This week’s readings include 5 robust systematic reviews – one study focusing on neonatal survival interventions, three studies related to mental health but with varied focuses (mental health awareness integration, intervention for mental health in humanitarian settings, and scale-up of services for mental health in LMICs), and one study focusing on child friendly spaces interventions.
The two questions I would like to raise for this week are:
1. What are the processes of effectively formulating policy and practice recommendations by systematic reviews?
It will be naïve to think that the evidence base will be quickly picked up and implemented in countries. Darmstadt and colleagues rightly pointed out that the “real challenge is to deliver these at high coverage in countries with weak health systems.” The translation of evidence into practice, policy, and programme interventions is extremely challenging. Operational guidelines can be a good start.
Using the neonatal survival interventions as an example, with a list of evidence-based, cost-effective interventions on hand, what should an MoH do? As a non-expert in this area, I would think an assessment of the current situation should be required from the very beginning – what is the current level of neonatal mortality? What are the neonatal survival interventions currently being implemented, and at what level? If there is a gap between the existing interventions and the evidence-based, cost-effective interventions, why is that? If indeed actions are required, political commitment and financial resources need to be secured. MoH, together with other national stakeholders including the medical community, then need to determine whether the health system in the country is ready for implementing the new interventions. Among other questions, the group needs to answer: is there a sufficient number of health facilities and health care professionals? Do the health facilities equip with necessary supplies? Do health care professionals have the needed skills to provide the services? From the demand perspective, are there traditional and social norms prevent mothers from seeking clinical care? What about other factors such as lack of knowledge, financial burden, and access issue?
To some extent, the challenges in translating evidence into policy and practice can be attributed to the generalization of the evidence and as a result, lack of local context. Due to limited evidence from large-scale effectiveness trials, conclusions and recommendations may be generic and therefore cannot be applied in local settings. In addition to the aspects of existing health systems at the local level, to ensure a successful translation, social, cultural and political factors should also be taken into consideration and carefully assessed.