Riding a wave in developing countries

Over the past decade, developing countries have become increasingly engaged with the processes and activities of evidence-based practice (EBP).1,2 Some facilitators of this process include the Joanna Briggs Institute (JBI) and Cochrane, among others. Organizations from a number of developing countries are currently members of these two bodies1,2 — a testament to their increasing participation in evidence synthesis. Systematic reviews and other EBP processes and resources are also being accessed and utilized by the developing world. The Joanna Briggs Institute, Cochrane and the Collaboration for Evidence-Based Healthcare in Africa (CEBHA) have in recent times established evidence synthesis and translation groups in sub-Saharan and Asian countries.3,4 Researchers, educationists, healthcare providers, health program implementers and policy makers are keen to understand the concept of EBP across the developing world. Institutions of higher learning and research in developing countries are encouraging graduate students to conduct and publish systematic reviews as a component of their programs of study. Some organizations have further provided end-users with platforms to access systematic reviews and relevant derivatives to guide practice and policy.5 In the past, concerns have been raised regarding the feasibility, practicability and relevance of EBP in the developing world. Despite this, there are clear examples where synthesized evidence from studies on maternal and neonatal vitamin A supplementation,6–8 and malaria prevention,9–11 to mention a few, have proven that EBP can be of enormous benefit to the developing world. Based on the Joanna Briggs model, EBP is a cyclical process. It starts with identifying a global health issue. Evidence is then generated, synthesized, transferred and finally utilized to address the issue.12 While significant effort has gone into identifying health issues in the developing world, more needs to be done. The World Health Organization (WHO), the European and Developing Councils Clinical Trials Partnership, the National Institutes of Health (USA) and the Medical Research Council (UK), and more, have collaborated with researchers in developing countries to map out and support evidence generation in areas of relevance and importance to the health of the developing world. The Joanna Briggs Institute, Cochrane and CEBHA have trained these developing world researchers and supported a number of evidence synthesis groups. However evidence synthesis by such groups could be adversely influenced by many factors. It is no secret that there is a paucity of published evidence from developing countries as compared to the developed world. Additionally inadequate research capacity and resources prevent the generation of high quality evidence. High impact journals based in the developed world are also perceived to poorly regard evidence generated from the developing world.13 To ensure evidence transfer, JBI, the Institute of Medicine of the National Academies of the USA and Cochrane provide end-users, including those in developing countries, access to synthesized evidence. Most transfers occur via electronic interfaces that might not be available in some developing countries. Utilization of evidence by end-users could be hampered by rigid timelines of program implementation, organizational policies that hinder change and insufficient political will to make use of synthesized evidence. End-users’ perceptions of not owning synthesized evidence could also adversely influence its use. To benefit from the momentum generated by EBP in developing countries, multipronged approaches adapted to the varying contexts of the developing world are necessary. Access to published evidence through avenues such as HINARI and open access journals will continue to be important to maintain the momentum of EBP. However, facilitating the further generation and publishing of contextually relevant evidence generated in the developing world should be prioritized. Contextually appropriate approaches to evidence transfer based on their particular needs and resources would enhance the use of synthesized evidence by developing world end-users.14 Evidence-based groups need to continue to educate stakeholders and end-users, for example, policy makers, researchers, educationists and the general public on the importance of EBP to their health and wellbeing. Actively engaging end-users over the course of the evidence synthesis process could enhance ownership of its outcomes. Active engagement could also provide a high level of appreciation of the EBP process and its importance to health. Finally, sharing of experiences and collaborative efforts by various organizations could better enhance the EBP process in the developing world.