Implementing clinical guidelines in low-income settings: A review of literature

Abstract

The use of clinical guidelines has been shown to confer benefits for care delivery in high-income settings, but little is known about their implementation in low-income settings. We conducted a systematic literature review on the implementation of World Health Organisation (WHO) clinical guidelines for hospital care in low-income settings. We searched Medline, Global Health and Scopus for articles describing the implementation of clinical guidelines issued by the WHO for hospitals in low-income countries. Each article in the final sample was reviewed independently by two reviewers who harmonised their findings to identify key factors affecting the implementation process, which were grouped into thematic categories through negotiated consensus among project team members. Seventeen studies met the inclusion criteria. Factors affecting the guideline implementation process in low-income countries were (1) degree of support from facility management and Ministry of Health, (2) credibility and acceptability of clinical guidelines from the perspective of health care providers, (3) efforts to adapt clinical guidelines to local circumstances and (4) use of guides and checklists for implementation. These four factors consistently emerged in our review and should be considered when designing future strategies to implement clinical guidelines in low-income countries.

Keywords:

• practice guidelines as topic
• developing countries
• World Health Organization

Acknowledgements

We would like to thank Jan Glover, Education Services Librarian, Cushing/Whitney Medical Library, Yale School of Medicine for her assistance in conducting the literature search. This review was funded in part by the Centers for Disease Control and Prevention, Addis Ababa, Ethiopia. Dr Chakkalakal was supported as a Robert Wood Johnson Foundation Clinical Scholar at Yale University School of Medicine while she was working on this project. In addition, this article poses no conflict of interest to any of the authors and was carried out in accordance with universal ethical principles.