From paper to digital pathway: WHO launches first ‘SMART Guidelines’

WHO has launched its first SMART Guideline, a landmark effort to accelerate the availability and impact of WHO health and data recommendations within digital systems at the country level, starting with antenatal care.

What are SMART guidelines?

As countries increasingly invest in digital technologies for health system strengthening, SMART Guidelines constitute a practical approach to making global guidance more effective across all areas of health and wellbeing.

They will support guideline developers, policy makers, technology teams, and health workers through the process of adapting and applying WHO global health and data recommendations to countries’ existing – and evolving – digital systems.

‘SMART’ stands for Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable. The SMART Guideline approach includes documentation, procedures, and digital health tools, introduced in a new comment published in The Lancet Digital Health.

“In this day and age, the rigorous process of developing WHO guidance is only one part of improving health outcomes for people around the world,” said Dr Soumya Swaminathan, WHO Chief Scientist.

“Recommendations become meaningful when they are lifted off the page and effectively applied to local systems at the country level; when they are aligned with an evolving evidence base. SMART Guidelines are a pioneering approach to digital health systems transformation.”

Why are SMART Guidelines needed?

Digital tools have huge potential to improve the reach and accessibility of WHO guidelines in every country, strengthening quality of care and accelerating progress towards national and Sustainable Development Goals.

However, adapting recommendations in line with existing digital systems, as well as local policies, procedures, is a well-documented challenge.

“Every country’s digital health landscape is different, from the software that has been selected to the data that is available and the priorities that have been defined. To reduce error, ensure transparency and adhere to technical standards, a systematic approach to understanding and adapting WHO recommendations is essential,” said Dr Nancy Kidula, Medical Officer in the WHO Regional Office for Africa.

The SMART Guidelines approach recognizes the complexity of this digital adaptation journey for health systems, facilities and providers. It is divided into five ‘knowledge layers’ which provide a systematic, transparent and testable structure for countries to work through. This ensures guidance is translated into effective and interoperable digital systems – systems which are fully able to connect, communicate and share with any other device or digital platform, for maximum benefit.

All SMART Guidelines content is software-neutral, meaning it can be adapted into whichever software platform a country has elected to use. The approach is rooted in respect for the privacy and security of patient health information.

Applying SMART Guidelines to maternal health and rights

The new WHO SMART Antenatal Care Guidelines support a key WHO priority: improving maternal health and well-being.

WHO advocates for health planning where women’s values and preferences are at the centre of their care. Localized adaptation of global recommendations is essential to ensure quality antenatal care, leading to the best possible physical, emotional, and psychological outcomes for all.

Applying the SMART approach to the WHO recommendations on antenatal care for a positive pregnancy experience is a dynamic way of repackaging existing, evidence-based guidance, making it easier to implement with digital solutions.

The WHO Antenatal Care SMART Guidelines build on groundwork laid by the Antenatal care recommendations adaptation toolkit for policymakers, and the WHO monitoring framework for antenatal care. They include a Digital Adaptation Kit, an implementation guide for machine-readable recommendations, and a WHO digital ANC module for health care providers.

Partnership and transparent process are key

SMART Guidelines are not a standalone solution. Good planning and governance on digital health by investors, governments, and technical bodies is needed when working to integrate digital approaches and investments into health systems.

“Digital health can transform health outcomes – but only if it is supported by sufficient resources for governance, people and processes,” said Dr Dan Rosen, Chief of Health Informatics Data Management and Statistics at the U.S. Centers for Disease Control and Prevention Division of Global HIV & TB.

“At this exciting moment in the history of digital development, we are committed to working with WHO and partners across all sectors to support equitable and universal access to quality health services for all.”

SMART Guidelines for HIV, STIs, immunization, family planning, child health and humanitarian emergencies are in development and will be released later this year. SMART guidelines will be vital to digital health systems transformation, and attainment of universal health coverage and UN Sustainable Development Goals.

WHO calls for partners to help build and sustain effective digital health systems and support the SMART Guideline approach.

Public Release. More on this here.