Article
Using clinical guidelines to improve the quality of care in countries moving towards Universal Health Coverage: Initial evidence from 10 countries
Search Medline for
Authors
Published: | July 10, 2012 |
---|
Outline
Text
Background: Many low to middle income countries (LMICs) are currently pursuing reforms for achieving universal health coverage (UHC) at an affordable cost. These reforms present a unique opportunity to build in quality strategies, including use of evidence-informed clinical guidelines, at an early stage of design. Literature suggests that LMICs are using guidelines in their reform efforts; however, details of how guidelines are developed and used are unknown.
Objectives: The Joint Learning Network for Universal Health Coverage (JLN) is a consortium of LMICs pursuing universal access through a shared learning platform. As part of the JLN's ‘Quality Track’ we sought to examine the extent to which LMICs use clinical guidelines to improve healthcare quality in their UHC reforms, including practical and political barriers to their development and use.
Methods: Semi-structured interviews were conducted over three months with guideline developers, policy makers and clinicians in 10 LMIC members of the JLN.
Results: All countries make some use of guidelines as a quality improvement tool in their reform efforts. Methods of development vary considerably. Technical and political challenges to guideline production and use emerged, including problems identifying good quality evidence relevant to the local setting, and ensuring that guideline recommendations are optimally implemented.
Discussion/Implications for guideline developers/users: Evidence-informed guidelines, when suitably linked with decision-making processes and backed by support and incentives for uptake can be a powerful lever for improving quality in LMICs moving to Universal Health Care. Local technical and political barriers often inhibit development and use of such guidance.