RCOG World Congress 2023

Title: Adapting and disseminating clinical best practice papers to expand safe abortion access in Rwanda

Authors: Dr. Jerome Mfitumukiza

Background

The RCOG Best Practice Papers present recognized methods and techniques for clinical practice, based on published evidence, for use by obstetricians and gynecologists, and relevant healthcare professionals to aid good clinical practice. Clinicians often wish to adapt existing guidance from authoritative sources, rather than developing their own de novo.

The adaptation of existing guidance has advantages:

•It removes the time and skill-dependent steps of literature search and critical appraisal.

•Clinicians, policymakers, and service users from the intended setting can bring their local perspectives to the final wording of recommendations, ensuring that these accord with local culture and with available services and interventions.

Methodology:

SRHR Champions in Rwanda worked remotely with the RCOG to adapt and endorse the Best Practice Paper on abortion care that is acceptable to the Rwandan context.

Sexual and Reproductive Health and Rights (SRHR) Champions - are leaders in their field. They combine their medical knowledge, experience, and skills with their passion and commitment to influence change in SRHR, including the right to access abortion.

Process:

•Identify amendments to suit the local context.

•Hold stakeholder meetings to gain consensus and validate the draft.

•Appoint peer reviewers.

•Draft a final version for the Ministry of Health endorsement.

•If joint branding is requested - send the final version to the RCOG for endorsement

•Disseminate through stakeholders' meetings.

Results

Developing generic clinical Best Practice Papers and providing remote technical support to the adaptation process has been found to be an effective approach, based on reported use and testimonies from clinicians involved.

Best Practice Papers were endorsed as national clinical guidance by the respective governments in Kenya, Zambia, Bangladesh, Pakistan, and Nigeria.

The Rwandan Champions played a significant role in updating the Rwandan National Abortion Care Guidelines using the adapted Best Practice Paper as an advocacy tool, presenting an important opportunity to inform abortion care practices in the country. Key areas from the Making Abortion Best Practice Papers were used in the National Guidelines.

The Best Practice Papers are currently scheduled to be validated in Rwanda in June 2023 and the MoH has expressed interest in working with the MAS Champions to disseminate the BPP in conjunction with the guidance document across Rwanda, to provide clinicians with an easy, accessible resource to use in daily practice.

Conclusion:

1. In some contexts, clinical guidance on specific areas does not exist; conversely, multiple guidelines exist, and one document is desirable.

2. The Best Practice paper can fill this gap, it is flexible and can be adapted by SRHR Champions, who work through official channels to advocate for local ownership of the process.

3. Adapting pre-existing guidance can also expedite the process of guidance development.

RCOG World Congress 2023

Adapting and disseminating clinical best practice papers to expand safe abortion access

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