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Evidence Based Healthcare in Africa


Evidence based healthcare (EBHC) is a systematic review of processes & analysis of the best evidence of drugs that is used to make decisions for individual patients


Evidence Based Medicine (EBM) is to understand the process of decision making that is extracted from scientific evidence.

EBM is used to help draw conclusions from clinical trials that were previously performed under clinical vigilance, that are used to develop and maintain new medical protocols for diagnosis or treatment of a disease, and later on these new protocols are considered to be the evidence base for future clinical trials. Evidence is collected based on studies and protocols that are conducted and developed to achieve the best outcome for the patients. This is also called Evidence-based Practice.

When we speak of EBM, two things need to be kept in mind. One is the assumption of the so called ‘Evidence’ and the second is that population-based evidence may not be applicable to each and every individual. ‘Evidence’ we all know, can be directly affected by sponsorship and bias against the probability of something being or not-being not being clinically relevant while blindly accepting that what worked for the population in general will work for  every individual may cause harm. Medicine is an uncertain science.

Evidence based medicine is highly useful in not having intuitive answers to questions or for those impressions that do more harm than any good. Litanies of medical procedures were also found to be harmful later than being beneficial.

Thalidomide, a drug that was for pregnant women used for ischemic heart disease is an example of evidence based medicine. With these examples, Africa has come to realise the value of potential steroids that aid to reduce respiratory distress in premature babies in spite of our late understanding. Some other examples for evidence based healthcare/ medicine includes increase in usage of normal saline versus colloids to rejuvenate oneself, continuing one’s professional development and education; guidelines on asthma, heart failure and screening of cancer. Evidence Based Healthcare (EBHC) expands its application of principles of EBM to allied health care professionals. Practicing EBHC produces outcomes of improved healthcare and it is capable of continuous improvement of that system in order to evaluate its outcomes and monitoring of the system. Most European countries have established their own institutions for EBHC along with development of guidelines and assessments of health technology. So far, the African Health Systems have not implemented and utilized these systems, and among the partners that are in collaboration, only South Africa has already established and functions as a Centre for Evidence Based Health Care (EBHC).

Africa faces a heat of challenges in its healthcare sector due to the country’s severe health issues and with inadequate medical tools and low score interventions that have proven to work. Hence, this Evidence Based Healthcare still faces some obstacles with a need to implement it. EBHC engages a view to harvest benefits of the IT and telecom firms in Africa, with health facilities that must possess trained staff and personnel to be able to access and interpret the available evidence of the medicine. In most developing African countries, there is sparse research to health findings and local health systems are inadequate in terms of infrastructure and facilities available. The two most evidence based medicine examples that have proven to work in the African economy set-up are male circumcision as one of those strategies that help to reduce the acquisition of HIV and second is the usage of bed nets that are treated with insecticide to prevent malaria during pregnancy. South Africa is a sole example of practicing Evidence Based Medicine and has established strong policies for maternal health. South Africa stands as a role model that is successful and inspiring other developing countries to replicate them with the concept of EBM.

The aim of this collaboration of evidence based healthcare is to attain most health development goals; to help reduce child mortality rates; improved maternal health; and combat HIV/ AIDS, malaria and other serious health issues. EBM has become a part of health education and has been embedded in the course curriculum of various universities and schools of health education in Africa. Establishing of the African Electronic Library for Health to help attain access to evidence based resources is also in process. EBM helps to develop certain guidelines that are most relevant for the healthcare setup of a particular African country. Many universities such as those in Uganda and Rwanda have included EBHC in their program curriculum and medical students are taught to perform searches for evidence and how to attain this evidence usage. A 5-day program was recently held in Addis Ababa to teach healthcare workers and librarians how to find relevant evidence for their health issues. Recently in Uganda, a health care symposium based on EBHC was organized that had about eighty participants.

To conclude, half knowledge is the greatest enemy of a disease. Free access to medical evidence for clinical practice is not too far away a reality for Africa, but a dream possibly to come true in coming years.

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