The World Health Organisation (WHO) is too reliant on expert opinion in particular fields in developing policies and recommendations, and should instead use more systematic reviews of relevant research and seek views of representatives who will have to live with those recommendations. The findings are reported early Online and in an upcoming edition of The Lancet.
Every year WHO develops and issues a large number of recommendations aimed at many different audiences, from the general public to healthcare organisations and governments.
Dr Andy Oxman, Norwegian Knowledge Centre for the Health Services, Oslo, Norway and Dr John Lavis at the Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada, interviewed WHO department directors or their delegates at the organisation's headquarters in Geneva, Switzerland, to find out the mechanics of how these recommendations are developed.
The authors found that expert opinion, rather than systematic reviews, was the primary source of information for recommendations to be drawn up. This goes against WHO's own guidelines for developing recommendations.
They say: "Expert committees or meetings of experts were almost always convened when developing recommendations whereas only a few directors mentioned having commissioned systematic reviews to inform the work of these expert groups."
The authors also discuss the difficulties associated with WHO's reliance on external financial support, but add the organisation could do a lot better with the resources it has.
The authors conclude: "Progress in the development, adaptation, dissemination and implementation of recommendations for member states will need leadership, the resources necessary for WHO to undertake these processes in a transparent and defensible way, and close attention to the current and emerging research literature related to these processes."
In an accompanying comment, Drs Tikki Pang and Suzanne Hill, Research Policy & Cooperation and Medicines Policy & Standards, WHO, Switzerland, say: "WHO is strongly committed to ensuring that its recommendations are based on the best available evidence and that it is continually improving its methods for the development of recommendations."
They add: "WHO has set good examples before and will strive to do so in the future. Basing guidelines on explicit and transparent consideration of the best evidence is crucial to WHO's international credibility, standing and reputation."
Dr Andy Oxman, Norwegian Knowledge Centre for the Health Services, Oslo, Norway, T) +47 4825 4924 E) oxman@online.no
Dr Tikki Pang, Medicines Policy and Co-operation, WHO, Switzerland, T) + 41 22 7912786 E) pangt@who.int
Journal
The Lancet