As we approach Evidence Live 2015, I’d like to begin a (hopefully engaging and productive) dialogue on the role of evidence-based medicine in low-resource settings (LRS), particularly in low- and middle-income countries (LMIC). One of our focal themes this year is ‘EBM across the globe: How the best evidence can improve global health,’ and this post is meant to orient ourselves with respect to one facet of this theme. As a small case study, let’s explore the role of primary health care in the management of Noncommunicable Diseases (NCDs).
NCDs, including cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases, are the leading cause of death worldwide. Each year NCDs kill 38 million people (68% of global annual deaths) an 29 million of these deaths occur in LMIC. Of these deaths, cardiovascular diseases alone account for 17.5 million deaths worldwide each year.
LMIC are now dealing with an unprecedented epidemiological shift toward a burden of NCDs, and in many countries, a double burden of NCDs and communicable diseases. Under-powered health systems, high demand for care, and lack of political will have stifled much progress in these jurisdictions to implementing primary health care to address this rapidly changing epidemiological landscape.
In response, the World Health Organisation developed and published (2010) the Package of Essential Noncommunicable Disease Interventions for Low-Resource Settings (abbreviated WHO PEN) to promote the management of NCDs through a primary health care approach. WHO PEN outlines the minimum medicines, technologies, and policies that national and sub-national health systems need to have in place in order to have capacity for primary health care for NCDs.
These strategies must be adapted to local contexts using endogenous, high-quality evidence. However, there is a disproportionately low amount of research originating from LMIC. We need evidence for these jurisdictions, from these jurisdictions, in order to improve capacity for evidence-based health care. Our attention should be drawn to the availability of education and resources to allow for the generation, appraisal, and application of evidence for clinical practice and health care policy.
We should ask ourselves: How do you stimulate grass-roots research? Who is responsible for increasing the capacity for research in low-resource settings? Is the current evidence base generalisable to these settings/ patients? How do we disseminate quality research? How do we promote the uptake and use of evidence in practice?
When we meet in April at EvidenceLive 2015, I hope we can discuss this topic, and the role we can play as EBM researchers, teachers, and practitioners in improving access to evidence-based health care. I would encourage you to invite a new colleague to coffee at the conference, and chat about your thoughts on this topic, and perhaps one of these questions:
How can we increase participation and representation of low-resource jurisdictions in the EBM community, and at Evidence Live?
How do we uphold evidence-based practice in low-resource settings? What are the challenges when doing so?
What are the educational opportunities for these settings?
How can we adapt and make available the knowledge, skills, and policies that are employed in high-income countries to low-resource settings?
How can we collaborate with Universities and practitioners in low-resource settings?
I’m looking forward to reading, listening, and speaking about this theme with delegates in April. In the meantime, feel free to share your ideas on twitter by tweeting us @EvidenceLive and using #EvidenceLive.
Dylan Collins is a Rhodes Scholar and PhD Student at the Nuffield Department of Primary Care Health Science, University of Oxford. His doctoral research focuses on primary health care for the management of NCDs in low-resource settings. He can be reached on Twitter @dylanrjcollins.