Guideline-driven
Research Priorities
Evidence Synthesis
Application of Evidence
Transfer of Knowledge

The GREAT Network was established in 2012 by the World Health Organization, St. Michael’s Hospital/University of Toronto, and international partnerships with low and middle income countries (LMICs). The GREAT Network is funded by the Canadian Institutes of Health Research and aims to provide guidance and support to local stakeholders of the healthcare system who are focused on enhancing maternal and perinatal health through implementation of relevant evidence-based clinical practice guidelines.

Mission and goals

The objectives of the GREAT Network are to:

  1. Establish a network of partners and stakeholders (including clinicians, healthcare providers, healthcare administrators, researchers/academics, policymakers, non-governmental organizations, community partners ) who are interested in improving maternal and infant health in LMICs through effective knowledge translation (KT) and implementation approaches;
  2. Build capacity in the science and practice of KT and implementation across relevant stakeholder groups in LMICs; and
  3. Develop a framework for guideline implementation relevant to the needs of partners in LMICs, and advance the science and practice of KT and implementation through understanding how to adapt, implement and evaluate guidelines that span community-level and hospital-based maternal and perinatal care, access to care, and the referral process in LMICs.

What we do

The GREAT Network is an umbrella organization, with designated collaborating centres in Kosovo, Thailand, South Africa, and Argentina, that provides oversight, technical assistance and strategic directions to guide country specific guideline implementation work.

The GREAT Network supports the development, delivery, and evaluation of a cross-cutting, multi-level implementation strategy for evidence-based guidelines that is relevant to the local context, and informed by priorities as well as barriers and facilitators identified by stakeholders during focus group discussions and prioritization meetings.

The pilot site for the GREAT Network’s in-country guideline prioritization and implementation planning work was Kosovo, a province of the former Yugoslavia. More than 95% of mothers give birth in a health facility in Kosovo but maternal morbidity remains greater than in higher-income countries. In October of 2012, the GREAT Network hosted a two-day meeting, entitled the GREAT meeting, in Pristina, Kosovo which brought together local stakeholders including clinicians, healthcare providers, healthcare administrators, researchers/academics, and policymakers to identify and prioritize barriers and facilitators to the implementation of evidence-based clinical care guidelines.

Focus groups were conducted with participants on Day 1 of the GREAT meeting to identify barriers and facilitators to guideline implementation. A prioritization meeting was held on Day 2 which used a nominal group process (Jones & Hunter, 1995) and RAND appropriateness method (Fitch et al., 2001) to establish common priorities. Working groups were formed to support delivery of a tailored implementation strategy based on priorities.

The above two-day methodology will be replicated in multiple country sites. To date, all workshops have been conducted in Myanmar (June 2014), Uganda (August 2014), Tanzania (November 2014) and Ethiopia (May 2015).

References

  • Fitch K et al. The RAND/UCLA appropriateness method user’s manual. RAND Corporation, 2001.
  • Jones J, Hunter D. Consensus methods for medical and health services research. BMJ 1995; 311:376–80.

Who we are

The activities and directions of the GREAT Network are informed by an Executive Committee (EC) comprised of 14 members, including two co-chairs. The EC members also serve as a liaison between the Network and local stakeholders within: their resident countries; their respective regions; and/or other countries that they work to support.

The GREAT Network Executive Committee:

  • Sharon Straus
    Co-chair
    St. Michael’s Hospital, University of Toronto
    Canada
  • A. Metin Gülmezoglu
    Co-chair
    World Health Organization
    Switzerland
  • Joshua Vogel
    World Health Organization
    Switzerland
  • Dina Khan
    World Health Organization
    Switzerland
  • Julia Moore
    St. Michael’s Hospital,
    University of Toronto
    Canada
  • Pisake Lumbiganon
    Khon Kaen University
    Thailand
  • Charles Shey Wiysonge
    Centre for Evidence-based Health Care, Stellenbosch University, South Africa
    Cochrane South Africa, South African Medical Research Council, South Africa
  • Edgardo Abalos
    Centro Rosarino de Estudios Perinatales (CREP)
    Argentina
  • Sami Uka
    World Health Organization, Country Office
    Kosovo
  • Kidza Mugerwa
    Makerere University College of Health Sciences
    Uganda
  • Katherine Ba-Thike
    Independent consultant
    Myanmar
  • Shaun Treweek
    University of Aberdeen
    United Kingdom
  • Simon Lewin
    Global Health Unit, Norwegian Knowledge Centre for the Health Services, Norway;
    Health Systems Research Unit, Medical Research Council of South Africa, South Africa
  • João Paulo Souza
    University of São Paulo
    Brazil

The GREAT Network is supported by a core project team, including:

  • Jamie Park
    Project coordinator
    St. Michael’s Hospital,
    University of Toronto
    Canada
  • Kavitha Thiyagarajah
    Project assistant
    St. Michael’s Hospital,
    University of Toronto
    Canada