Evidence Based Health Care in Africa

In African countries, where health problems are severe and resources scarce, there is not much room for error when determining which interventions to undertake. Medical evidence backing the effectiveness of particular interventions and clinical decision making is often not available, appropriate, or accessible to health care professionals in this part of the world. At present, there is a great deal of clinical research going on in Africa. Unfortunately, much of this research is not implemented in policy-making and clinical practice.

Presently, worldwide, many researchers and policy-makers are discussing the gap between clinical research, policy and implementation. A recent survey by Lavis et al (1) among 308 researchers in 10 low and middle income countries showed that less than 50% of the interviewed researchers reported to have been engaged in one or more of three promising bridging activities between research, policy and practice. The three particularly promising activities that were identified included 'providing systematic reviews of the research literature to their target audience' (27%), 'providing access to a searchable database of articles, reports, syntheses or systematic reviews on topic' (40%) and 'establishing or maintaining long-term partnerships related to the topic with target audience representatives' (43%).

We must maximize the chances of the research being done in Africa and its results being used in both clinical practice and the public health sector to make the most of scarce resources, and to provide scientific evidence for the African context. Although a great deal of new research is being conducted in Africa, still too little evidence is being produced in the developing world. Therefore the best available evidence in the developing world may not always be of the same hierarchal standard of what is expected in developed countries.

There is a need to increase the knowledge and expertise on evidence based medicine to be able to perform evidence based health care in Africa. Training health care practitioners to locate relevant research, interpret results and develop evidence themselves, moves us closer to reducing the gap between research, health care policy and practice in resource-poor countries, leading to informed clinical decision making. The creation of an African collaboration for Evidence Based Health Care focusing on African health problems and tailored to local circumstances is considered useful for all levels of health care.

1 Lavis JN, Guindon GE, Cameron D, Boupha B, Dejman M, Osei EJ et al. Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of researchers. CMAJ 2010; 182(9):E350-E361

Selected references for further reading:

Forland F, Rohwer AC, Klatser P, Boer K, Mayanja-Kizza H. Strengthening evidence-based healthcare in Africa. Evid Based Med. 2013. Abstract
Ochodo EA, Leeflang MM. Systematic reviews of diagnostic test accuracy for evidence-based diagnostic practice in Africa. African Journal of Laboratory Medicine. 2012;1.
Ehrhardt S, Meyer CG. Transfer of evidence-based medical guidelines to low- and middle-income countries. Tropical medicine & international health : TM & IH. 2011. Abstract
Lavis JN, Guindon EG, Cameron D, Boupha B, Dejman M, Osei EJ, et al. Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of researchers. CMAJ. 2010;182(9):E350-61. Abstract
Guindon EG, Lavis JN, Becerra-Posada F, Malek-Afzali H, Shi G, Yesudian AC, et al. Bridging the gaps between research, policy and practice in low- and middle-income countries: a survey of health care providers. CMAJ. 2010;182(9):E362-72. Abstract
McMichael C, Waters E, Volmink J. Evidence-based public health: what does it offer developing countries? J Public Health (Oxf). 2005;27(2):215-21. Abstract
Garner P, Meremikwu M, Volmink J, Xu Q, Smith H. Putting evidence into practice: how middle and low income countries "get it together". BMJ. 2004;329(7473):1036-9.