gms | German Medical Science

Policies to strengthen health systems need to draw on the best available evidence. However, to be useful to policy makers, research evidence needs to be retrieved, appraised, and synthesised, and the recommended options framed in the form of guidelines or guidance. Health systems guidance can be defined as systematically developed statements produced at a global or national level to assist with making decisions about which options are appropriate for addressing health system challenges and with the implementation of options.

There is little experience globally in developing evidence-based guidance on health systems questions. This presentation discusses the lessons learnt from the development of the new WHO guidance on optimizing the delivery of key maternal and newborn interventions in low- and middle-income countries through taskshifting (the Optimize4MNH guidance), and from recent work by the ‘Task Force on Developing Health Systems Guidance’, established by the WHO.

As in clinical guidelines, a central component of the Optimize4MNH guidance was the use of systematic reviews of the effectiveness of taskshifting interventions. The Optimize4MNH guidance also used systematic reviews of qualitative evidence and country case studies to examine the acceptability and feasibility of taskshifting and implementation considerations. In addition, the guidance piloted a new framework for presenting evidence to guidance panels in order to ensure that all relevant aspects were considered before options were recommended. Tools are also being developed to facilitate the use of this global health systems guidance in policy deliberations at global and national levels.

The novel approaches used to develop the Optimize4MNH guidance may be useful for similar initiatives. Further research is now needed on: the range of evidence that should be considered for such guidance; frameworks for presenting evidence and policy options to stakeholders; approaches to developing policy options; and tools for adapting these policy options at national level.