What know
Building Knowledge Infrastructure in Global Health

Normative or Agregative Model ?

— Grégoire Lurton

Quick Positioning

Research of a Global Health Metrician

  • Statistical Development
  • Core of my current work. Research on methods to measure different dimensions of health

  • Tool Development
  • Short term consulting projects

  • Statistical Infrastructure Development
  • 5 years of HIV monitoring strengthening in Guinea, Mali, Niger and Sierra Leone with Solthis

Present research questions

  1. How do we create independent and well perfoming statistical infrastructures in low resource health systems ?
  2. How can we offer an internal critic framework for statistical knowledge in these systems

Evidence Based Policy ?

Much of the material remains unprocessed, or, if processed, unanalyzed, or, if analyzed, not read, or, if read, not used or acted upon. Only a minuscule proportion, if any, of the findings affect policy and they are usually a few simple totals.
—Robert Chambers, 1983

Modes of Local - Global Interaction ?

Local Global Local
Back and forth Develops Policy Provides funding Documents Policy Results
Compiling and transmission Documents Policy Results Compiles Best practices and formulates recommentation Integrates best practices from other countries
Knowledge Transformation Produces local epidemiological Data Models Global Burden of Disease Investigates dark spots of GBD
Methods update Designs local method Integrates local methods in global practices Chooses appropriate methods

Asymetry in interaction

Some examples :

  • Academic Legitimity
  • Most big academic players in the Global North.

  • Technical Role
  • Norms and classifications produced in the Global North

  • Financial Power
  • Global Fund will fund 5 years of HIV program if you commit to report a couple "simple" indicators

Lost to Follow-up

Concept Transplantation 1 - Analysis

 

"However, performing large studies in developing areas is challenging. One major problem is that many mothers and their infants are lost to follow-up."

Concept Transplantation 1 - Analysis

 

"However, little has been reported about patients who do not adhere to care, fail to attend their scheduled consultations, or are lost to follow-up. In most studies of patients on antiviral therapy only those lost to follow-up in clinical trials were considered."

Concept Transplantation 2 - Noticing a problem

 

"However, accurate estimates of patient survival and other clinical outcomes have been difficult to obtain, as they are significantly impacted by patient loss to follow-up."

Concept Transplantation 2 - Noticing a problem

 

"Loss to follow-up is an important problem both for the care of individual patients and the evaluation of antiretroviral treatment programmes in low- and middle-income countries."

Concept Transplantation 3 - Looking for a new concept

 

"However, the degree to which different measures of retention are related to outcomes, and to one another, among the same sample of HIV-infected patients is largely unexplored."

Concept Transplantation 3 - Looking for a new concept

 

"Our recommendations for LTF definition are to base the definition on the study/programmatic outcome of interest, available encounter data, and the cohort visit schedule. Except in the context of collaborative networks,we do not advocate a universal standard as the definition of LTF should depend on the intended application and the cohort(s) of study."

Methods transplantation

Outcome for local statistical systems

  • Statistical Infrastructure
  • Not built, just ad-hoc systems with little local ownership

  • Division of computational work
  • Upside down, low skilled workers bear the burden of computation

  • Monitoring role
  • Not fulfilled, low validity

From Norm to Aggregation

  • New computational Tools
  • Accessibility of powerful methods to understand complex systems (ex: Agend Based Modeling)

  • New Work Methods
  • Reproducible research methods allow tracking of data and computation methods, and reproducibility and adaptation by different actors

  • New models of collaborative work
  • Open Source software development, co-construction of output, flexible norm