The role of WHO guidelines in shaping global health policies

The WHO guideline development process
Key WHO guidelines and their global impact
Challenges in implementing WHO guidelines
WHO guidelines for responding to health crises
Conclusion
References
More information

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The World Health Organization (WHO) is an agency of the United Nations (UN). Founded in 1948, it is dedicated to promoting global health through the use of science-based strategies. His efforts are focused on expanding universal health care, providing leadership during health crisis responses, and promoting health across the lifespan. ¹

WHO’s global role is to establish and monitor international standards or guidelines, helping to standardize health services and goals worldwide. In addition, it helps coordinate the many players involved in achieving common goals. ¹³

The WHO guideline development process

WHO Guidelines “is broadly defined as any information product developed by WHO that contains recommendations for clinical practice or public health policy.” ²

WHO develops evidence-based guidelines for all levels of health care and patient management. This includes asking the right questions, extracting and gathering the evidence, and assessing its reliability and trustworthiness. The aim is to promote informed decision-making for any clinical action at the individual or public health level to achieve the best outcomes. ²

Originally designed to address clinical management protocols, the WHO guidelines have now expanded to public health policies, health systems and health promotion strategies. ²

Some of the related challenges include identifying factors that change the outcome, including interactions between interventions or with the local situation and the effects caused by different levels of implementation. ³ WHO explored the complexities and difficulties in synthesizing evidence and developing guidelines.

Group decision-making is integral to formulating such guidelines. Scarce or conflicting evidence or strongly divergent views can prevent consensus, which is the goal achieved through discussion and compromise. ⁴ Stakeholders involved in this process include the affected population, guideline users, quality of evidence, and time and resource constraints. ⁴

The guideline review committee ensures that the guidelines are of high quality and that the development process is transparent, based on good evidence and goes through rigorous quality assurance processes. ²

Some recent WHO guidelines include those on malaria, complementary feeding of very young children, nutrition for adults and children, clinical management of diphtheria, postpartum blood loss, chronic low back pain in adults, and the Action Program on Mental Health Deficits. ³

Key WHO guidelines and their global impact

National health policies and strategies are key to conceptualizing goals and systems for achieving public health and implementing systems to improve health outcomes. WHO guidelines support countries in health policy development. ⁵

For example, National Immunization Strategy (NIS) guidelines help develop country-specific vaccination targets for vaccine-preventable childhood infectious diseases. They guide both national agencies and external partners in their programs and investments, aiming to integrate NIS into the national health agenda. The NIS can be updated and revised as needed in light of past performance and current reality. ⁶

WHO’s Health Emergencies Program coordinates with countries and partner organizations to prepare for, prevent, identify and respond to infectious disease outbreaks and other health emergencies. It supports research efforts in this area and strengthens health systems to address public health threats. ¹

Challenges in implementing WHO guidelines

Culture, limited resources, geographic limitations, religious beliefs, and other local factors play a large role in determining whether WHO guidelines can be easily implemented in a region or country. An example is the implementation of early and exclusive breastfeeding, a WHO guideline. ⁹

WHO actively promotes the spread of exclusive breastfeeding in the first six months of life, aiming for a level of 50% or more by 2025. This is done through the WHO-UNICEF Global Breastfeeding Collective, the WHO Network for Global Monitoring and Implementation Support of the International Code for the Marketing of Breast-milk Substitutes, also known as the NetCode to prevent aggressive marketing of breast-milk substitutes and train community health workers to support lactation, diagnose problems early and monitor infant growth. ⁹

A pilot intervention study in Africa showed that community counselors could successfully motivate mothers to avoid prelacteal feeding and adopt exclusive breastfeeding. ⁸ Resistance to immediate breastfeeding in this trial was met by careful selection and training of peer counselors who had completed the WHO courses.Breastfeeding counseling: a training course‘ and ‘HIV and infant feeding counseling: a training course” for more than a week, being tested before and after completing the courses. Part of the intervention was monthly follow-ups by the counselors who met with the mothers at their homes. ⁸

