National stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa
Date
2018-07-31
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: There is increased international focus on improving the rigour of clinical practice guideline (CPG)
development practices. However, few empirical studies on CPG development have been conducted in low- and
middle-income countries. This paper explores national stakeholders’ perceptions of processes informing CPG
development for primary healthcare in South Africa, focusing on both their aspirations and views of what is
actually occurring.
Methods: A qualitative study design was employed including individual interviews with 37 South African
primary care CPG development role-players. Participants represented various disciplines, sectors and provinces.
The data were analysed through thematic analysis and an interpretivist conceptual framework.
Results: Strongly reflecting current international standards, participants identified six ‘aspirational’ processes that they
thought should inform South African CPG development, as follows: (1) evidence; (2) stakeholder consultation; (3)
transparency; (4) management of interests; (5) communication/co-ordination between CPG development groups; and
(6) fit-for-context. While perceptions of a transition towards more robust processes was common, CPG development
was seen to face ongoing challenges with regards to all six aspirational processes. Many challenges were attributed
to inadequate financial and human resources, which were perceived to hinder capacity to undertake the necessary
methodological work, respond to stakeholders’ feedback, and document and share decision-making processes.
Challenges were also linked to a complex web of politics, power and interests. The CPG development arena was
described as saturated with personal and financial interests, groups competing for authority over specific territories
and unequal power dynamics which favour those with the time, resources and authority to make contributions. These
were all perceived to affect efforts for transparency, collaboration and inclusivity in CPG development.
Conclusion: While there is strong commitment amongst national stakeholders to advance CPG development processes,
a mix of values, politics, power and capacity constraints pose significant challenges. Contrasting perspectives regarding
managing interests and how best to adapt to within-country contexts requires further exploration. Dedicated resources
for CPG development, standardised systems for managing conflicting interests, and the development of a political
environment that fosters collaboration and more equitable inclusion within and between CPG development groups are
needed. These initiatives may enhance CPG quality and acceptability, with associated positive impact on patient care.
Description
CITATION: Kredo, T., et al. 2018. National stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa. Health Research Policy and Systems, 16:68, doi:10.1186/s12961-018-0348-3.
The original publication is available at https://health-policy-systems.biomedcentral.com
The original publication is available at https://health-policy-systems.biomedcentral.com
Keywords
Primary care (Medicine) -- South Africa, Medical protocols -- South Africa
Citation
Kredo, T., et al. 2018. National stakeholders’ perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa. Health Research Policy and Systems, 16:68, doi:10.1186/s12961-018-0348-3