Article type
Year
Abstract
Background: The World Health Organisation is currently developing a global guideline on optimizing the delivery of effective maternal and newborn health interventions through task-shifting/sharing (Optimize4MNH). Task-shifting entails moving tasks from one group of health workers to another, usually less specialised, group of health workers, and is regarded as one possible solution to the human resources for health crisis in many settings. The guideline aims to recommend options regarding which maternal and newborn health interventions can be delivered by less specialised cadres in a manner that is safe, effective, acceptable and feasible.
Objectives: To discuss themethods used to develop evidence-based Optimize4MNH guideline.
Results: A central part of the guideline is the use of systematic reviews that assess existing research regarding the safety and effectiveness of service delivery by different health worker cadres. This is now a standard part of many clinical guidelines, both within the World Health Organisation and elsewhere. However, the Optimize4MNH guideline also uses systematic reviews of qualitative evidence and systematic analysis of country case studies to address issues regarding the acceptability and feasibility of taskshifting and implementation considerations. In addition, the guideline pilots a new framework, being developed by the DECIDE project (www.decide-collaboration.eu) and the GRADE Working Group, for presenting evidence to the guideline panel in order to ensure that all relevant aspects are considered before options are recommended. This ‘Evidence to Recommendations Framework’ presents information regarding the benefits and harms of the intervention when delivered by the cadre in question, but also anticipated resource use, impacts on health inequities, acceptability to key stakeholders and feasibility. Recommendations are described and justified with reference to these aspects.
Conclusions: The Optimize4MNH initiative incorporates a range of state-of-the-art approaches for developing health systems guideline, many of which may be useful for similar initiatives addressing other questions.
Objectives: To discuss themethods used to develop evidence-based Optimize4MNH guideline.
Results: A central part of the guideline is the use of systematic reviews that assess existing research regarding the safety and effectiveness of service delivery by different health worker cadres. This is now a standard part of many clinical guidelines, both within the World Health Organisation and elsewhere. However, the Optimize4MNH guideline also uses systematic reviews of qualitative evidence and systematic analysis of country case studies to address issues regarding the acceptability and feasibility of taskshifting and implementation considerations. In addition, the guideline pilots a new framework, being developed by the DECIDE project (www.decide-collaboration.eu) and the GRADE Working Group, for presenting evidence to the guideline panel in order to ensure that all relevant aspects are considered before options are recommended. This ‘Evidence to Recommendations Framework’ presents information regarding the benefits and harms of the intervention when delivered by the cadre in question, but also anticipated resource use, impacts on health inequities, acceptability to key stakeholders and feasibility. Recommendations are described and justified with reference to these aspects.
Conclusions: The Optimize4MNH initiative incorporates a range of state-of-the-art approaches for developing health systems guideline, many of which may be useful for similar initiatives addressing other questions.