Another area is infant and child malnutrition. This can be mitigated by developing health policies mandating longer maternity leave with more benefits and implementing the WHO-UNICEF Baby Friendly Hospital Initiative. This includes skin-to-skin contact immediately after birth, early exclusive breastfeeding, responsive breastfeeding, rooming and continued professional and community support, as well as monitoring progress and identifying pitfalls. ¹⁰

“Breastfeeding practices respond strongly to supportive interventions and the prevalence of exclusive and continuous breastfeeding may improve over several years.” ¹⁰

WHO guidelines for responding to health crises

The coronavirus disease 2019 (COVID-19) pandemic threatens to take the world by storm in 2021-22. WHO prepared the Global Plan for Preparedness, Preparedness and Response to COVID-19, updating it in 2022. This helped countries decide on its public health priorities. ⁷

The dual goals of this global health policy were to reduce the spread of the virus through vaccination and to direct clinical management to reduce mortality, morbidity, and long-term sequelae. ⁷ It covers multiple steps, including surveillance, strategies to limit the spread of the virus, testing, clinical management protocols, vaccination targets and countering misinformation about the pandemic.

The WHO guidelines bring together available evidence to support health policy development, helping to identify priorities and strengthen public health infrastructure, while building global health emergency preparedness and response. ⁷

Conclusion

The WHO guidelines serve as a basis for context-specific public health strategies, together with monitoring strategies to assess their efficacy and adverse effects. In addition, WHO continues to work to strengthen national health systems to ensure the availability, accessibility and affordability of care for all. For example, it prioritizes the Primary Health Care program and the Universal Health Coverage (UHC) package. ^{11, 12}

Drug resistance, vaccination programmes, prevention and treatment of mental and non-communicable diseases and countering infodemics are other priority areas for WHO as it supports countries in their efforts to achieve the health-related Sustainable Development Goals. ¹¹. These guidelines have been developed based on the best evidence, using input from experts and stakeholders. They allow information to be shared without duplication of effort and waste of resources, but can be revised as needed.¹⁴

References

1. World Health Organization. Retrieved from https://www.who.int/about/ on February 21, 2024.
2. WHO guidelines. Retrieved from https://www.who.int/publications/who-guidelines on February 21, 2024.
3. Improving standard methods for developing WHO guidelines. Retrieved from https://www.who.int/news/item/28-01-2019-enhancing-who-s-standard-guideline-development-methods on February 21, 2024.
4. Decision-making for guideline development at WHO. WHO Handbook for Guideline Development – 2nd ed. (ISBN 978 92 4 154896 0) © World Health Organization 2014. Retrieved from https://iris.who.int/bitstream/handle/10665/145714/9789241548960_chap16_eng.pdf.
5. Supporting national health policies, strategies, plans. Retrieved from https://www.who.int/activities/supporting-national-health-policies-strategies-plans on February 21, 2024.
6. Working draft – August 2021 Guidelines for the development of a national immunization strategy. Retrieved from https://iris.who.int/bitstream/handle/10665/351144/WHO-IVB-2021.05-eng.pdf on February 21, 2024.
7. Brief information on the COVID-19 policy. Retrieved from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-policy-briefs on February 21, 2024.
8. Engebretsen, IMS, etc. (2014). Early infant feeding practices in three African countries: the PROMISE-EBF study promoting exclusive breastfeeding by peer counselors. International Journal of Breastfeeding. doi: https://doi.org/10.1186/1746-4358-9-19. https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-9-19.
9. Breastfeeding © 2024 WHO. Retrieved from https://www.who.int/health-topics/breastfeeding#tab=tab_3 on February 27, 2024.
10. Infant and toddler feeding. Retrieved from https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding on February 27, 2024.
11. 10 Global Health Issues to Track in 2021 Retrieved from https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021 on February 27, 2024.
12. UHC compendium: health interventions for universal health coverage. Retrieved from https://www.who.int/universal-health-coverage/compendium on February 27, 2024.
13. Ruger, JP et al. (2009). The global role of the World Health Organization. Global Health Management. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3981564.
14. Strengthening the capacity of countries to adopt and adapt evidence-based guidelines, a manual for contextualizing guidelines. Retrieved from https://iris.who.int/bitstream/handle/10665/372275/9789289060028-eng.pdf.

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