A framework for ICT-based knowledge sharing in sustainable rural development : the case of Gilgit-Baltistan, Pakistan

Some 50% of the people in the world live in rural areas, often under harsh conditions and in poverty. The need for knowledge of how to improve living conditions is well documented. In response to this need, new knowledge of how to improve living conditions in rural areas and elsewhere is continuously being developed by researchers and practitioners around the world. People in rural areas, in particular, would certainly benefit from being able to share relevant knowledge with each other, as well as with stakeholders (e.g. researchers) and other organizations (e.g. NGOs). Central to knowledge management is the idea of knowledge sharing. This study is based on the assumption that knowledge management can support sustainable development in rural and remote regions. It aims to present a framework for knowledge management in sustainable rural development, and an inventory of existing frameworks for that. The study is interpretive, with interviews as the primary source for the inventory of stakeholders, knowledge categories and Information and Communications Technology (ICT) infrastructure. For the inventory of frameworks, a literature study was carried out. The result is a categorization of the stakeholders who act as producers and beneficiaries of explicit and indigenous development knowledge. Stakeholders are local government, local population, academia, NGOs, civil society and donor agencies. Furthermore, the study presents a categorization of the development knowledge produced by the stakeholders together with specifications for the existing ICT infrastructure. Rural development categories found are research, funding, agriculture, ICT, gender, institutional development, local infrastructure development, and marketing & enterprise. Finally, a compiled framework is presented, and it is based on ten existing frameworks for rural development that were found in the literature study, and the empirical findings of the Gilgit-Baltistan case. Our proposed framework is divided in four levels where level one consists of the identified stakeholders, level two consists of rural development categories, level three of the knowledge management system and level four of sustainable rural development based on the levels below. In the proposed framework we claim that the sustainability of rural development can be achieved through a knowledge society in which knowledge of the rural development process is shared among all relevant stakeholders.

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.