Linking focal knowledge with global action:: examining the Global Fund to Fight AIDS, Tuberculosis and Malaria through a knowledge system lens

New global public health institutions are increasingly emphasizing transparency in decision-making, developing-country ownership of projects and programmes, and merit- and performance-based funding. Such principles imply an institutional response to the challenge of bridging the "know-do gap", by basing decisions explicitly on results, evidence and best practice. Using a knowledge systems framework, we examine how the Global Fund to Fight AIDS, Tuberculosis and Malaria has affected the ways in which knowledge is used in efforts to combat these three diseases. We outline the formal knowledge system embedded in current rules and practices associated with the Global Fund's application process, and give three examples that illustrate the complexity of the knowledge system in action: human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) policy in China; successful applications from Haiti; and responses to changing research on malaria. These examples show that the Global Fund has created strong incentives for knowledge to flow to local implementers, but with little encouragement and few structures for the potentially valuable lessons from implementation to flow back to global best practice or research-based knowledge. The Global Fund could play an influential role in fostering much-needed learning from implementation. We suggest that three initial steps are required to start this process: acknowledging shared responsibility for learning across the knowledge system; analysing the Global Fund's existing data (and refining data collection over time); and supporting recipients and technical partners to invest resources in linking implementation with best practice and research.