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Abstract
This study explored experiences, perceptions and views among World Health Organization (WHO) staff about the changes, progress and challenges brought by the guideline development reforms initiated in 2007. Thirty-five semistructured interviews were conducted with senior WHO staff. Sixteen of the interviewees had in-depth experience with WHO’s formal guideline development process. Thematic analysis was conducted to identify key themes in the qualitative data, and these were interpreted in the context of the existing literature on WHO’s guideline development processes. First, the reforms were seen to have transformed and improved the quality of WHO’s guidelines. Second, independent evaluation and feedback by the Guidelines Review Committee (GRC) was described to have strengthened the legitimacy of WHO’s recommendations. Third, WHO guideline development processes are not yet designed to systematically make use of all types of research evidence needed to inform decisions about health systems and public health interventions. For example, several interviewees expressed dissatisfaction with the insufficient attention paid to qualitative evidence and evidence from programme experience, and how the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process evaluates the quality of evidence from non-randomised study designs, while others believed that GRADE was just not properly understood or applied. Fourth, some staff advocated for a more centralised quality assurance process covering all outputs from WHO’s departments and scientific advisory committees, especially to eliminate strategic efforts aimed at bypassing the GRC’s requirements. Overall, the ‘culture change’ senior WHO staff called for over 10 years ago appears to have gradually spread throughout the organisation. However, at least two major challenges remain: (1) ensuring that all issued advice benefits from independent evaluation, monitoring and feedback for quality and (2) designing guideline development processes to better acquire, assess, adapt and apply the full range of evidence that can inform recommendations on health systems and public health interventions.
- qualitative study
- health policy
- public health
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Footnotes
Handling editor Stephanie M Topp
Contributors UG and SJH had the original idea for the manuscript. Data collection was done by UG. Data analysis was done by UG and SJH. UG prepared the original draft of the manuscript, and SJH provided input and comments on successive drafts. Both authors read and approved the final draft.
Funding This study was completed as part of the research project ’Strengthening International Collaboration for Capitalizing on Cost-Effective and Life-Saving Commodities' (i4C) that is funded through the Research Council of Norway’s Global Health & Vaccination Programme (GLOBVAC Project No 234608). SJH is additionally funded by the Canadian Institutes of Health Research and the Ontario Government’s Ministry of Research, Innovation & Science.
Competing interests UG has previously supported WHO’s guideline development process on ‘Transforming and scaling up health professionals’ education and training’ as an intern in 2011 and led a multicountry case study for the Norwegian Knowledge Centre for the Health Services in 2011–2012, which informed the development of WHO’s recommendations on ‘Optimizing health worker roles for maternal and newborn health.’ SJH has previously worked for WHO. Both authors have previously published articles examining WHO’s role in global health governance.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement At the time of data collection, consent was not obtained from the interviewees to share the qualitative data beyond what is contained in this article. We are, therefore, unable to provide access to the raw data.