Dear HIFA and CHIFA colleagues,
Below are the citation, abstract and selected extracts of an important new paper that is highly relevant to HIFA, and a comment from me.
CITATION: Duke T, AlBuhairan FS, et al. World Health Organization and knowledge translation in maternal, newborn, child and adolescent health and nutritionArchives of Disease in Childhood 2022;107:644-649.
https://adc.bmj.com/content/107/7/644
ABSTRACT
The World Health Organization (WHO) has a mandate to promote maternal and child health and welfare through support to governments in the form of technical assistance, standards, epidemiological and statistical services, promoting teaching and training of healthcare professionals and providing direct aid in emergencies. The Strategic and Technical Advisory Group of Experts (STAGE) for maternal, newborn, child and adolescent health and nutrition (MNCAHN) was established in 2020 to advise the Director-General of WHO on issues relating to MNCAHN. STAGE comprises individuals from multiple low-income and middle-income and high-income countries, has representatives from many professional disciplines and with diverse experience and interests.
Progress in MNCAHN requires improvements in quality of services, equity of access and the evolution of services as technical guidance, community needs and epidemiology changes. Knowledge translation of WHO guidance and other guidelines is an important part of this. Countries need effective and responsive structures for adaptation and implementation of evidence-based interventions, strategies to improve guideline uptake, education and training and mechanisms to monitor quality and safety. This paper summarises STAGE’s recommendations on how to improve knowledge translation in MNCAHN. They include support for national and regional technical advisory groups and subnational committees that coordinate maternal and child health; support for national plans for MNCAHN and their implementation and monitoring; the production of a small number of consolidated MNCAHN guidelines to promote integrated and holistic care; education and quality improvement strategies to support guidelines uptake; monitoring of gaps in knowledge translation and operational research in MNCAHN.
WHAT IS ALREADY KNOWN ON THIS TOPIC?
WHO produces numerous guidelines on aspects of maternal, newborn, child and adolescent health, and countries have difficulty with implementation, in part because resources for knowledge translation are limited.
There are many health system constraints to implementation of WHO guidelines, including inadequate numbers, inequitable distribution and lack of support for healthcare workers.
The COVID-19 pandemic is leaving maternal, newborn, child and adolescent health and nutrition (MNCAHN) services depleted in many countries, and there is a need to maintain focus on improving quality and equity of access to services.
WHAT THIS STUDY ADDS?
Proposes several steps for the translation of knowledge in maternal, newborn, child and adolescent health and nutrition.
Proposes a structure for implementation of MNCAHN programmes and quality improvement across regions, and within countries.
Emphasises the need to focus on healthcare workers, local needs and strengthening capacity.
KNOWLEDGE TRANSLATION
WHO definition: ‘The synthesis, exchange and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health’.
CHALLENGES IN TRANSLATION OF WHO TECHNICAL AND PROGRAMME GUIDANCE
1. Number and complexity of guidelines...
2. Limited resources at a country level for knowledge translation and dissemination...
3. Health system constraints...
4. Limited community engagement and communication...
5. Limited engagement of non-health sector actors...
RECOMMENDATION 1: strategies to improve coordination and oversight, the importance of technical advisory groups and subnational committees...
The membership of the national TAG [technical advisory group] should be determined in-country...
RECOMMENDATION 2: strategies to improve guideline uptake
STAGE recommends that WHO:
1. Produce a small number of consolidated MNCAHN guidelines to promote integrated and holistic care. Examples include the Pocketbook of Hospital Care for Children... Such consolidated guidelines are more useful to healthcare practitioners than multiple individual single disease guidelines...
2. Develop a comprehensive operational handbook for MNCAHN that provides programmatic and training guidance for implementation...
3. Support guidelines produced or adapted by national ministries of health and national healthcare professional associations...
4. Encourage and support national ministry of health guideline websites...
5. Support National MCH Quality Improvement Programmes...
6. Develop a new WHO programme of support to institutions of healthcare worker training in LMIC to increase the teaching of WHO guidelines and address healthcare worker deficiency...
7. Develop child health nurse training as a postgraduate course supported by WHO...
8. Develop more multimedia outputs including videos in multiple languages...
RECOMMENDATION 3: monitor implementation of MNCAHN care and gaps in knowledge translation at a national and local level...
COMMENT (NPW): It is good to read this new paper on a subject that is repeatedly explored on HIFA: how to improve knowledge translation - the usability, availability, adaptation, uptake and implementation of WHO guidelines. It is also valuable to see a consensus emerging from a technical advisory group, and interesting to see the focus of the three recommendations: strengthen national and subnational technical advisory groups and committees; improve guideline uptake, and monitor implementation.
1. The challenge of knowledge translation is about more than MNCAHN. It is about all aspects of health: prevention, diagnosis, management, rehabilitation, palliation.
2. The challenge of knowledge translation is about more than WHO guidelines. As we have discussed on HIFA for several years, the availability and use of reliable healthcare information is dependent on the integrity of a global evidence system. Guidelines from WHO (and others) are an important component of this system but the system needs to be addressed holistically.
3. That said, there is value in looking specifically at MNCAHN and specifically at WHO guidelines. A focus on MNCAHN is a step that can be complemented by similar approaches to other aspects of health services, with an emphasis on quality. The development of WHO guidelines has been radically transfored in the past few decades. Just a few years ago WHO guidelines were based largey on expert opinion. They are now much more rigorous and based on transparent and systematic review of the available evidence. More recently, there has been more attention to the dissemination and uptake of guidelines, and the above paper represents another step in this direction.
4. Given the above: to address the challenges of knowledge translation requires an inclusive, iterative, continuous effort that engages all stakeholders, beyond the limitations of three time-limited, restricted meetings of a limited 'strategic and technical advisory group of experts'. This new paper, and its recommendations, should be seen as the start of a wider consultation and conversation.
I also note that WHO itself is not represented on the list of more than 30 eminent authors (who include many HIFA and CHIFA members), although the whole process was designed 'to advise the director-general of WHO on issues relating to MNCAHN'. The report has been discussed with WHO in 2020 and 2021, and it would be very helpful to engage them, too, in a wider, global conversation.
HIFA stands ready to contribute.
Best wishes, Neil
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Neil Pakenham-Walsh, Global Coordinator HIFA, www.hifa.org neil@hifa.org
Working in official relations with WHO
