gms | German Medical Science

Background: In 2010, the Government of Kazakhstan and the World Bank initiated a multi-year, multi-component health system reform project to introduce institutional transformation and improve health outcomes. Evidence-based clinical practice guidelines (CPGs) are seen as instrumental.

Context: The Canadian Society for International Health (CSIH) has partnered with Kazakhstan’s Ministry of Health to build capacity to adapt and implement high quality international CPGs. Working Groups (WGs) comprised of clinical experts and health policy-makers are now established in four major medical specialties. CSIH has been supporting this process through a twinning program that has focused on mentorship and training workshops.

Best practice description: The adaptation process is based on CAN-IMPLEMENT. Key CPG topics are being identified, primarily by the Kazakhstani partners, using priority setting principles. The quality of candidate CPGs is then assessed by two CSIH experts using AGREE II. The WGs review the selected CPGs on a recommendation-by-recommendation basis and adopt, reject or modify each recommendation. Implementation barriers and facilitators are also identified. Background sections of a CPG template for Kazakhstan are then completed based on the chosen CPG.

Lessons Learned to Date: the desire of local officials to adapt too many CPGs within a short timeline is counterproductive; most relevant literature is only published in English and insufficient English language skills are a major barrier for local partners; copyright issues have added complexity and limited progress; a short version of AGREEII (emphasis on scope, bias and usability) may be ideal in this setting.