WHO South-East Asia Journal of Public Health
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POLICY AND PRACTICE
Year : 2015  |  Volume : 4  |  Issue : 1  |  Page : 86-91

Barriers and facilitators to development of standard treatment guidelines in India


1 Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences, Shahdara; Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), New Delhi, India
2 Department of Paediatrics, Maulana Azad Medical College and L N Hospital, New Delhi, India
3 Delhi Society for Promotion of Rational Use of Drugs (DSPRUD); Nodal Corporate Resource, Fortis Healthcare Ltd; Department of Pharmacology, Maulana Azad Medical College, New Delhi, India
4 Delhi Society for Promotion of Rational Use of Drugs (DSPRUD); National Academy of Medical Sciences; Advisor, Health, Government of National Capital Territory of Delhi, Delhi and Chairman, Task Force for Research, Apollo Hospitals Educational and Research Foundation (AHERF), India

Correspondence Address:
Sangeeta Sharma
Department of Neuropsychopharmacology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi 110095
India
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DOI: 10.4103/2224-3151.206626

PMID: 28607279

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This paper describes 15 years’ experience of the development process of the first set of comprehensive standard treatment guidelines (STGs) for India and their adoption or adaptation by various state governments. The aim is to shorten the learning curve for those embarking on a similar exercise, given the key role of high-quality STGs that are accepted by the clinical community in furthering universal health coverage. The main overall obstacles to STG development are: (i) weak understanding of the concept; (ii) lack of time, enthusiasm and availability of local expertise; and (iii) managing consensus between specialists and generalists. Major concerns to prescribers are: encroachment on professional autonomy, loss of treating the patient as an individual and applying the same standards at all levels of health care. Processes to address these challenges are described. At the policy level, major threats to successful completion and focused implementation are: frequent changes in governance, shifts in priorities and discontinuity. In the authors’ experience, compared with each state developing their own STGs afresh, adaptation of pre-existing valid guidelines after an active adaptation process involving local clinical leaders is not only simpler and quicker but also establishes local ownership and facilitates acceptance of a quality document. Executive orders and in-service sensitization programmes to introduce STGs further enhance their adoption in clinical practice.


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