A landmark paper on the use of evidence in policy making has just been published in the medical journal The Lancet. The study was carried out by Dr Andrew Oxman and Dr Atle Fretheim from the Norwegian Knowledge Centre for Health Services and Dr John Lavis from McMaster University in Canada. The EU-funded study, conducted between 2003 and 2004, involved researchers interviewing senior World Health Organisation (WHO) officials and analysing guidelines to determine how they were produced.
The policy research was undertaken as part of European Commission’s Fifth Framework International Collaboration with Developing Countries (INCO), which funded the project PRACTIHC (PRAgmatic Trials in Health Care systems). The international network facilitated information for action on priority health problems, providing an example of impact-orientated health systems and policy research.
Headquarters in Geneva
© WHO/Pierre Virot
The WHO, based in Geneva, Switzerland, is one of the project’s formal partners. The role of the organisation includes the production of health guidelines. These range from how to prevent the spread of bird flu and malaria control to enacting anti-tobacco legislation. WHO issues around 200 sets of recommendations each year and acts in the manner of a world arbiter for public health by combing different scientific theories and studies in order to produce the best policies.
WHO regulations dating back to 1951 stress the role of expert opinion in the development of recommendations. However, guidelines approved in 2003 stress the use of systematic reviews for evidence effects and processes that would permit the incorporation of value based information. The team studied the use of evidence, especially for effects in recommendations developed by WHO departments. They found that systematic reviews and concise summaries of findings were rarely used for developing recommendations. Furthermore, processes were non-transparent and found to rely heavily on experts from a particular specialty rather than those who must live with the recommendations.
The organisation recognised the need for proper procedures when it endorsed the rules for WHO guidelines in 2003. However, no systems have been established to check for compliance with the guidelines, which the study suggests are not being followed. WHO has not yet stated if and how it will help Member States to adapt and implement recommendations.
The Director of WHO Research Policy, Dr Tikki Pang, noted the criticism, commenting that time constraints and a shortage of both information and funds sometimes compromised the work of the international organisation. Often evidence may not exist and information from developing countries may be incomplete and during an outbreak the data may change. Dr Pang also explained that while some guidelines may be based on a limited number of expert opinions, others were drawn up after careful scrutiny and were therefore more reliable. One such example was WHO’s recent recommendations for the treatment of bird flu patients.