This document discusses the importance of national clinical practice guideline programs. It notes that while evidence-based medicine has been emphasized since the 1990s, 70% of countries in the WHO Eastern Mediterranean Region still lack formal guideline development and implementation programs. The document outlines the benefits of national programs, including increasing quality of care, efficiency, and health outcomes. It also analyzes challenges faced by many countries, such as limited resources and capacity. The document describes WHO initiatives to support countries in establishing their own programs, using Egypt as an example. It emphasizes the need for high-level commitment, stakeholder engagement, and expanded national capacities to effectively develop and implement evidence-informed clinical guidelines.

1. Embrace the change: National programmes for
the development and adaptation of guidelines
Arash Rashidian, MD PhD
Director of Science, Information and Dissemination

2. A snapshot of national COVID-19 treatment guidelines in the Region in 2021
Were the guidelines based on evidence?
Status of national guidelines in 10
countries of the Region
Did clinicians follow national
guideline recommendations?
50% overlooked serious
drugdrug interactions
2 out of 3 medicines listed proved
to be ineffective or harmful
50% included medicines contrary
to WHO recommendations despite
citing WHO guidelines
3 out of 4 physicians prescribed
treatments not included in
national guidelines

3. The concept of
evidence-based
medicine was
introduced in the
1990s
Three decades later, 70% of
countries in the Region lack
national programmes for
guideline development,
adaptation or
implementation

4. Towards a Region where evidence-informed decision-making is
the norm
Resolution (EM/RC66/R.5; 2019) urged
Member States to:
“Establish national programmes
to adapt and/or develop
evidence-based public health and
clinical practice guidelines on
national priority issues” (item 2.3)
Evidence-
informed
policy-
making
Knowledge
translation
Health
technology
assessment
Guideline
development
and
adaptation
Routine data,
health
information
systems
National
surveys
Ad hoc
studies,
monitoring &
evaluation

5. Why are national guideline
programmes important?

6. Why the
national
guideline
programme
matters
Strengthens
credibility and
reduces bias in
decisions
Ensures national
ownership and
involves
stakeholders
Increases
quality of
care and
efficiency
Enhances
health
promotion and
well-being
Saving lives, promoting health, achieving
universal health coverage

7. What should be done?

8. Key challenges for use of guidelines: status of countries in the
Region in 2023
80% lack technical capacity
50% have dedicated units in Ministries of Health
55% face fragmentation and lack of collaboration
75% report limited financial resources
All countries face poor adherence to guidelines
Many specialty society guidelines but lack of systematic national oversight

9. What is a
national
guideline
programme?
Ecosystem/infrastructure
 Laws, regulations and commitment
 National technical, financial and human resource
capacity
 Stakeholder engagement
Development/adaptation
 National steering committee
 Robust methods and quality assurance
 National roadmap for action
Guideline impact
 Dissemination and implementation plans
 Monitoring and evaluation
 Accountability and responsiveness

10. WHO initiatives for guideline programmes in the Region
Regional support
16 web-based resources for
technical capacity
Template for guideline
presentation
Roadmap for country action
Country support
Topic-specific guidelines:
Qatar
National programme:
Egypt
Review of national programme:
Islamic Republic of Iran

11. Egypt’s plan to establish a national guideline programme
with WHO support
Stakeholders
and needs
assessment
by WHO
Guidance on
guideline centre
requirements and
processes
Capacity-building for
senior policy-makers
and key clinicians
Roadmap
for national
programme
Long-term
technical
support
from WHO
Law on development
of national guideline
programme by
Egyptian Health
Council
Establishment of
guideline centre
Expert
mapping for
national
committees
and groups
Ministry
policy for
guideline
centre
Jul 23
Onward
Apr
23
Feb
23
Feb 23
Nov-
Feb
2223
Jan 23
Mar
22
Jul
22
Nov 22

12. Lessons from Egypt’s experience
• Ensure high-level policy-
maker commitment
• Bring all stakeholders to
the table
• Expand national
capacities for action

13. Moving
forwards on
national
guideline
programmes
How does the national guideline programme
support your country in addressing priority
needs in clinical care and public health?
What further actions do you expect from the
WHO in support of your national agenda?
What role should academic institutions and
specialty societies play in the national
guideline programme in your country?