16th Cochrane Colloquium, Special Session with Richard Horton - Monday 6 Oct., 13:00-14:00h

1. What is the Cochrane Collaboration?
• A “global network”
• “Improving healthcare decision making
globally”

2. How global? Mixed
Cochrane Centres
Western Europe 10 Cochrane Library
South Asia 3 Issue 3, 2008
North America 3 1/76 reviews
Latin America 2
Australasia 2 4/108 protocols
Africa 2
relevant to LMIC
Western Pacific 2
Middle East 1

3. Contribution to health-related MDGs?
Child survival : 10/32
Maternal health : 18/70
HIV : 91
Malaria : 46
TB : 19
NTD :6

4. Click on Cochrane Reviews
“Global Impact”
• Inventory of resources (2004)
• Press releases from the publisher
• Reviews/protocols: publication graph
• Impact factor

5. Current position, future directions
A small survey of 22 scientists and
policy-makers working in global
health
They were sent Gerd’s 5 questions
18 responses

6. Gerd’s questions
1. Do you see the CC as an important player in global
health?
2. Do you think the CC is a major contributor to
international health policies and programmes?
3. Do you think the CC is a significant contributor to the
global knowledge base?
4. Do you see the CC as a global health organisation?
5. What are your (so far unmet) expectations?

7. Cochrane and Global Health
5 Propositions
1. The CC is held in immense respect
2. Many observers hope for a stronger role for the CC in
global health
3. Some observers are disappointed by a lack of visible or
tangible commitment to global health
4. There are some difficulties faced by the CC
5. Several actions could be taken to address these
perceived shortfalls

8. 1. The Collaboration is held in immense respect
“The CC has played a leading role in
synthesising the evidence for effective clinical
practice and has begun to contribute to the
development of better policies for health and
health care.”

9. “The definitive source for evidence
synthesis and information…there is
nothing else which can compete with this.”

10. “a fantastic resource for practitioners and
policymakers alike.”

11. “We think that the CC is an important and
helpful player in the area of child health.
Some CC reviews have supported significant
policy changes.”

12. 2. Many observers hope for a
stronger role in global health
“I would like to see it building on [its]
impressive achievements…to develop the
capacity to undertake systematic reviews in
LMIC.”

13. “I would welcome increased involvement
by Cochrane in global health.”

14. “Additional focus on LMIC needs would
be very valuable”

15. “We have found the CC very useful,
however feel it needs to shift emphasis
towards global health itself.”

16. “Cochrane has a lot to offer if it gets
confronted with the right type of questions.”

17. “One wishes, however, that the
Collaboration will continue to increase its
footprint in the developing world.”

18. “More effort needs to be made to both
address problems of significance to
developing countries but also to go beyond
clinical trials to allow for inclusion of well-
documented field experiences as an
intrinsic component of our knowledge
base.”

19. 3. Some observers are disappointed by
the lack of visible commitment to
global health
“Cochrane’s contributions are small and
ever decreasing.”

20. Is Cochrane a major contributor to global
health? “Not as much as it should be”;
“unfortunately this is not the case today.”

21. Is Cochrane a global health organisation?
“No”; “No.”

22. “Cochrane needs to make itself more relevant
to global public health.”

23. “Cochrane has not responded to global health
issues.”

24. “I have not been aware of any CC
contribution to international work
in global health.”

25. “I’m afraid that to the best of my
knowledge, Cochrane work hasn’t really
had much impact, if any, on policies and
practice in the AIDS field.”

26. 4. There are some difficulties the
Collaboration faces
“My sense is that Cochrane is having
enough trouble trying to get its own house
in order.”

27. “I see the messiness of implementation of
policy in countries with authorities that
are corrupt, lacking basic infrastructure,
and relevant skills. These are precisely the
places that RCTs don’t get done.”

28. “What I do not understand is how CC would
define “evidence-base.””
− diverse contexts, methods, issues of data
access/quality

29. “Does the CC even have amongst its
membership [those] who are agile with
these issues?”

30. 5. There are several actions that could be
taken to address the perceived shortfalls of
the Collaboration in global health
“More topics that are relevant to issues that
confront populations in the developing
world.”

31. “Evaluate and challenge many ‘standards
of care’ that are based on expert opinion
rather than sound evidence reviews.”

32. “Include methods that relate to
quasi-experimental study designs and
sound observational studies.”

33. “Enhance the research to policy link within
the Collaboration.”

34. “Influence research funders to enhance
funding to address information gaps
highlighted by the Cochrane Collaboration.”

35. “Include in every systematic review
implications for practice (and research) in
resource-limited settings.”

36. “CC could do much more on effective
practices relevant to the global knowledge
base.”

37. “A closer collaboration with WHO, for
example, to identify key questions of
global health importance for systematic
reviews, would be beneficial for both
partners.”

38. “A structured interaction between
Cochrane and policy-makers/practitioners
would potentially help a lot here.”

39. “How to build community effectiveness and
equity issues into meta-analyses of efficacy,
and how to present these data to
policymakers in a clear and relatively non-
technical way.”

40. “How to build the capacity of universities
and medical schools ‘in the south’ to use
the Cochrane principles of efficacy and
effectiveness.”

41. Tentative conclusions
• Cochrane is a global network
• Cochrane does contribute to global health knowledge
• Cochrane is beginning to influence policy, but too slowly/quietly
• Cochrane is not yet a global health organisation
COCHRANE HAS REACHED A STRATEGIC DECISION POINT
DOES IT WANT TO BE A GLOBAL HEALTH ORGANISATION?
If No: A missed opportunity?
If Yes: Consider: Making a public and visible commitment
Adding to/realigning your work programme
Rethinking your communication/advocacy