Local or Global Action?

In "Global Aspects of Health...," Larkin identifies the problem that local initiatives face; she writes that "it is more difficult to assess their impact... where a variety of officially sanctioned initatives and informal women's projects are to be found," and that "many of the more formally based programmes have been criticised for being no more than add-on initiatives to existing programmes." Are these "formally based programs" wrongly criticised? Do they serve to help or to dilute the force of a unified and broader initiative? I think that working on a local level is more effective; this way, needs that are visible only to those with an "epistemological privilege" can be addressed. However, at the same time, this way also suffers from its single-ness (by which I mean it is less accessible to the most amount of people). So, what is your opinion, which is better--or rather, if you had to choose one, which and why--action at a local or global level? Where does the balance between the two rest, how much should local initiatives rely on global initiatives, and vice versa?