CITATION: Bull World Health Organ. 2025 Jul 1;103(7):415–415A. doi: 10.2471/BLT.25.294222
Local capacity for policy development and implementation
Aklilu Azazh et al.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12231077/
Extracts below and three comments from me.
'The World Health Organization (WHO) plays a core normative and technical role in providing global reference standards, policy options and guidelines, and other normative products. This function has been reinforced in the Fourteenth Global Programme of Work, which highlights WHO’s responsibility for developing, implementing and monitoring and evaluating global guidance...
'To be impactful, WHO normative products should be locally contextualized and relevant to countries. Such contextualization cannot be achieved without understanding the lived experience of the people implementing the normative products, the contexts in which they work, and the supports and challenges they encounter in the process of change... Here we provide a reflection on common underlying challenges in improving guideline adaptation and uptake across four African countries (Ethiopia, Kenya, Uganda and United Republic of Tanzania)...
'In the WHO African Region, since 2021, WHO has supported governments in conducting rapid research on guideline adaptation and uptake across five countries (Cabo Verde, Ethiopia, Kenya, Uganda and United Republic of Tanzania)...
'Researchers supporting guideline development and systematic adaptation of published guidelines have analysed the system-level and capacity-related challenges that hinder evidence-based adaptation in low-resource settings. Findings include that, for sustained action and change, institutionalizing capacity development and related skills in guideline development is needed – in addition to the required governance and coordination structures...
'In line with these findings, the World Health Assembly resolution WHA78 Strengthening national capacities in evidence-based decision-making for the uptake and impact of norms and standards10 calls for action to address the persistent gaps in the uptake of global norms and standards and barriers to achieving equitable health outcomes in countries.'
COMMENTS (NPW):
1. It's curious that the article makes no mention of the synthesis of global and local evidence. This challenge has been highlighted multiple times on HIFA, including through our TDR-funded Evidence-Informed Policy and Practice project. It is also relevant to our current work with Norway, Kenya and Ghana on the SUPPORT-SYSTEMS project.
2. The proposed need for 'institutionalizing capacity development and related skills in guideline development' requires further delineation to understand better the proposed steps. Also, what is the current status of 'institutionalisation'? Is there a lack of interest to develop guidelines, or is the problem more to do with whether and how to have a robust approach to this.
3. It has been suggested often (including on HIFA) that international guidelines developed by WHO and others should include feedback loops from countries whereby member states indicate how these guidelines can be made more useful.
I have invited the authors to join us and meanwhile look forward to learn from other members, including and especially those who have been involved in national guideline development. Please email your comments to hifa@hifaforums.org
Many thanks, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org