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.
