Bruyere Research Institute, Ottawa, Canada.
Science Division, World Health Organization, Geneva, Switzerland.
Health Res Policy Syst. 2022 Sep 7;20(1):98. doi: 10.1186/s12961-022-00899-y.
WHO publishes public health and clinical guidelines to guide Member States in achieving better health outcomes. Furthermore, WHO's Thirteenth General Programme of Work for 2019-2023 prioritizes strengthening its normative functional role and uptake of normative and standard-setting products, including guidelines at the country level. Therefore, understanding WHO guideline uptake by the Member States, particularly the low- and middle-income countries (LMICs), is of utmost importance for the organization and scholarship.
We conducted a scoping review using a comprehensive search strategy to include published literature in English between 2007 and 2020. The review was conducted between May and June 2021. We searched five electronic databases including CINAHL, the Cochrane Library, PubMed, Embase and Scopus. We also searched Google Scholar as a supplementary source. The review adhered to the PRISMA-ScR (PRISMA extension for scoping reviews) guidelines for reporting the searches, screening and identification of evaluation studies from the literature. A narrative synthesis of the evidence around key barriers and challenges for WHO guideline uptake in LMICs is thematically presented.
The scoping review included 48 studies, and the findings were categorized into four themes: (1) lack of national legislation, regulations and policy coherence, (2) inadequate experience, expertise and training of healthcare providers for guideline uptake, (3) funding limitations for guideline uptake and use, and (4) inadequate healthcare infrastructure for guideline compliance. These challenges were situated in the Member States' health systems. The findings suggest that governance was often weak within the existing health systems amongst most of the LMICs studied, as was the guidance provided by WHO's guidelines on governance requirements. This challenge was further exacerbated by a lack of accountability and transparency mechanisms for uptake and implementation of guidelines. In addition, the WHO guidelines themselves were either unclear and were technically challenging for some health conditions; however, WHO guidelines were primarily used as a reference by Member States when they developed their national guidelines.
The challenges identified reflect the national health systems' (in)ability to allocate, implement and monitor the guidelines. Historically this is beyond the remit of WHO, but Member States could benefit from WHO implementation guidance on requirements and needs for successful uptake and use of WHO guidelines.
世界卫生组织（WHO）发布公共卫生和临床指南，以指导会员国实现更好的健康结果。此外，世卫组织 2019-2023 年第十三个工作总规划优先加强其规范职能作用，并采用规范和标准制定产品，包括国家一级的指南。因此，了解会员国对世卫组织指南的采用情况，特别是对低收入和中等收入国家（LMICs）的采用情况，对该组织和学术界都至关重要。
我们使用全面的搜索策略进行了范围审查，包括 2007 年至 2020 年期间发表的英文文献。审查于 2021 年 5 月至 6 月进行。我们在五个电子数据库中进行了搜索，包括 CINAHL、Cochrane 图书馆、PubMed、Embase 和 Scopus。我们还搜索了 Google Scholar 作为补充来源。该审查按照 PRISMA-ScR（范围审查扩展的 PRISMA）指南报告了搜索、筛选和识别文献中的评估研究的情况。以主题的形式呈现了关于世卫组织在 LMICs 中指南采用的关键障碍和挑战的证据的叙述性综合。
范围审查包括 48 项研究，研究结果分为四个主题：（1）缺乏国家立法、法规和政策一致性，（2）医疗保健提供者缺乏指南采用的经验、专业知识和培训，（3）指南采用和使用的资金限制，以及（4）指南遵守的医疗保健基础设施不足。这些挑战存在于会员国的卫生系统中。研究结果表明，在所研究的大多数 LMICs 中，现有卫生系统中的治理往往薄弱，世卫组织指南关于治理要求的指导也不足。由于缺乏对指南采用和实施的问责制和透明度机制，这一挑战进一步加剧。此外，世卫组织指南本身对于某些健康状况来说不够清晰，并且在技术上具有挑战性；但是，会员国在制定国家指南时主要参考世卫组织指南。
确定的挑战反映了国家卫生系统分配、实施和监测指南的（无）能力。从历史上看，这超出了世卫组织的职权范围，但会员国可以从世卫组织关于成功采用和使用世卫组织指南的要求和需求的实施指导中受益。
