WHO recommendations on antenatal care for a positive pregnancy experience

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6. Dissemination, applicability and updating of the guideline and <strong>recommendations</strong> <strong>WHO</strong> <strong>recommendations</strong> on antenatal care for a positive pregnancy experience 6.1 Dissemination This guideline will be available online for download and also as a printed publication. Online versions will be available via the websites of the <strong>WHO</strong> Departments of Reproductive Health and Research (RHR), Nutrition for Health and Development (NHD) and Maternal, Newborn, Child and Adolescent Health (MCA), and through the <strong>WHO</strong> Reproductive Health Library (RHL). 7 Print versions will be distributed to <strong>WHO</strong> regional and country offices, ministries of health, <strong>WHO</strong> collaborating centres, NGO partners and professional associations, using the same distribution list that was developed for the implementation of focused ANC (FANC). The guideline will be accompanied by an independent critical appraisal based on the AGREE instrument (Appraisal of Guidelines for Research & Evaluation) (213). Technical meetings will be held within the <strong>WHO</strong> Departments of RHR, NHD and MCA to share the <strong>recommendations</strong> and derivative products, which will include a practical manual for implementation of the new 2016 <strong>WHO</strong> ANC model, with the teams responsible for policy and programme implementation. Two sets of evidence briefs will be developed: one set for policy-makers and programme managers and the other set for health-care professionals. These evidence briefs, which will highlight the <strong>recommendations</strong> and implementation-related contextual issues, will be developed and disseminated in collaboration USAID, FIGO and ICM. The briefs will be organized in alignment with the different sections of the guideline, for example focusing on nutrition, maternal and fetal assessment or preventive measures to allow for derivative products to be tailored and disseminated accordingly to partners. The executive summary and <strong>recommendations</strong> from this publication will be translated into the six UN languages for dissemination through the <strong>WHO</strong> 7 RHL is available at: http://apps.who.int/rhl/en/ regional offices and during meetings organized by, or attended by, staff of the <strong>WHO</strong> Departments of RHR, MCA and NHD. In addition to online and print versions of this guideline, an interactive web-based version is planned, which will be developed by a professional infographics group. This will facilitate the dissemination and uptake of the guideline <strong>recommendations</strong> by making them available online in a user-friendly format, and will allow a platform for cross-referenced <strong>recommendations</strong> to be updated on an ongoing basis to ensure that the <strong>recommendations</strong> are up to date. Furthermore, this would allow for products to be organized by different topics (e.g. nutrition) and allow for focused activities and products to be developed. English, French, Portuguese and Spanish (the latter in collaboration with the <strong>WHO</strong> Regional Office for the Americas/Pan American Health Organization [PAHO]) web-based versions are planned and have been budgeted for. The guideline will also be launched on the <strong>WHO</strong> Department of RHR official website as part of the monthly "HRP News”. This site currently has over 3000 subscribers including clinicians, programme managers, policy-makers and health service users from all around the world. In addition, a number of articles presenting the <strong>recommendations</strong> and key implementation considerations will be published, in compliance with <strong>WHO</strong>’s open access and copyright policies. Relevant <strong>WHO</strong> clusters, departments and partnerships, such as HIV/AIDS, Tuberculosis and Malaria, the Initiative for Vaccine Research (IVR) and the Partnership for Maternal, Newborn & Child Health (PMNCH) will also be part of this dissemination process. In an effort to increase dissemination of <strong>WHO</strong> guidelines on sexual and reproductive health and rights, a search function with the ability to search the database of <strong>WHO</strong> guidelines and <strong>recommendations</strong> has been created and recently launched by 120
the Department of RHR. 8 The ANC guideline <strong>recommendations</strong> will be made available via this new search function. The Maternal and Perinatal Health and Preventing Unsafe Abortion team of the <strong>WHO</strong> Department of RHR, in collaboration with the Departments of NHD and MCA and other partners, will support national and subnational working groups to adapt and implement the guideline. This process will include the development or revision of existing national guidelines or protocols in line with the <strong>WHO</strong> guideline. The GREAT Network (Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge) will be used to bring together relevant stakeholders to identify and assess the priorities, barriers and facilitators to guideline implementation, and to support the efforts of stakeholders to develop adaptations and guideline implementation strategies tailored to the local context (214). This includes technical support for local guideline implementers in the development of training manuals, flow charts and quality indicators, as well as participation in stakeholder meetings. 