Background: South Africa is developing National Health Insurance (NHI), which will require coordination of health provision across sectors. Clinical practice guidelines (CPGs) are a tool for implementing care. Therefore, it is important to explore the current landscape of CPGs in SA including what is available and who is leading their development.
Objectives: We aimed to identify and describe all available CPGs in South Africa.
Methods: We conducted a cross-sectional evaluation using a two-part search process: an iterative, electronic search of the grey literature and relevant websites (143 websites searched); and a systematic search for peer reviewed literature (PubMed). CPGs were extracted by one reviewer, including a description of the developer, condition, and reporting of items associated with quality CPGs.
Results: The search was conducted between September and December 2017. We retrieved 243 CPGs published after January 2000. 140 were developed in the past five years. Developers include National and Provincial Department of Health (DoH), professional societies, ad hoc collaborations of clinicians, and the Council for Medical Schemes. Topics varied: the DoH focused high-burden conditions, on HIV/AIDS, TB and Malaria, and CPGs from other developers focused on non-communicable diseases. 39% of CPGs developed by societies or clinicians included a conflict of interest statement compared to 5% of DoH CPGs.
Conclusions: Accessing CPGs was challenging, requiring extensive searching. South Africa has many contributors to CPG development from all sectors and across disciplines, but there is no evidence of coordination or prioritisation of CPG development. CPGs identified were often out of date and quality was poorly reported, impacting on the usability and credibility of those available. Exploring the CPG landscape suggests next steps to support the NHI may include maintaining an accessible CPG repository; and establishing a national coordinating unit responsible for developing standards and supporting high-quality development.