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World Health Organization guideline development: an evaluation
David Sinclair1, Rachel Isba, Tamara Kredo
1Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom. sinclad@liverpool.ac.uk
Plos One
|June 7, 2013
Summary
The World Health Organization (WHO) improved guideline development with its Guidelines Review Committee (GRC), enhancing systematic methods and transparency. However, full integration of these evidence-based standards across all departments remains a challenge.
Area of Science:
- Health policy and systems research
- Evidence-based practice
- Global health governance
Background:
- WHO guideline development in 2007 relied heavily on expert opinion, lacking systematic evidence-based methods and adherence to its own guidelines.
- The World Health Organization (WHO) established a Guidelines Review Committee (GRC) to implement and oversee internationally recognized standards for guideline development.
- This study examines the impact of the GRC on WHO guideline documents and senior staff perceptions of the new procedures.
Purpose of the Study:
- To evaluate the impact of the WHO Guidelines Review Committee (GRC) on the quality of WHO guideline documents.
- To explore senior staff perceptions regarding the implementation and effectiveness of new WHO guideline development procedures.
- To assess the extent to which internationally recognized standards for guideline development have been adopted and institutionalized within the WHO.
Main Methods:
- Appraisal of ten GRC-approved and ten pre-GRC WHO guidelines using the AGREE II tool.
- Interviews with 20 senior staff across 16 WHO departments.
- Qualitative analysis of interview transcripts using the framework approach to identify key themes.
Main Results:
- GRC-approved guidelines demonstrated higher AGREE II scores across all domains compared to pre-GRC guidelines.
- Significant improvements were observed in "Rigour of Development" (37.6% increase) and "Editorial Independence" (52.7% increase).
- Staff interviews revealed mixed views on a centralized quality assurance mechanism, challenges with the GRADE approach, and varied departmental capacity for implementation.
Conclusions:
- WHO guideline development has become more systematic and transparent since 2007.
- Despite improvements, some WHO departments bypass established procedures.
- The GRC and its quality assurance standards are not yet fully embedded within the organization.
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