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Strengthening evidence-based healthcare in Africa
  1. Frode Forland1,
  2. Anke C Rohwer2,
  3. Paul Klatser1,
  4. Kimberly Boer1,
  5. Harriet Mayanja-Kizza3
  1. 1KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
  2. 2Centre for Evidence-based Health Care, Stellenbosch University, Cape Town, South Africa
  3. 3College of Health Sciences, Makerere University, Kampala, Uganda
  1. Correspondence to Dr Frode Forland
    KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam 1105 AZ, The Netherlands; f.forland{at}

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The importance of evidence-based practice in Africa

A Collaboration for Evidence Based Healthcare in Africa (CEBHA) has been established with partners from eight sub-Saharan African countries, Ethiopia, Uganda, Rwanda, Burundi, Tanzania, Malawi, Zimbabwe and South Africa. The aim of the Collaboration is to facilitate the provision of patient care based on evidence-informed decisions using context specific current best evidence; and to build capacity and sustainable structures of Evidence Based Healthcare in Africa.

We believe that access to equitable and effective healthcare should be a right for people in all countries. Irrespective of where one lives, the need for valid evidence determining the efficacy of healthcare interventions is essential. Where the unmet needs for health services are most prominent, it is essential to adopt practices that have proven to be beneficial and not harmful or ineffective to ensure scarce resources are not wasted. Incorporating Evidence-Based Health Care (EBHC) into the African context means setting priorities, developing evidence summaries and guidelines and implementing research findings relevant for African countries to support healthcare for all. Contextualising evidence relates to several issues, including the lack of evidence available for an African setting. The effectiveness of an intervention in Africa may be different from that found in studies elsewhere because of factors such as: later presentation, co-infections, malnutrition, higher levels of self-medication and use of traditional remedies, reduced level of resources, including human resources for basic healthcare, and political instability. In addition, effective interventions, as determined by many systematic reviews, may not be available or affordable in most African settings. This means that Africa needs valid and Africa-specific research and that authors of systematic reviews should take this into account by avoiding overgeneralisation when making conclusions.

EBHC extends the application of the principles of evidence-based medicine (EBM) as defined by Sackett et al,1 to all healthcare professionals. Evidence-based public health …

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