenges and reviewing the new tools, resources and interventions that are available is the first step in starting to coordinate these various actors in global health delivery.

Q: What difference might this effort make?

A: This effort could catalyze new criteria, user-generated ratings, and an “Angie’s List”-like forum to catalog and discuss which tools are available and how to best adapt and implement them in resource-limited settings.