The Use of Research Evidence in Two International Organizations' Recommendations about Health Systems.
BACKGROUND
Little is known about the extent to which research evidence informs the development of recommendations by international organizations.


METHODS
We identified specific World Health Organization (WHO) and World Bank recommendations on five topics (contracting, healthcare financing, health human resources, tuberculosis control and tobacco control), catalogued the related systematic reviews and assessed the recommendations to determine their consistency with the systematic reviews that were available at the time of their formulation.


RESULTS
Only two of the eight publications examined were found to cite systematic reviews, and only five of 14 WHO and two of seven World Bank recommendations were consistent with both the direction and nature of effect claims from systematic reviews. Ten of 14 WHO and five of seven World Bank recommendations were consistent with the direction of effect claims only.


CONCLUSIONS
WHO and the World Bank - working with donor agencies and national governments - can improve their use of (or at least, their reporting about their use of) research evidence. Decision-makers and clinicians should critically evaluate the quality and local applicability of recommendations from any source, including international organizations, prior to their implementation.
Hoffman
Steven J
SJ
Faculty of Law, Department of Political Science and Munk Centre for International Studies, University of Toronto, Toronto, ON.
Lavis
John N
JN
Bennett
Sara
S