Adapting clinical guidelines in India—a pragmatic approach
BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5147 (Published 17 November 2017) Cite this as: BMJ 2017;359:j5147
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Dr. Mehndiratta and collaborators,
Your article is very interesting, and, as you wrote, many people are trying to develop methods for adapting good quality clinical guidelines in a shorter time and with acceptable cost, mainly for low and middle-income countries. We have been trying to avoid reinventing the wheel by seeking new alternatives for developing clinical guidelines. We decided to explore and use the results of 21 years of Evidence-Based Medicine developed tools. We published the article: "RAPADAPTE for rapid guideline development: high-quality clinical guidelines can be rapidly developed with limited resources". It would be very interesting to share both groups' experiences. https://academic.oup.com/intqhc/article/28/3/268/2238273
The RAPADAPTE method is also being used in Bahrain for developing breast cancer clinical guidelines. The developers' group in Bahrain is led by Prof. Zbys Fedorowicz.
Thank you
Competing interests: No competing interests
India has many systems of medicine, and all of the systems need to be included in Indian Guidelines
India is a country which adopts various systems of medicine, including Homeopathy, Siddha, Unani, Allopathy and so on. Other than allopathy, no other system of medicine is based on randomised controlled studies, and they are used traditionally. These system based treatments are also adopted by the State or central government such as treatment for dengue in India. In India there are many misconceptions, so many traditional healers and many quack. So guidelines for medical management in India should include all the systems of medicine if they are proved beyond doubt.
Competing interests: No competing interests
Clinical guidelines in India: Bureaucratic implementation?
Sir,
The authors describe a pragmatic approach to clinical guideline development for use in India. (1) Their efforts are laudable, given the lack of such guidance in India. However, there are several areas of concern that would need to be addressed before a robust framework for implementation is established:
1. India has a mixed health system that includes both public sector and private sector establishments. (2,3)
2. The public health system, though one of the largest in the world, is under-financed, and low-performing.(3)
3. The private sector corners about 80% of all out-patient visits, most of which are funded by out-of-pocket expenditure.(2–4)
4. India’s health sector is largely unregulated.(2,3)
5. Several approaches to regulate India’s health market have been tried, often with limited success.(3)
6. The National Health Policy 2017 makes several commitments regarding increasing public health spending, reducing out-of-pocket expenditure, and ensuring that the quality of care is not compromised. However, specific details as to how these will be achieved are lacking.(5)
In the absence of a robust and uniform regulatory mechanism, implementation of the clinical guidelines will be difficult. Therefore, although the development of clinical guidelines is a welcome move in itself, unless the concerns raised above are addressed, Indian citizens may fail to benefit from the exercise.
References:
1. Mehndiratta A, Sharma S, Gupta NP, Sankar MJ, Cluzeau F. Adapting clinical guidelines in India—a pragmatic approach. BMJ [Internet]. 2017 [cited 2017 Nov 28];359. Available from: http://www.bmj.com/content/bmj/359/bmj.j5147.full.pdf
2. Sheikh K, Saligram PS, Hort K. What explains regulatory failure? Analysing the architecture of health care regulation in two Indian states. Health Policy Plan [Internet]. 2015 [cited 2017 Nov 28];30:39–55. Available from: https://academic.oup.com/heapol/article-abstract/30/1/39/563025
3. Peters DH, Muraleedharan VR. Regulating India’s health services: To what end? What future? Soc Sci Med [Internet]. 2008 [cited 2017 Nov 28];66(10):2133–44. Available from: https://ac.els-cdn.com/S0277953608000622/1-s2.0-S0277953608000622-main.p...
4. Gupta I, Bhatia M. The Indian Health Care System [Internet]. 2016 [cited 2017 Nov 28]. Available from: http://international.commonwealthfund.org/countries/india/
5. Ministry of Health and Family Welfare, Government of India. NATIONAL HEALTH POLICY, 2017 [Internet]. New Delhi: Ministry of Health and Family Welfare, Government of India; 2017 [cited 2017 Nov 28]. Available from: http://cdsco.nic.in/writereaddata/National-Health-Policy.pdf
Competing interests: No competing interests