The reckoning: Improving the World Health Organization's tuberculosis control *policy through practical knowledge.

摘要

Is it possible on a global scale to improve the lives of our most vulnerable and impoverished citizens? One fundamental challenge is to create dynamic political institutions that learn incrementally from policy failures. This dissertation shows how international institutions can learn. It explores how the World Health Organization learned to create a more effective tuberculosis control policy.;WHO strengthened its ability to learn by more deeply and widely engaging with knowledge entrepreneurs through the Stop TB Partnership. WHO accessed practical knowledge through the presence and persistence of Partners in Health (PIH)---a highly critical and pragmatic private organization within their policy network.;First, PIH gained practical knowledge because its commitment to human rights empowered it to see public health problems that WHO did not see and to partner with community activists to implement public health projects. Second, as multi-disciplinary scholars, PIH was able to analyze, act upon and communicate this practical knowledge persuasively and credibly to WHO. Third, PIH engaged strategically to develop and further accelerate policy changes in the UN system writ large and collaborated with NGOs and foundations sympathetic to their perspectives thus enabling and empowering their research and credibility at WHO.;An enabling environment outside these policy relationships empowered critical voices at the table. Specifically, two external conditions were important: an ideational environment that complemented the agenda of critical partners and external critiques of the organization's responsiveness and effectiveness.;WHO's experience in defining TB management strategies demonstrates that international organizations can learn when they create networks of public and private organizations that improve their access to practical knowledge. Practical knowledge reflects the lessons and perspectives of those who receive and implement policy. International organizations may access this practical knowledge through knowledge entrepreneurs.;International organizations, like the World Health Organization, can learn to improve their policies through trial and error policy development by learning incrementally through policy failures. NGOs with these dispositions and skills can contribute to developing and implementing effective global policy at international organizations. Such contributions strengthen transnational state-based institutions by improving their practical legitimacy amongst policy implementers and thus their capacity to govern.