Building sustainable capacity to adopt, adapt or develop child health guidelines, Malawi, Nigeria and South Africa

Many national child health guidelines in Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses. Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries. National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making. Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development.