Developing a strategy for identifying recommendations prioritized for implementation in the Colombian health system

Health systems guidelines (HSGs) developed by the WHO and clinical practice guidelines (CPGs) developed by the Colombian Ministry of Health can potentially support national and subnational policy-development processes. Barriers to implementation encountered when making necessary changes to the Colombian health system led to our research question: What prioritized recommendations are pending implementation in Colombia, and which require changes in health system arrangements?

A document analysis of all 58 Colombian CPGs and all 14 WHO HSG documents was performed in April 2020. We extracted information about recommendations prioritized on the CPGs/HSGs, updated status (documents were outdated if 5 years had elapsed since publication, and close to outdated if they were in the fifth year since publication), and the strength and direction of the recommendation as graded by the guideline development group. Recommendations were evaluated by two researchers to determine whether their implementation required making changes to the health system. Those changes were classified into three dimensions: governance, financial and delivery arrangements.

In the 71 guidelines, 958 recommendations were identified. A total of 393 (41.0%) were updated, 425 (44.4%) were outdated and 140 (14.6%) were close to outdated. Regarding the strength and direction of the recommendations, 540 were strong (56.4%), 189 were weak (19.7%) and 173 were suggested or recommended in a specific context (18.1%). Most of the recommendations were in favour of the intervention (n = 861, 89.9%), and only 97 were against the intervention (10.1%). Among the 363 recommendations from the WHO HSGs, 244 (67.2%) had not been implemented in Colombia. Of 958 recommendations, 518 (54.1%) needed a health system arrangement for their implementation: 259 in governance, 102 in financial and 503 in delivery.

We identified 518 recommendations that require change in Colombian health system arrangements. The most common change was related to availability of care, given that many of the recommendations refer to technologies/services approved and publicly funded but not widely available or accessible to different population groups. Further research may evaluate whether this strategy helps to define priorities for implementation.