Incorporating Evidence into Health Systems in LMIC with Clinical Audits and Feedback: A Tool for Health System Strengthening.
By Kamga Emmanuel, Okwen P Mbah
Being the future of healthcare in LMIC, evidence-based healthcare ensures patients benefit from best quality healthcare and at cost effective rates. Use of evidence-based medicine has rapidly grown amongst developed countries but it still remains relatively poor in LMIC. Even in sectors where evidence-based guidelines existed, compliance with best practices by healthcare workers have been shown to be weak. An approach of audits and feedback has been shown to be helpful in getting research evidence into practice as it was able to identify barriers and address these as well as facilitate behaviour change in the practice in primary health care.
Given that most health systems in LMIC are based on the reorientation of primary health care system and are now centred on the health district system, this new system provides a unique opportunity for introduction and scaling health interventions and has been used successfully for public health interventions like immunisations programs, integrated management of childhood illnesses, malaria and distribution of mosquito bed nets. A good body of evidence suggests that incorporating clinical audits and feedback at district health service level could potentially be a game changer for evidence implementation in LMICs and hence help with health system strengthening. With the approach we developed, we are able to funnel the evidence at the health district level where we now use the process of clinical audit and feedback for implementation. Introducing the implementation at district level is helpful for systematisation, ownership, sustainability and opportunities to exploit existing structures like lay health workers and existing programs like performance-based financing or community mutual health schemes.
There is a critical need for larger scale rigorous impact evaluation studies to assess how these may work in LMIC health systems with larger number of health facilities and using a district perspective. The approach facilitates access and use of available evidence through development of evidence-based criteria, bringing about uniform evidence-based practice within the health district. There is the need to incorporate this into health systems as a smart approach to evidence based care in LMIC.