What twenty years in global health taught me about the distance between evidence and action

I have been in rooms where evidence informed the framing of a decision without changing its direction. I have watched supply chain data tell a clear story that the review cycles were too slow to act on. I have seen gender policies which were carefully designed and formally adopted, but meet implementation environments that were not yet ready to carry them.

And this is where we land at the end of the day. That in spite of thoughtful decisions, evidence-based plans, and the genuine hard work of the people inside these systems, the gap persists. And understanding why & how to close it, is what most of my work has been about.

The global health field has become extraordinarily good at generating evidence. We have more data than ever. We have frameworks for everything: gender-transformative, rights-based, equity-focused, community-led, adaptive, resilient. We have theories of change so elaborate they require their own orientation sessions. And yet the distance between what the evidence says and what programmes actually do remains stubbornly wide.

Part of the answer is technical. Data systems that do not talk to each other, M&E frameworks designed for donor reporting rather than learning, evaluation timelines that produce findings after decisions have already been made. These are real and fixable.

“The most important intervention in global health is building the capacity of practitioners to hold evidence and power in the same hand, at the same time, without losing either.”

But the deeper answer is human and political. Evidence does not speak for itself. It requires champions. It requires people with enough institutional credibility, enough relational trust & enough strategic skill to make a finding land in a room where it is required. And that is a leadership skill, that we never trained for.

After twenty years working across government, UN agencies, USAID-funded programmes, and independent research; in settings from Delhi's HIV response to multi-country SRHR projects; I have come to believe that the most important intervention in global health is not another framework. It is building the capacity of practitioners to hold evidence and power in the same hand, at the same time, without losing either.

That is what I want Barbet to contribute to. Not more reports that go unread. But thinking that is precise enough to be useful, honest enough to be trusted, and connected enough to the reality of implementation to actually change something.

The questions I find most interesting are the ones the field has not quite figured out how to ask yet. I intend to ask them here.