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Making systematic reviews global

Lisa A Bero, Davina Ghersi
Editorial Article

On January 24 2011, the World Health Organization (WHO) executive board awarded The Cochrane Collaboration the status of a non-governmental organisation (NGO) in official relations with the WHO, establishing a partnership with formalised communication between the two organisations.[1] In this editorial we reflect on the importance of this step and the opportunities that it implies.

The decision to formalise the relationship between these two, complex organisations is the result of many years of informal, ad-hoc collaboration on a number of projects and programmes. An early example of the Cochrane-WHO partnership was the WHO Reproductive Health Library (RHL), launched in 1997. This online review journal has provided universal free access to Cochrane Reviews that consider aspects of sexual and reproductive health. This has offered actionable and practical advice to clinicians, policy-makers and consumers, with the aim of improving health outcomes, particularly in low- and middle-income countries (LMICs).

Building relationships between the two organisations serves a number of purposes:

  • Advancing the use of evidence to inform health care and health policy decision-making
  • Ensuring that reviews are conducted that are directly relevant to LMICs
  • Building research capacity in LMICs.

Since the introduction of RHL, there have been many other projects and programmes where individuals and groups from The Cochrane Collaboration and the WHO have worked together. The Evidence in Practice Network (EVIPnet) and the production of SUPPORT summaries of Cochrane Reviews aimed at policy-makers in resource-poor settings are examples of projects aimed at improving the use of evidence to inform health care decisions.

Collaboration with the WHO will enable The Cochrane Collaboration to extend its reach to countries where its impact may currently be limited. Individuals and groups within Cochrane who work with the WHO to produce relevant reviews and who participate in capacity-building activities, such as workshops and co-authoring reviews with WHO staff, are making a valuable contribution towards ensuring that WHO recommendations are based on sound evidence. Cochrane collaborators have conducted specific reviews and review updates aimed at supporting the creation of specific WHO guidelines, as well as the Essential Medicines List. This has been accompanied by the WHO's adoption of the GRADE tool, whenever possible, for evaluating the quality of evidence for supporting the production of evidence-based recommendations. Cochrane collaborators have also provided training to WHO-affiliated staff in the use of GRADE and interpretation of systematic reviews. This work has extended to the development of country-specific guidelines in WHO member states. Current plans include a library of evidence for nutrition interventions, including relevant Cochrane Reviews.

Collaboration is not limited to activities involving WHO headquarters in Geneva. The Campbell & Cochrane Equity Methods Group, for example, is developing ways to improve the relevance of Cochrane Reviews for LMICs, and Group members established a WHO Collaborating Center for Knowledge Translation and Health Technology Assessment in Health Equity with PAHO, WHO's Regional Office for the Americas. The Center is currently expanding and updating its Equity-Oriented Toolkit for Health Technology Assessment. The Equity Methods Group has also produced an equity checklist for review authors.[2]

At its forthcoming mid-year meeting in Split, Croatia, the Collaboration will develop strategies for increasing engagement and participation across the globe. One aspect of this will certainly include consideration of how Cochrane can most effectively support the WHO in delivering evidence-based health care and health policy in LMICs.