Education And Debate Getting research findings into practice

Implementing research findings in developing countries

BMJ 1998; 317 doi: http://dx.doi.org/10.1136/bmj.317.7157.531 (Published 22 August 1998) Cite this as: BMJ 1998;317:531
  1. Paul Garnera, senior lecturer in international health (pgarner@liv.ac.uk),
  2. Rajendra Kaleb, neurologist,
  3. Rumona Dicksona, lecturer in research synthesis,
  4. Tony Dansc, associate professor,
  5. Rodrigo Salinasd, manager, district effectiveness project.
  1. a International Health Division, Liverpool School of Tropical Medicine, Liverpool L3 5QA
  2. b37 Shanwar, Pune 411 030, India
  3. cCollege of Medicine, University of the Philippines, 547 Pedro Gil, Metro Manila 1000, Philippines
  4. dDepartmento de Ciencias Neurologicas, Universidad de Chile, Avenida J M Infante 533, Santiago, Chile
  1. aCorrespondence to: Dr Garner

    This is the last in a series of eight articles analysing the gap between research and practice

    Series editors: Andrew Haines and Anna Donald

    Developing countries have limited resources, so it is particularly important to invest in health care that works. The growing number of relevant systematic reviews can assist policymakers, clinicians, and consumers in making informed decisions. Developing countries have led the way in generating approaches to ensure professional standards of behaviour through interventions such as producing guidelines and introducing essential drug programmes, and by producing reliable research summaries to help ensure that policies are based on good evidence.

    Summary points

    • Financial resources are limited in developing countries so it is vital thatthe health care provided is effective

    • The number of systematic reviews relevant to developing countries is increasing

    • Disseminating the findings of systematic reviews to policymakers, health professionals,and consumers is an essential prerequisite to changing practices

    • Practice guidelines and international programmes that provide essential drugs are well established and provide a powerful route for reinforcing evidence based practice

    • Large obstacles impede the implementation of evidence based practices, such as the unethical promotion of drugs; these problems need to be addressed by regulation

    • Action is required at all levels of healthcare systems, from consumers through to health professionals, ministries of health, and international organisations

    Introduction

    Yakamul, an illiterate villager in Papua New Guinea, was sitting by a fire listening to a health professional from the West tell her to take chloroquine throughout her pregnancy. She responded: “I ting merisin bilong ol wait man bai bagarapim mi [I think this Western medicine could harm me].” She had never attended a workshop in critical appraisal butshe realised that medicine could do her more harm than good. Her response reminds health professionals to ask fundamental questions about the care we provide and of our responsibility …

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