Communities of Practice: the Missing Link for Knowledge Management on Implementation Issues in Low-Income Countries?

Topics: Medicine, Health economics, Knowledge management Pages: 24 (6283 words) Published: April 15, 2013
Tropical Medicine and International Health


volume 16 no 8 pp 1007–1014 august 2011


Communities of practice: the missing link for knowledge
management on implementation issues in low-income
Bruno Meessen1, Seni Kouanda2, Laurent Musango3, Fabienne Richard1, Valery Ridde2,4 and Agnes Soucat5 1

Institute of Tropical Medicine, Antwerp, Belgium
IRSS, Ouagadougou, Burkina Faso
WHO-AFRO, Libreville, Gabon
University of Montreal, Montreal, Canada
African Development Bank, Tunis, Tunisia


The implementation of policies remains a huge challenge in many low-income countries. Several factors play a role in this, but improper management of existing knowledge is no doubt a major issue. In this article, we argue that new platforms should be created that gather all stakeholders who hold pieces of relevant knowledge for successful policies. To build our case, we capitalize on our experience in our domain of practice, health care financing in sub-Saharan Africa. We recently adopted a community of practice strategy in the region. More in general, we consider these platforms as the way forward for knowledge management of implementation issues.

keywords knowledge management, user fee, community of practice, implementation science

The 2000 Millennium Summit and the MDGs have created
a strong momentum for programs and strategies addressing major health problems in low-income countries, at global, regional and country level. At global level, massive efforts have been made by the scientific community to

clarify what interventions should be prioritised. The
evidence is often robust (Jones et al. 2003; Campbell &
Graham 2006). At country level, several heads of state of
sub-Saharan Africa – where the health care battle is most
tense – have taken bold action to accelerate progress
towards the health MDGs. In many countries, this trend
only seems to accelerate as 2015 approaches. This political
dynamic in the south matches a parallel momentum in the
north, sometimes accompanied by significant financial
commitment (Sachs & McArthur 2005; Lancet 2007).
This scientific and political leadership is most welcome.
Yet, it will not suffice. The countries lagging behind the
most in terms of human development are often also those
where operational constraints are most binding. Bold
decision-making by governments may eventually lead to
disappointing results if implementation of necessary

ª 2011 Blackwell Publishing Ltd

reforms lags behind. This article advocates better implementation of policies in low-income countries through better knowledge management. To make our point, we
start from our own domain of practice, health care
financing and zoom in on the recent decision by several
governments to remove user fees for some key health
interventions. We will show that implementation constraints are severe and that knowledge management (KM) – here understood as ‘‘the discipline of enabling individuals, teams and entire organizations to collectively

and systematically capture, store, create, share and apply
knowledge, to better achieve their objectives’’ (Young
2008) – has been far from satisfactory in many cases. We
will then rapidly review what is problematic about the
current practice of KM at national and international levels. Our assessment is based on our experience, but many issues
we raise will probably sound all too familiar to many
experts in the region. We then share with the readers the
approach we are currently taking with a growing group of
actors in sub-Saharan Africa. Our hypothesis is that the
community of practice strategy could be a real breakthrough for managing knowledge on implementation challenges.

Tropical Medicine and International Health

volume 16 no 8 pp 1007–1014 august 2011

B. Meessen et al. Communities of practice

Removing financial barriers to accelerate progress...
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