背景:世卫组织发布公共卫生和临床指南,以指导会员国实现更好的卫生结果。此外,世卫组织的《2019-2023年第十三个工作总规划》优先考虑加强其规范性职能作用,并吸收规范性和标准制定产品。包括国家一级的指导方针。因此,了解会员国采纳世卫组织准则,特别是低收入和中等收入国家(LMICs),对组织和奖学金至关重要。
方法:我们使用全面的搜索策略进行了范围审查,以包括2007年至2020年之间以英文发表的文献。审查是在2021年5月至6月间进行的。我们搜索了五个电子数据库,包括CINAHL,Cochrane图书馆,PubMed,Embase和Scopus。我们还搜索了GoogleScholar作为补充来源。审查遵循PRISMA-ScR(用于范围审查的PRISMA扩展)报告搜索的指南,从文献中筛选和鉴定评价研究。以主题方式介绍了围绕世卫组织在LMIC中采用指南的关键障碍和挑战的证据的叙述性综合。
结果:范围审查包括48项研究,调查结果分为四个主题:(1)缺乏国家立法,法规和政策一致性,(2)经验不足,医疗保健提供者的专业知识和培训,以获得指导方针,(3)指南吸收和使用的资金限制,(4)医疗基础设施不足,无法满足指南的要求。这些挑战来自会员国的卫生系统。研究结果表明,在大多数研究的LMICs中,现有卫生系统的治理往往薄弱,以及世卫组织关于治理要求的指南提供的指导。缺乏采用和执行准则的问责制和透明度机制,进一步加剧了这一挑战。此外,世卫组织指南本身要么不清楚,对某些健康状况在技术上具有挑战性;然而,世卫组织准则主要被会员国在制定国家准则时用作参考。
结论:确定的挑战反映了国家卫生系统分配能力,实施和监督准则。从历史上看,这超出了世卫组织的职权范围,但会员国可受益于世卫组织关于成功采纳和使用世卫组织指南的要求和需求的实施指南。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.