I think this topic is of real significance, but I wonder to what extent the lessons learned from past experience are sufficiently generalizable. Setting aside the question of whether the research conclusively points toward a necessary change (which is another very significant and interesting topic), I think approaches will vary based on a number of complex factors including:
1. What is the operational level of the change you are seeking?
Who has the authority to implement the change? Is the intervention or change something that can be implemented by individual practitioners (e.g., physicians, public health officials), or does it require a policy approval or decision within an organization (e.g., a hospital, clinic, or agency), or is it something that needs to be agreed upon or enacted at the association or government level?
2. What are the political and personality factors among the individuals and organizations that have the authority to approve the change or not?
This is going to vary everywhere, but I think lessons can be drawn from experiences in which people have overcome obstacles among different personality/obstacle types (e.g., individuals who will only act if they see something in it for themselves, individuals with a vested interest in keeping the status quo, individuals who are just set in their ways and don't want to be bothered).
3. Who are you?
Are you an insider/part of the system and what is your institutional relationship to the authorities you are trying to influence? Or are you an outsider (from a foreign-financed NGO or an independent entity) and what is your reputation, what kinds of leverage/incentives do you have available?
There are a wide range of approaches that might be appropriate depending on the answers to the questions above, and it would be useful to develop a toolkit (describing the different types of interventions) together with a number of brief case studies providing examples of different approaches used at many of the different operational levels and local settings in which changes have successfully (or even unsuccessfully) been promoted.
In my own past experience, which focused on promoting the use of evidence-based clinical guidelines at the institutional hospital or clinic level, our approach was to (a) identify and promote individual champions within the institution and (b) learn about existing quality review processes and try to find ways to engage within them to promote change. But if we had been doing something at the city, regional, or national level our approach of course would have been quite different.
P.S. It's been more than a decade since I've engaged with HIFA because my career took me in other directions for a while, but I've stayed on the HIFA mailing lists because it's a cause I've always felt passionate about. I'm excited to be back and firmly rooted in global public health, and I look forward to engaging with all of you more proactively again!
Senior Research Associate, Department of Epidemiology, Milken School of Public Health, George Washington University
Managing Director, HealthConnect International, http://healthconnect-intl.org/
MPH Program, Milken Institute School of Public Health, George Washington University
HIFA profile: Mark Storey has designed, implemented, and evaluated ICT for health programs for over fourteen years. As the former Director of ICT Programs at the American International Health Alliance, he created the Learning Resource Center project, which established ICT capacity at over 160 health organizations in Eurasia and Africa, and the EurasiaHealth Knowledge Network, an online clearinghouse and virtual community supporting health professionals in the Eurasia region. He has directly provided consulting support for health ministries in Albania, Eritrea, Kyrgyzstan, and Turkmenistan. He specializes in program design and management, evaluation and assessment, information architecture, and sustainability training.
[*Note from NPW, moderator: Thank you Mark for this thoughtful contribution, and welcome back! For your HIFA profile I have borrowed the text from http://healthconnect-intl.org/team.html as this is more uptodate than the one we have.]