Although we fully concur with Andrew Oxman and colleagues about the importance of evidence in developing WHO recommendations,1
our experience with WHO's Department of Reproductive Health and Research (RHR) provides strong evidence that the development process for at least some of WHO's guidelines is truly exemplary. RHR has produced the Medical Eligibility Criteria for Contraceptive Use,2
a guideline that has been incorporated into national programme guidance in more than 50 countries. The process for creating and updating this guideline and its counterpart, the Selected Practice Recommendations for Contraceptive Use,3
has been described in detail.4
Briefly, systematic reviews with graded quality of evidence are used by an expert working group (clinical and research experts and those who will have to live with the guidelines, such as family planning providers in low-income countries) to develop recommendations. Evidence from these systematic reviews is cited in the guidelines, and many of the systematic reviews are published in peer-reviewed journals. Furthermore, the Continuous Identification of Research Evidence (CIRE) system has been developed to identify, assess, and synthesise new evidence as it becomes available. CIRE findings are used to determine whether an update to the guidelines is warranted. WHO and the United Nations Population Fund have created a strategic partnership programme that is implementing these guidelines at regional and country levels.
Oxman and colleagues' point about the need for resources for WHO recommendations is an important one. The system described above, while making efficient and effective use of limited existing resources, requires additional support from several donors.
We declare that we have no conflict of interest. The findings and conclusions in the letter are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.