6.2 Applicability issues Anticipated impact of the guideline on the organization of ANC Effective implementation of the <strong>recommendations</strong> in this guideline will likely require reorganization of care and redistribution of health-care resources, particularly in low- and middle-income countries (LMICs). The potential barriers to implementation include the following: • nlack of human resources with the necessary expertise and skills to implement, supervise and support recommended practices, including client counselling; • nlack of infrastructure to support interventions, e.g. lack of power to support ultrasound equipment; • nlack of physical space to conduct individual or group-based counselling; • nlack of community understanding of the new model of care, particularly around the contact schedule and potentially longer wait times; • nlack of physical resources, e.g. equipment, test kits, supplies, medicines and nutritional supplements; 8 This can be accessed at: search.optimizemnh.org • nlack of effective referral mechanisms and care pathways for women identified as needing additional care; • nlack of understanding of the value of newly recommended interventions among health-care providers and system managers. • nlack of health information management systems (HMISs) designed to document and monitor recommended practices (e.g. client cards, registers, etc.). Given the potential barriers noted above, a phased approach to adoption, adaptation and implementation of the guideline <strong>recommendations</strong> may be prudent. Various strategies for addressing these barriers and facilitating implementation have been suggested in the list of considerations at the end of Chapter 4. Monitoring and evaluating the impact of the guideline The implementation and impact of these <strong>recommendations</strong> will be monitored at the healthservice, regional and country levels, based on clearly defined criteria and indicators that are associated with locally agreed targets. In collaboration with the monitoring and evaluation teams of the <strong>WHO</strong> Departments of RHR and MCA, data on country- and regional-level implementation of the <strong>recommendations</strong> will be collected and evaluated in the short to medium term to evaluate their impact on national policies of individual <strong>WHO</strong> Member States. Interrupted time series, clinical audits or criterionbased audits could be used to obtain the relevant data on the interventions contained in this guideline. 6.3 Updating the guideline In accordance with the concept of <strong>WHO</strong>’s GREAT Network, which employs a systematic and continuous process of identifying and bridging evidence gaps following guideline implementation (214), the proposed guideline will be updated five years after publication unless significant new evidence emerges that necessitates earlier revision. The <strong>WHO</strong> Steering Group will continue to follow the research developments in the area of ANC, particularly for those questions for which no evidence was found and those that are supported by low-quality evidence, where new <strong>recommendations</strong> or a change in the published recommendation may be warranted, Chapter 6. Dissemination, applicability and updating 121
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« To achieve the Every Woman Every
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Funding was provided for this guide
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Evaluation (GRADE) and Confidence i
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Zinc supplements Multiple micronutr
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Ultrasound scan Doppler ultrasound
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Task shifting components of antenat
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expect from ANC is to have a “pos
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2. Methods WHO <st
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a list of ANC outcomes was prioriti
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content experts among the GDG membe
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• nFeasibility: Feasibility is in
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are indicated by a footnote in the
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A. Nutritional interventions <stron
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A.1.2: Nutrition education on energ
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A.1.3: Energy and protein dietary s
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A.1.4: High-protein supplements REC
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Summary of evidence and considerati
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Equity Effective interventions to i
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A.7: Vitamin B6 (pyridoxine) supple
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only a quarter of the planned sampl
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A.10: Restricting caffeine intake R
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B. Maternal and fetal assessment B.
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to produce results than urine dipst
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B.1.6: Substance use RECOMMENDATION
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on screening, please refer to the 2
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Women’s values A scoping review o
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B.2.2: Symphysis-fundal height (SFH
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B.2.4: Ultrasound scan RECOMMENDATI
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are willing to be screened and test
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Women’s values A scoping review o
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C.4: Preventive anthelminthic treat
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WHO recommendations on antenatal care for a positive pregnancy experience

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