World Health Organization Guideline Development: An Evaluation
Abstract
Background
Research in 2007 showed that World Health Organization (WHO)
recommendations were largely based on expert opinion, rarely used
systematic evidence-based methods, and did not follow the
organization's own “Guidelines for Guidelines”. In response, the WHO
established a “Guidelines Review Committee” (GRC) to implement and
oversee internationally recognized standards. We examined the impact of
these changes on WHO guideline documents and explored senior staff's
perceptions of the new procedures.
Methods and Findings
We used the AGREE II guideline appraisal tool to appraise ten
GRC-approved guidelines from nine WHO departments, and ten pre-GRC
guidelines matched by department and topic. We interviewed 20 senior
staff across 16 departments and analyzed the transcripts using the
framework approach. Average AGREE II scores for GRC-approved guidelines
were higher across all six AGREE domains compared with pre-GRC
guidelines. The biggest changes were noted for “Rigour of Development”
(up 37.6%, from 30.7% to 68.3%) and “Editorial Independence” (up 52.7%,
from 20.9% to 73.6%). Four main themes emerged from the interviews: (1)
high standards were widely recognized as essential for WHO credibility,
particularly with regard to conflicts of interest; (2) views were mixed
on whether WHO needed a single quality assurance mechanism, with some
departments purposefully bypassing the procedures; (3) staff expressed
some uncertainties in applying the GRADE approach, with departmental
staff concentrating on technicalities while the GRC remained concerned
the underlying principles were not fully institutionalized; (4) the
capacity to implement the new standards varied widely, with many
departments looking to an overstretched GRC for technical support.
Conclusions
Since 2007, WHO guideline development methods have become more
systematic and transparent. However, some departments are bypassing the
procedures, and as yet neither the GRC, nor the quality assurance
standards they have set, are fully embedded within the organization.
Citation
Sinclair, D.; Isba, R.; Kredo, T.; Zani, B.; Smith, H.; Garner, P. World Health Organization Guideline Development: An Evaluation. PLoS ONE (2013) 8 (5) e63715. [DOI: 10.1371/journal.pone.0063715]
Links
World Health Organization Guideline Development: An Evaluation