The injustice of unfit clinical practice guidelines in low-resource realities

Nanna Maaløe*, Anna Marie Rønne Ørtved, Jane Brandt Sørensen, Brenda Sequeira Dmello, Thomas van den Akker, Monica Lauridsen Kujabi, Hussein Kidanto, Tarek Meguid, Ib Christian Bygbjerg, Jos van Roosmalen, Dan Wolf Meyrowitsch, Natasha Housseine

*Corresponding author for this work

Research output: Contribution to JournalReview articleAcademicpeer-review


To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.

Original languageEnglish
Pages (from-to)e875-e879
Number of pages5
JournalThe Lancet Global Health
Issue number6
Early online date23 Mar 2021
Publication statusPublished - Jun 2021

Bibliographical note

Funding Information:
This Viewpoint received no specific funding. Several authors of this Viewpoint have substantial clinical experience and research experience in sub-Saharan Africa, including challenges in providing clinical practice in resource-constrained realities, in which available guidelines are unachievable. We would like to recognise the health-care providers serving at the frontlines of low-resource health-care systems and the women giving birth, from whom we will continue to learn. Additionally, we would like to thank Britt Pinkowski Tersb?l (Denmark) and Rashid Saleh Khamis (Zanzibar) for their valuable critical feedback on this Viewpoint.

Funding Information:
This Viewpoint is written by members of the PartoMa research project , which is funded by the Danida Fellowship Centre, Ministry of Foreign Affairs of Denmark (Danida project 18–08-KU). In partnership with Tanzanian health providers, the aim of the PartoMa project is to co-create context-tailored clinical practice guidelines and associated training for best possible safe and respectful care during birth. All authors declare no other competing interests.

Publisher Copyright:
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license

Copyright 2021 Elsevier B.V., All rights reserved.


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