Invitation to comment: ICF-based criteria for the development of clinical guidelines in UHC

Universal Health Coverage (UHC) includes essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care with easy access when and where services are needed without financial hardship. Thus, clinical guidelines must reflect holistic interprofessional services across the life-course, considering care at all levels and all aspects of a health condition that impact on functioning, health and well-being.

The WHO Handbook for Guideline development (2nd Edition) (1) defines the characteristics of a WHO clinical guideline, as well as thirteen steps to follow in developing a guideline (See Box 1).

Box 1.  Steps in the Development of a WHO Guideline

However, it does not refer to the ICF framework and terminology. This WHO Handbook is thus insufficient to develop clinical guidelines within a UHC context, as it is doesn’t provide criteria for a person-centred approach. It also doesn’t provide a universal terminology for the holistic interprofessional interventions from a bio-psycho-social approach, which include a focus on functioning and the contextual factors that influence health.

The ICF classifies functioning, disability and health in individuals and populations. The ICF describes Functioning as the human experience related to body functions, body structures, and activities and participation. It is viewed as the dynamic interaction with a health condition, personal and environmental factors. Disability, on the other hand, is the human experience of impaired body functions and structures, activity limitations and participation restrictions in interaction with a health condition, personal and environmental factors. The ICF also prescribes a universal language about health and disability which promotes inter-professional communication and collaborative health care.

South Africa is in a process of health reform with the proposed introduction of UHC supported by a National Health Insurance. Clinical guidelines need to reflect this new health policy framework. The ICF is recommended as the most suitable framework to reframe clinical guidelines, but no ICF-based criteria existed for the development of clinical guidelines in UHC.

A collaboration between three professional rehabilitation organisations - South African Speech-Language-Hearing Association (SASLHA), Occupational Therapy Association of South Africa (OTASA), and South African Society of Physiotherapy (SASP) - led to a request to the WHO-FIC Collaborating Centre in South Africa to provide ICF training. Subsequently, sixteen participants completed an ICF Facilitators Course initially developed by Dutch WHO-FIC Collaborating Centre, and revised to meet the needs of this particular group by members of the collaborating centres in South Africa and Australia.

An additional module was included to explore the use of the ICF in the development of clinical guidelines, an expressed need for this group. This paper is the end product of a group assignment required to successfully complete this module.

The group initially determined the scope of the project and debated the criteria that were essential when using the ICF for clinical guideline development. They then determined the critical question to determine compliance with each criterion. Each criterion was carefully formulated, explained and the evidence supporting the inclusion of the criteria was reviewed.

The following 16 criteria, based on the WHO’s ICF framework for health, are recommended for the development and evaluation of clinical guidelines for UHC.

Box 2. Sixteen criteria for the development and evaluation of clinical guidelines for UHC

The proposed 16 criteria are the result of group thinking and deliberations on using the ICF framework and language in the development and review of clinical guidelines to be used within UHC reform.

These recommended criteria need further consideration and evaluation.

The authors invite the Functioning and Disability Reference Group of WHO-FIC to review and further refine these criteria.

Contact author: Stefanus Snyman, stef@snymans.org

Alternative contact: Soraya Maart; soraya.maart@uct.ac.za