1 The following slides were presented at a meeting of potential editors and methods advisors for the proposed Cochrane review group in February The slides were designed to promote discussion rather than represent the views and directions of this group.

2 MEETING THE NEEDS OF & INVOLVING PEOPLE FROM LOW/MIDDLE INCOME COUNTRIES (LMICs) Omar Abdulwadud (Australia) Ruhi Saith (India) Josiane Bonnefoy (Chile) Edmonton, Canada (4-5 March 2008)

3 NEEDS & CHALLENGES FACING PUBLIC HEALTH REVIEW GROUP (PHRG) Low participation rate Low-level of awareness of Cochrane Collaboration Lack of training & mentorship Practical help with review completion Poor access to information/Cochrane Library Funding Developing stronger link Published reviews not always relevant

4 Organisations connected with LMICs  Regional Cochrane Centres  SACC (Nigeria branch) African Cochrane Network proposed  SACN (based in India)  INCLEN (Network of Clinical Epidemiology Units/CEUs)  INCLEN-Africa:7 CEUs & 120 members  India-CLEN: 8 CEUs & over 200 members  Cochrane Developing Countries Network  Other Cochrane Review Groups

5 COCHRANE CENTRES/ BRANCHES IN LMICs (Source: Cochrane Collaboration) SACC Brazilian CC Venezuelan Branch India branch South Asian Cochrane Network Nigerian Branch

6 ( INCLEN

7 Cochrane Developing Countries Network (CDCN) ( AIMS & OBJECTIVES Promote & develop training activities in DCs Support review authors Raise funds for extending the Collaboration Activities to DCs Identify trials relevant to DCs Increase the no. of high quality reviews relevant to DCs Identify funding opportunities that are beyond the current entities scope Establish strategic alliances with other organisations whose activities are devoted to DCs Promote greater participation & inclusiveness within the Collaboration Become the information & resource point for activities & resources (training, dissemination, research, mentoring, etc.) Promote & develop awareness & dissemination of activities Promote access to The Cochrane Library Detect & channel their needs that may be addressed by CC Establish mechanisms for networking & actively Promoting synergies from current entities

8 TRAINING & SUPPORT Organisations that provide training (LMICs) Cochrane Centre-related  SACC  SACN INCLEN-related  INCLEN- Africa  India-CLEN Other CRGs (?) Cochrane DCs Network (?)

9 Types of training & support initiatives for reviewers in LMICs ActivityFOCUS Recruitment Researchers Medical & Public Health professionals Policy makers TrainingSkills/knowledge Learn to write (protocol/ review) Learn to use RevMan Meta-analysis Training of trainers to allow periodic/regular cycles of training SupportFormal support: Institutional Funding Facility (computers/ venue) Materials (information i.e. literature-electronic & non- electronic) Informal support: Mentoring (1 st time reviewers) Networking (within/outside country)

10 KEY ISSUES FOR DISCUSSION NEEDS & CHALLENGES ARE MANY LMICs participation right from the start is vital To ensure:  Sense of ownership &  Sustainability. STRONGER LINK with  Individuals or  institutions? Implications i.e. sustainability

11 Stronger link,coordinated training & support for LMICs WHOUNICEFCDC INCLEN (Executive Office) Cochrane Centres/ branches (e.g. SACC/Nigeria) Low & middle income country (Researchers/institutions/ policy makers) INCLEN Regional Offices (7) INCLEN Country based CEU Regional Offices PHRG & Other RGs Cochrane Developing Countries Network Cochrane Collaboration (Steering Group) Omar Abdulwadud, Monash University (March 2008) Country Office Field Office Country Office Resource utilization better Implementation easier Evaluation easier Program sustainability assured

12 DISCUSSION: Training & Support Incentive scheme?  Fellowship program/financial assistance to attract reviewers.  Topic selection, protocol development to review completion. Work with others? (CRGs, Centres/branches, CDCs Network). Separate or merge with existing training programs?  e.g. HIV/AIDS mentoring & Reviewers for Africa Programmes Use established communication channel? Engage new partners? (e.g. WHO, CDC, UNICEF, INCLEN) Funding? Source?

13 DISCUSSION  Relevance (published reviews) Editors & peer referees to assess suitability & relevance of reviews (topic selection & prior to publication) Restrict reviews to priority topics (Waters & Doyle, BMJ 2004) Involve funding organisations/policy makers in topic selection? Feedback from CCs prior to publishing?  Enhance accessibility of published reviews Via CEUs, WHO & UNICEF offices, professional associations? Publish in free electronic & open-source journals easily available? Reporting in media Follow model of evidence updates? (publish 2-pages review summaries relevant to LMICs) Design dissemination strategies from start for each review? Tailor reporting of review findings to different users? (Journals- academics; short summaries -policy makers & program managers) Addressing issue of local languages

14 REFERENCES Taryn Young. Strengthening evidence based health care in Africa: Proposal for an African Cochrane Network. The South African Cochrane Centre 07/08/2007. Paul Chinnock, Nandi Siegfried, Mike Clarke. Is Evidence- Based Medicine Relevant to the Developing World? Systematic reviews have yet to achieve their potential as a resource for practitioners in developing countries. eCAM The South African Cochrane Centre (SACC) based survey Allen C, Clarke M & Tharyan P. International Activity in the Cochrane Collaboration with particular reference to India. The National Medical J. of India 2007;20 (5): International Clinical Epidemiology Network (INCLEN) Cochrane Developing Countries Network (CDCN) (

15 THANK YOU!: The Public Health Agency of Canada (PHAC) The National Collaborating Centre for Methods & Tools (NCCMT) Professor Elizabeth Waters & Her staff EPHPP