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Original Research
Building capacity for clinical practice guideline development: Experiences from Malawi, Nigeria and South Africa
Submitted: 31 July 2025 | Published: 16 July 2026
About the author(s)
Idriss I. Kallon, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South AfricaElodie A.S. Besnier, Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
Tamara Kredo, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; and, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and, Department of Medicine, Division of Clinical Pharmacology, Stellenbosch University, Cape Town, South Africa; and, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Sara Cooper, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and, Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; and, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Willem Odendaal, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; and, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Carmen Späth, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
Emmanuel E. Effa, Department of Internal Medicine, Faculty of Clinical Sciences, University of Calabar, Calabar, Nigeria; and, Cochrane Nigeria, Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
Ekpereonne B. Esu, Cochrane Nigeria, Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
Dachi Arikpo, Cochrane Nigeria, Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
Simon Lewin, Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway; and, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; and, Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
Nyanyiwe M. Mbeye, Department of Community and Environmental Health, Evidence Informed Decision-making Centre, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
Retsedisitsoe P. Mazibuko, Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
Denny Mabetha, South African Medical Research Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
Roselyn Chipojola, Department of Community and Environmental Health, Evidence Informed Decision-making Centre, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
Ameer Hohlfeld, Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
Michael McCaul, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Anke C. Rohwer, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
Abstract
Background: Within the Global Evidence, Local Adaptation (GELA) project, we offered training to guideline development group (GDG) and steering group (SG) members in Malawi, Nigeria and South Africa, to build capacity in clinical practice guideline (CPG) development.
Aim: This study aimed to evaluate the capacity development of GDG and SG committee members within GELA.
Setting: Guideline development group members were mainly based at health or academic institutions, while SG members were mostly linked to the health ministries in Malawi, Nigeria and South Africa.
Methods: We used mixed-methods for our summative evaluation, comprising a document analysis, online surveys, semi-structured, in-depth interviews and a structured reflection. For the survey, respondents rated their confidence in knowledge, skills and behaviour before and after GELA. Data were analysed with R studio. We interviewed selected participants from all countries and analysed qualitative data through framework analysis. The author team met in-person to reflect on activities, survey findings and interview data.
Results: Confidence in CPG development skills and related behaviour increased during GELA. Qualitative themes showed an enhanced understanding and valuing of a rigorous guideline development process that should be sustained and institutionalised. The intensive nature of training, limited internet connectivity, time constraints and unmet expectations, were some reported challenges. Participants appreciated increased collaboration and opportunities for future networking. Reflections highlighted the importance of learning by doing.
Conclusion: Global Evidence, Local Adaptation built capacity of GDG and SG members to participate in rigorous CPG development through a multifaceted approach. Continued networking and collaboration of various stakeholders is key to sustain learning.
Contribution: Capacity for rigorous CPG development can be built through a strategic multifaceted capacity development programme and learning by doing.
Keywords
Sustainable Development Goal
Metrics
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