The science of large-scale change in global health.

摘要

Nnovation in health care includes important chal- lenges: to find or create technologies and practices that are better able than the prevailing ones to reduce morbidity and mortality and to make those improvements ubiquitous quickly. In many respects in the pursuit of global health, the second challenge-the rapid spread of effective changes-seems to be the greater. Many sound (even powerful) solutions exist, such as new medicines and innovations in health care delivery, but their adoption is unreliable and slow. Often, they remain hidden in pockets around the globe, flourishing locally without reliably reaching those in need elsewhere. Some such solutions come from biomedical research, but even more take shape at the point of care, in settings where local problem solvers create effective new approaches to problems that odiers who live far away face as well. Failure to deploy improved technologies and practices widely and quickly is a form of waste that donors, researchers, clinicians, and, most of all,communities in developing nations cannot afford. It behooves those who sponsor biomedical science to make commensurate investments in operational sciences that can inform and energize the active dissemination of new solutions. This is a crucial, but as yet largely neglected, global project: to rapidly spread effective prototypes to entire populations. Scaling up should become a major and sustained enterprise in the global health community. It has its own scientific foundations.