Many organizations are collaborating to improve
reproductive health programs worldwide by identifying and encouraging
the use of "best practices." But what is a best practice?
Best practices can range from specific training
techniques or medical procedures to entire programs. Some of these
practices are backed by the strongest evidence available to public
health specialists: the results of systematic reviews of randomized
controlled trials. Some are based on less rigorous studies that may be
the only measures available to evaluate their effectiveness. Other
reproductive health interventions cannot be tested but have shown
promise based on the field experience of one or more organizations.
The World Health Organization (WHO) Programme to Map
Best Reproductive Health Practices focuses on evidence-based clinical
practices identified through systematic reviews of research. Its main
dissemination tool is WHO's annual electronic journal, the Reproductive
Health Library (RHL). The program has also developed a series of
interactive workshops to encourage use of the RHL and adoption of
evidence-based obstetric practices. A randomized controlled trial to
test this method of facilitating best practice implementation is under
way in 22 hospitals in Mexico City and 18 hospitals in northeastern
Thailand, with results expected in 2004.
A related effort to promote proven obstetric practices
identified through the RHL, the Better Births Initiative, is helping
hospital maternity staff in four South African provinces adopt
beneficial practices and abandon practices that are painful, potentially
harmful, or of no proven benefit. After preliminary results of a pilot
study in 10 hospitals in Gauteng province showed an increase in the
number of hospitals adopting evidence-based clinical practices,1
the initiative was expanded to five districts in Gauteng and to the
provinces of Eastern Cape, Western Cape, and KwaZulu-Natal. The strategy
of the Better Births Initiative is also being adapted for pilot programs
in China, Tanzania, and Zimbabwe.
Much of the data in the RHL is on obstetric practices,
notes Dr. A. Metin Gülmezoglu, RHL coordinating editor. "There
have been a lot of systematic reviews related to pregnancy and
childbirth, but we are starting to get more evidence related to HIV and
family planning," he says.
Where such evidence does not exist, however, program
managers and providers need guidance on the value of adopting practices
that appear promising through program evaluations and other assessments,
but have not been rigorously tested. To meet this need, Advance Africa
— a project sponsored by the U.S. Agency for International Development
(USAID) — has created a compendium of reproductive health
interventions and program models that are considered to have had some
measurable impact, largely outside experimental settings. Technical
experts review each practice submitted to the compendium, and those that
meet Advance Africa's criteria2 are classified as best
practices. The compendium's searchable database includes information
about lessons learned and program context that can help program managers
apply best practices. Advance Africa also provides technical assistance
in identifying best practices to improve programs.
The Implementing Best Practices Consortium Initiative,
which is led by WHO's Department of Reproductive Health and Research,
works with reproductive health organizations to match best practices to
program needs, harmonize approaches, and reduce duplication of effort.
The best practices, drawn from both research and program experience,
have been identified by consortium members as the most efficient and
effective approaches to improving reproductive health care. Participants
in the initiative's regional and inter-country meetings attend a
workshop on best practices before working in country teams to plan how
to use such practices to meet various goals. During a 2002 meeting in
Cairo, for example, members of the Jordanian team discovered that
several groups in their country were developing training curricula in
reproductive health counseling. The Jordanian team decided to create a
single reproductive health training curriculum and program for health
care providers instead, reducing duplication of materials and effort
while meeting specific training objectives, such as improving
counseling. Through these meetings and follow-up mentoring of country
teams, WHO and 17 other organizations that comprise the Implementing
Best Practices Consortium create networks to support program managers in
applying best practices.
— Kathleen Henry Shears
References
- Smith H, Garner P. Better Births Initiative: A programme for
action in middle- and low-income countries. In Making Childbirth
Safer through Promoting Evidence-based Care. Washington, DC:
Global Health Council, 2002.
- Advance Africa. Compendium of Best Practices: A Compendium for
Reproductive Health Service Delivery. Available online.
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