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  • 1PRICELESS SA, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. marykewelman@yahoo.com.

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South Africa has many clinical practice guidelines (CPGs) for its National Health Insurance (NHI) system, but development lacks coordination and quality reporting is poor. Establishing a national coordinating unit is crucial for improving CPG usability and credibility.

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Area of Science:

  • Health Services Research
  • Health Policy
  • Clinical Governance

Background:

  • South Africa is implementing National Health Insurance (NHI), necessitating coordinated healthcare provision across sectors.
  • Clinical practice guidelines (CPGs) are essential tools for standardizing care, influencing clinical decisions, and managing health system costs.
  • Understanding the landscape of CPG development is critical for effective NHI implementation in South Africa.

Purpose of the Study:

  • To identify and describe all publicly available clinical practice guidelines (CPGs) developed in South Africa for the South African context.

Main Methods:

  • A cross-sectional evaluation employed a two-part search: electronic searching of grey literature and relevant websites, and a systematic search of PubMed for peer-reviewed literature post-2000.
  • Data extraction and categorization of identified CPGs were performed by two independent reviewers, with discrepancies resolved by a third reviewer.
  • Extracted data included developer information, the condition addressed, and reporting of CPG quality indicators.

Main Results:

  • The search identified 285 CPGs published after January 2000, with 171 developed in the preceding five years.
  • Developers comprised national and provincial health departments, professional societies, clinician collaborations, and the Council for Medical Schemes.
  • Department of Health CPGs focused on high-burden infectious diseases, while others addressed non-communicable diseases; conflict of interest statements were inconsistently reported.

Conclusions:

  • Accessing CPGs proved challenging, highlighting a lack of formal coordination and prioritization in CPG development in South Africa.
  • Inconsistent reporting of quality items and variation in comprehensiveness and methodology may affect the usability and credibility of existing CPGs.
  • Establishing a national CPG coordinating unit to set development standards and support high-quality guideline creation is recommended for successful NHI implementation.