Doctors pledge to spread evidence based healthcare in Africa

BMJ 2013; 346 doi: (Published 17 January 2013) Cite this as: BMJ 2013;346:f356
  1. Anne Gulland
  1. 1London

Insecticide treated bed nets to prevent the spread of malaria and male circumcision to prevent HIV infection are just two of the evidence based healthcare measures that should be more widely used in Africa, doctors say.

Last month doctors from nine African countries, alongside European colleagues, met in Rwanda to sign the Kigali declaration (web extra), which urges governments, non-governmental organisations, and healthcare professionals to implement evidence based healthcare.

The declaration is the brainchild of the Collaboration for Evidence Based Healthcare in Africa, a partnership founded by the Royal Tropical Institute in Amsterdam in association with a group of African clinicians.

The declaration calls on health workers, policy makers, and researchers to be trained and for infrastructure to be provided to support evidence based healthcare. It says that evidence based healthcare should be integrated into health education curriculums and that systematic reviews and guidelines relevant to Africa should be developed.

It also urges governments “to take the lead in supporting evidence based healthcare by prioritising interventions and prevention strategies that are fair and proven effective.”

The collaboration has been training librarians across Africa on how to use the internet and smartphones to access the most relevant research.

Frode Forland, a public health specialist at the institute and one of the signatories to the declaration, said that evidence based healthcare had had a “remarkable impact” on health policy in Europe and the United States but that Africa had lagged behind.

“There are no established evidence based institutes such as the [UK] National Institute for Health and Clinical Excellence,” he said. “There is a huge lack of secondary research on the needs of African health problems.”

He cited use of insecticide treated bed nets by pregnant women and children as an example of an intervention that had been “proved by good systematic reviews” but that were still not implemented widely enough in Africa.

He also pointed out that, despite the publication of three randomised controlled trials in Kenya, Uganda, and South Africa showing that men who had been circumcised were between 50% and 60% less likely to carry HIV than those who had not,1 2 3 the procedure was not widespread.

“It’s an easy procedure, and we’re not talking about doing it on children but on men, as a preventive health measure,” said Forland.

He also cited deworming as an example of a procedure that was common but that had little supporting evidence.4

The declaration calls on the “international scientific community to support and collaborate on primary and secondary research relevant to African health needs and priorities.”

Forland said that helping healthcare systems to introduce evidence based decision making was not seen as “sexy” by funders.

He added that research into African health problems should take place in Africa. “Research has to be done where the needs are. There’s no reason why you should sit in England investigating African health problems,” he said. “There is a growing community of scientists, doctors, and health workers in Africa who are committed to working in their own countries.”


Cite this as: BMJ 2013;346:f356