Implementing global knowledge in local practice: a WHO lung health initiative in Nepal

Authors: ten Asbroek, AHA¹; Delnoij, DMJ²; Niessen, LW¹; Scherpbier, RW³; Shrestha, N⁴; Bam, DS⁵; Gunneberg, C⁵; van der Hor, CW¹; Klazinga, NS²

Source: Health Policy and Planning, Volume 20, Number 5, September 2005 , pp. 290-301(12)

Publisher: Oxford University Press

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Health Policy and Planning blends such individual specialities as epidemiology, health and development economics, management and social policy, planning and social anthropology into a lively academic mix that constantly stimulates and keeps readers abreast of modern international health care.

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Abstract:

Clinical practice guidelines are used widely to improve the quality of primary health care in different health systems, including those of low-income countries. Often developed at international level and adapted to national contexts to increase the feasibility of effective uptake, guideline initiatives aim to transfer global scientific knowledge into local practice. The WHO's Practical Approach to Lung Health (PAL) is an example of such an initiative and is currently being developed to improve the quality of care for youths and adults with respiratory diseases.

We assessed ex-ante the feasibility of successful implementation of PAL in a pilot programme in rural Nepal, studying three components: the quality of the innovation (i.e. the guidelines), the effectiveness of the implementation strategy (i.e. training) and the receptiveness of the social system of health staff at all levels (i.e. social and organizational characteristics). We assessed the guideline innovation with the AGREE instrument for guidelines, the intended implementation strategy by critical comparison with literature on effective strategies, and the social system with both a stakeholder analysis and a descriptive analysis of the health care system at district level.

This ex-ante assessment of an adaptive local implementation of international WHO guidelines showed that in July 2002 the ‘implementability’ of the package was challenged on the three components studied. To increase the chances of successful implementation, the national guideline development process should be improved and the implementation strategy needs to be upgraded. In order to successfully transfer global knowledge into local practice, we need to develop additional multifactorial sustained interventions that tackle other culture-specific and health system-specific barriers as well. The primary health workers are key informants for these barriers.

Keywords: quality of care; implementation; guidelines; stakeholder analysis; social system; low-income countries; Nepal

Document Type: Research article

DOI: 10.1093/heapol/czi034

Affiliations: 1: Institute of Medical Technology Assessment/Institute of Health Policy and Management, Erasmus Medical Centre, Erasmus University Rotterdam, the Netherlands, 2: Department of Social Medicine, Academic Medical Center – University of Amsterdam, the Netherlands, 3: previously: Stop TB, Communicable Diseases Cluster, World Health Organization, Geneva, Switzerland; currently: Family and Community Health Cluster, World Health Organization, Geneva, Switzerland, 4: Department of Community Media and Family Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal, 5: National Tuberculosis Centre, Thimi, Nepal,