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Adam Wagstaff's blog

How can health systems “systematic reviews” actually become systematic?

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From Karl Pillemer’s post on Cornell’s Evidence-Based Living blogIn my post “Should you trust a medical journal?” I think I might have been a bit unfair. Not on The Lancet, which I have since discovered, via comments on David Roodman’s blog, has something of a track record of publishing sensational but not exactly evidence-based social science articles, but rather on Ernst Spaan et al. for challenging the systematicness of their systematic review of health insurance impacts in developing countries. It’s not that I now think Spaan et al. did a wonderful job. It’s just that I think they probably shouldn’t have been singled out in the way they were.

Who’s writing what in the ‘Knowledge Bank’? And is it being used?

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An organization with ‘motor company’ in its name might produce several types of vehicle (cars, trucks, etc.) in several variations (models) at several different plants, and might sell these vehicles in several different regions of the world. The company wouldn’t last long if it didn’t know how many of each model – and at what cost – it was producing in each plant, and how many – and at what price – it was selling in each region. In the World Bank – where we like to think of ourselves as the ‘knowledge bank’ – we produce several types of document in several vice presidencies (VPUs) and we make them available in hard copy and in electronic format in all regions of the world. Yet as far as I know we don’t systematically track how many of each document type each VPU produces, let alone how successful each is in terms of sales and downloads. We have these data for World Bank books, but they’re a small fraction of our overall document output.

The lack of data ought to make it hard to think about how the institution might do things differently in its knowledge work to serve developing countries better. What type of Bank documents are produced most? And which are used most? Which VPUs are the big producers of knowledge? Which document types are downloaded most? Which VPUs produce the most downloaded documents?

Should you trust a medical journal?

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While we non-physicians may feel a bit peeved when we hear “Trust me, I’m a doctor”, our medical friends do seem to have evidence on their side. GfK, apparently one of the world’s leading market research companies, have developed a GfK Trust Index, and yes they found that doctors are one of the most trusted professions, behind postal workers, teachers and the fire service. World Bank managers might like to know that bankers and (top) managers come close to the bottom, just above advertising professionals and politicians.

Given the trust doctors enjoy, the recent brouhaha over allegations of low quality among some of the social science articles published in medical journals must be a trifle embarrassing to the profession. Here’s the tale so far, plus a cautionary note about a recent ‘systematic review’.

Tracking withdrawals from the ‘Knowledge Bank’

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As I reported in my last post, Jim Kim’s arrival as World Bank President has reinvigorated the debate about the idea of the World Bank being a ‘knowledge bank’. In the post, I argued that the knowledge produced by the Bank – whether gleaned from its lending operations, or from its research and other analytic work – is a global public good, and that we should therefore assess the success of the institution in its knowledge work not in terms of how specific ‘client’ governments value the outputs of its knowledge work but rather in terms of how people around the world use and value them.

So what exactly is a “knowledge bank”?

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Unsurprisingly, with the recent arrival of a new president fresh from the groves of academia, the halls and meeting rooms of the World Bank are buzzing once again with talk of the “Knowledge Bank” or KB for short. But what exactly is a “knowledge bank”?

To my mind the paper that pins the idea down best is “Positioning the World Bank” by Chris Gilbert, Andrew Powell and David Vines in the Economic Journal in 1999.

Knowledge as a public good
Gilbert & Co argue that knowledge about best-practice development is a global public good – the entire world stands to benefit from it, even though some may benefit from it more than others. Given the public good character of global knowledge on development, too little of it would appear if production were left to the free market.

Measuring universal health coverage – plus ça change?

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In case you hadn’t noticed, there’s a growing clamor for a global commitment to universal health coverage (UHC). You might have seen the recent special issue of the Lancet on “the struggle for UHC”. Inevitably, accompanying this clamor, there’s been a lot of wracking of brains on how to measure progress toward UHC. With the excitement of a new political agenda, there’s understandably a desire to carve out a new measurement agenda too. While not wanting dampen people’s enthusiasm for the UHC cause, I would like us to reflect whether on the measurement agenda we’re building enough on what’s been done before.

Yet more on coping with information overload with an iPad

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Last year I wrote a couple of posts on coping with information overload using an iPad, one in July and the other in December. The iPad world continues to develop apace, so  here's a quick update, this one - as requested - complete with links to the apps. 

International development apps

In my last post, I covered three World Bank apps: InfoFinder, which allows you to search in the Bank's documents and reports database, DataFinder which gets you into the Bank's data vaults, and WB Finances which shows you what the Bank is doing in its operational work. The Bank's latest iPad app is the 2012 World Development Report which contains the text of the report plus various additional features. While not an iPad app, the Bank's Open Knowledge Repository is quite iPad-friendly and a great way to search for and access World Bank publications.

A vast treasure trove of development knowledge just opened up

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Today's launch of the World Bank's Open Knowledge Repository (OKR) and Open Access Policy might not seem a big deal. But it is.

The knowledge bank’s assets are huge, but until today were hard to access

The Bank is a huge producer of knowledge on development. This knowledge surfaces in formal publications of the Bank – the institution publishes books and flagship reports like the World Development Report. It also surfaces in publications of external publishers, including journal articles – up to now, these external publications haven't been seen by the Bank as part of its knowledge output despite the fact they dwarf the Bank's own publications in volume and in citations. The Bank's knowledge also surfaces in reports, and in informal "knowledge products" like briefing notes and other web content.

Are the Knowledge Bank’s staff under-specialized?

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Ideas often come from unexpected quarters. Last week, Ricardo Hausmann came to the World Bank to talk about his work on economic complexity. I missed the seminar, but afterwards read his Atlas of Economic Complexity: Mapping Paths to Prosperity. (I had actually already looked at the stunning – but rather confusing charts – of his coauthor Cesar Hidalgo after reading Tim Harford’s great new book Adapt: Why Success Always Starts with Failure.)

On the face of it, the Atlas of Economic Complexity doesn’t have a lot to do with the topic of this blog post – whether World Bank staff are under-specialized.  But bear with me, and I hope I’ll convince you otherwise.

Humanizing health systems

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In 1960, I wouldn’t have been writing this blog post. For a start I was just a baby at the time. Second, we were several decades away from 1994 when Justin Hall – then a student at Swarthmore – would sit down and tap out the world’s first blog. Most importantly of all, though, according to Google’s ngram viewer, people didn’t write about health systems much in 1960 (see chart). Usage of the term in books took off only in the mid 1960s, waned in the 1980s, and then started rising again in the 1990s. This doesn’t look like a statistical artifact. Usage of the term “Nobel prize” has stayed relatively constant over the period, and while the term “health economics” has also trended upwards, the growth has been much slower. So “health systems” is a fairly new term – and it’s on the rise.

Click on this image to see a larger version.

Not everyone thinks that’s a good thing.

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