South African clinical practice guidelines: A landscape analysis.

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.