Adopting an iterative, pragmatic approach to guideline writing, the PCI clinical team has just concluded the co-writing of national level treatment guidelines for South Sudan. Drawing on a diverse bank of resources, our collaborative methodology enabled us to rapidly appraise the evidence base and produce high quality guidelines on a breadth of topics within just a few weeks.
Importance of national Standard Treatment Guidelines
As part of a collaboration with South Sudan’s Ministry of Health, the WHO identified a need to update and expand its national Standard Treatment Guidelines. These guidelines set out to ensure quality treatment is available at an affordable cost – a critical aspect in attaining Universal Health Coverage.
Something especially important in South Sudan where health expenditure per capita is only US$73 and the total expenditure on health is only 2.7% of GDP Citation. Against the global average spend per capita of US$1000 (and median of US$100 in lower and middle income countries) and 6.3% of GDP average in lower and middle income countries. Citation
With prior experience working on similar guidelines for Somaliland, Dr Nigel Pearson was contracted by WHO to write the guidelines. Working in collaboration with Nigel, PCI was able to offer a 9-person team* made up of practicing primary care practitioners to co-write the guidelines. These were to be adapted for four different books for different levels of the health system; hospitals, health centres, health units and community health teams.
The guidelines will be used in capacity building of health professionals in rationally treating patients. They refer to essential drugs and are based on national and international evidence-based guidelines. The objective is for:
“Patients to receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community.”
What the guidelines include
The guidelines cover an extensive range of healthcare topics: NCDs (high blood pressure, diabetes, asthma, respiratory infections, mental health); maternal health; reproductive health; immunisation; malnutrition; skin diseases; diarrhoea; measles; emergency medical care; HIV and TB; malaria; hepatitis; palliative care; tropical diseases; leprosy; sickle cell disease; epilepsy; ENT diseases – the list goes on…
PCI’s longstanding advisor, Nigel, provided an initial draft based on previous guidelines and each member of our primary care practitioner team were able to draw on their own work in resource-poor settings to further develop and update content in their areas of special interest/expertise. PCI also provided high level peer review and editing.
What makes PCI methodology distinct?
We take an iterative, collaborative approach which enables fast production of pragmatic evidence-based content. Whilst guideline writing can often take years of work by committee, our team was able to produce the guidelines in a matter of weeks.
The team based their editing and writing on a large database of resources, including former South Sudanese guidelines, guidelines from other African countries, National Institute of Clinical Excellence (NICE) guidelines and the British National Formulary, Red Whale’s GP Update Handbook and of course PCI’s own chronic disease Clinical Guides which are written for fragile and resource-poor settings and aligned to WHO guidance.
Rooted in the many years’ experience that the PCI team has as practising clinicians, we also made practical judgements on what to include/exclude to optimise usefulness of the guidelines to busy clinicians.
Ensuring local ownership
The guidelines were then validated in-country – another key part of the process critical to ensuring local ownership of guidelines. Nigel, with WHO colleagues, led the consultation process in South Sudan with the Ministry of Health and key UN and international agency staff. This culminated in a three-day workshop held in Juba, with 50 South Sudanese clinicians and UN staff.
“The development and implementation of South Sudan Standard Treatment Guidelines (SS-STGs 2019) is a key milestone to improve health service delivery in the country”, said Dr Ocan Charles, Health Policy Advisor who represented Dr Olushayo Olu, WHO Representative for South Sudan at the opening of a three-day workshop from 2-4 May 2019. Click here for full WHO news story
The new guidelines could potentially transform the quality of treatment in hospitals and health facilities across South Sudan. They should improve patient outcomes, reduce mortality and help the health ministry and partners make significant cost efficiencies in health care delivery. We’re proud that our unique methodology could play a role in this and look forward to seeing these guidelines implemented across the country.