Dear CHIFA colleagues,
WHO global guideline development is now rigorous and systematic, and is one of the most important functions of the Organization. It hasn't always been this way. Right up to the 1990s, guidelines were produced by 'experts' sitting around a table. Thanks to the work of the Cochrane Collaboration and other organisations, WHO started experimenting with more structured reviews. The watershed moment was 2007, when WHO created the Guidelines Review Committee, which completely reformed their overall approach. Core elements include:
- Mandatory systematic reviews for all recommendations.
- Use of GRADE (Grading of Recommendations, Assessment, Development and Evaluation).
- Requirement for Guideline Development Groups (GDGs) with diverse expertise and conflict-of-interest management.
- Standardized templates, decision tables, and peer review.
- Public posting of guidelines and evidence profiles.
The rigour of WHO guideline development is a huge advance in the strengthening of the global evidence ecosystem https://www.hifa.org/about-hifa#ecosystem
But there are clearly challenges on how national policymakers and public health professionals can use, adapt and adopt this guidance, and thereby develop national policy that reflects national evidence and realities.
A further recent innovation from WHO is their 2023 publication 'Strengthening countries’ capacities to adopt and adapt evidence-based guidelines: a handbook for guideline contextualization'
https://iris.who.int/server/api/core/bitstreams/63282011-3089-4189-b09d-...
A key challenge is: how to improve not only the rigour, but the usability and adaptability of WHO guidelines.
One way to approach this is to ask national policymakers whether the content or presentation of global guidelines could be improved to make them more readily usable at country level.
Coming back specifically to national policymaking on GBS, has anyone had experience of this? If you know others who could help with this, please forward this message and invite them to join us: www.hifa.org/gbs & www.hifa.org/joinchifa
I also invite people to review the current WHO global GBS guideline itself: https://www.who.int/publications/i/item/9789240099128
One of the key recommendations is that: 'Women should be provided with evidence-based, up-to-date information on the prevention of early onset GBS disease in newborns and the maternal screening offered in their setting before being offered screening. The information should facilitate an understanding of the purpose of screening, the procedure involved in obtaining swabs in their setting and the potential implications of a positive result including subsequent intrapartum antibiotic prophylaxis. Women should give consent for the procedure and be able to refuse without mistreatment.'
It is encouraging that WHO guidelines are not only rigorous but also increasingly cognisant of the importance of meeting information needs.
Best wishes, 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