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DFID Research: Introducing best practice for developing guidelines at WHO; progress made, but not always welcome

PLOS ONE looks at how internal reforms have impacted upon global guidelines

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Picture: Sascha Pohflepp/ Flickr
Picture: Sascha Pohflepp/ Flickr

The World Health Organization (WHO) has improved the way it develops global guidelines, but the procedures put in place to assure quality could still be derailed by departments wanting to do things their own way, concluded a study recently published in the medical online journal PLOS ONE.

Researchers at the Liverpool School of Tropical Medicine (LSTM) and the South African Cochrane Centre were invited to re-evaluate WHO guidelines as part of the DFID supported Effective Healthcare Research Consortium. This came after a study from 2007 showed that the guidelines had fallen behind international best practice, were based mainly on expert opinion and rarely used reliable research and evidence-based methods. In response, the WHO took a whole series of steps to reform guidelines development, one of the organization’s core functions.

The research showed that the reforms, including the set-up of an internal Guidelines Review Committee (GRC) and other quality procedures, had resulted in better guidelines, particularly in relation to using rigorous methods, and with dealing with conflicts of interest on the Guidelines Panels.

LSTM’s Dr David Sinclair, the lead author of the report, commented; “The process of developing guidelines was far more systematic and transparent” but he warned that “there was substantial resistance to change within some groups and that the procedures are not fully embedded within the organization”.

The authors of the report conclude that the position of the Guideline Review Committee is fragile, and the procedures it has put in place could yet be derailed by departments wanting to do things their own way.

WHO recognizes the importance of high-quality guidelines when making recommendations in public health”, says Dr Charles Penn, the current chair of the GRC. “The Organization therefore values both the recognition of the current gains and welcomes the encouragement for continuous improvement.”

Dr Holger Schunemann, a leading guidelines specialist at McMaster University helping the organization modernise its guidelines procedures, comments:

The World Health Organization has made great advances in embracing and setting internationally recognised best practice in guideline development. While embedding this best practice carefully, further progress will be made.

The full study can be accessed through PLOS ONE.

Published 22 July 2013