Should Cochrane go more global?

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16th Cochrane Colloquium, Special Session with Richard Horton - Monday 6 Oct., 13:00-14:00h

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Should Cochrane go more global?

  1. 1. What is the Cochrane Collaboration? • A “global network” • “Improving healthcare decision making globally”
  2. 2. How global? Mixed Cochrane Centres Western Europe 10 Cochrane Library South Asia 3 Issue 3, 2008 North America 3 1/76 reviews Latin America 2 Australasia 2 4/108 protocols Africa 2 relevant to LMIC Western Pacific 2 Middle East 1
  3. 3. Contribution to health-related MDGs? Child survival : 10/32 Maternal health : 18/70 HIV : 91 Malaria : 46 TB : 19 NTD :6
  4. 4. Click on Cochrane Reviews “Global Impact” • Inventory of resources (2004) • Press releases from the publisher • Reviews/protocols: publication graph • Impact factor
  5. 5. Current position, future directions A small survey of 22 scientists and policy-makers working in global health They were sent Gerd’s 5 questions 18 responses
  6. 6. Gerd’s questions 1. Do you see the CC as an important player in global health? 2. Do you think the CC is a major contributor to international health policies and programmes? 3. Do you think the CC is a significant contributor to the global knowledge base? 4. Do you see the CC as a global health organisation? 5. What are your (so far unmet) expectations?
  7. 7. Cochrane and Global Health 5 Propositions 1. The CC is held in immense respect 2. Many observers hope for a stronger role for the CC in global health 3. Some observers are disappointed by a lack of visible or tangible commitment to global health 4. There are some difficulties faced by the CC 5. Several actions could be taken to address these perceived shortfalls
  8. 8. 1. The Collaboration is held in immense respect “The CC has played a leading role in synthesising the evidence for effective clinical practice and has begun to contribute to the development of better policies for health and health care.”
  9. 9. “The definitive source for evidence synthesis and information…there is nothing else which can compete with this.”
  10. 10. “a fantastic resource for practitioners and policymakers alike.”
  11. 11. “We think that the CC is an important and helpful player in the area of child health. Some CC reviews have supported significant policy changes.”
  12. 12. 2. Many observers hope for a stronger role in global health “I would like to see it building on [its] impressive achievements…to develop the capacity to undertake systematic reviews in LMIC.”
  13. 13. “I would welcome increased involvement by Cochrane in global health.”
  14. 14. “Additional focus on LMIC needs would be very valuable”
  15. 15. “We have found the CC very useful, however feel it needs to shift emphasis towards global health itself.”
  16. 16. “Cochrane has a lot to offer if it gets confronted with the right type of questions.”
  17. 17. “One wishes, however, that the Collaboration will continue to increase its footprint in the developing world.”
  18. 18. “More effort needs to be made to both address problems of significance to developing countries but also to go beyond clinical trials to allow for inclusion of well- documented field experiences as an intrinsic component of our knowledge base.”
  19. 19. 3. Some observers are disappointed by the lack of visible commitment to global health “Cochrane’s contributions are small and ever decreasing.”
  20. 20. Is Cochrane a major contributor to global health? “Not as much as it should be”; “unfortunately this is not the case today.”
  21. 21. Is Cochrane a global health organisation? “No”; “No.”
  22. 22. “Cochrane needs to make itself more relevant to global public health.”
  23. 23. “Cochrane has not responded to global health issues.”
  24. 24. “I have not been aware of any CC contribution to international work in global health.”
  25. 25. “I’m afraid that to the best of my knowledge, Cochrane work hasn’t really had much impact, if any, on policies and practice in the AIDS field.”
  26. 26. 4. There are some difficulties the Collaboration faces “My sense is that Cochrane is having enough trouble trying to get its own house in order.”
  27. 27. “I see the messiness of implementation of policy in countries with authorities that are corrupt, lacking basic infrastructure, and relevant skills. These are precisely the places that RCTs don’t get done.”
  28. 28. “What I do not understand is how CC would define “evidence-base.”” − diverse contexts, methods, issues of data access/quality
  29. 29. “Does the CC even have amongst its membership [those] who are agile with these issues?”
  30. 30. 5. There are several actions that could be taken to address the perceived shortfalls of the Collaboration in global health “More topics that are relevant to issues that confront populations in the developing world.”
  31. 31. “Evaluate and challenge many ‘standards of care’ that are based on expert opinion rather than sound evidence reviews.”
  32. 32. “Include methods that relate to quasi-experimental study designs and sound observational studies.”
  33. 33. “Enhance the research to policy link within the Collaboration.”
  34. 34. “Influence research funders to enhance funding to address information gaps highlighted by the Cochrane Collaboration.”
  35. 35. “Include in every systematic review implications for practice (and research) in resource-limited settings.”
  36. 36. “CC could do much more on effective practices relevant to the global knowledge base.”
  37. 37. “A closer collaboration with WHO, for example, to identify key questions of global health importance for systematic reviews, would be beneficial for both partners.”
  38. 38. “A structured interaction between Cochrane and policy-makers/practitioners would potentially help a lot here.”
  39. 39. “How to build community effectiveness and equity issues into meta-analyses of efficacy, and how to present these data to policymakers in a clear and relatively non- technical way.”
  40. 40. “How to build the capacity of universities and medical schools ‘in the south’ to use the Cochrane principles of efficacy and effectiveness.”
  41. 41. Tentative conclusions • Cochrane is a global network • Cochrane does contribute to global health knowledge • Cochrane is beginning to influence policy, but too slowly/quietly • Cochrane is not yet a global health organisation COCHRANE HAS REACHED A STRATEGIC DECISION POINT DOES IT WANT TO BE A GLOBAL HEALTH ORGANISATION? If No: A missed opportunity? If Yes: Consider: Making a public and visible commitment Adding to/realigning your work programme Rethinking your communication/advocacy

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