The World Health Organization (WHO) has been criticized recently for recommendations based on systematic reviews of the best available evidence and for the quality of some of its guidelines [1]–[3].
In 2007, WHO put in place procedures for developing transparent, evidence-based guidelines based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology [4],[5].
This methodology, developed by an international network of methodologists with an interest in grading quality of evidence and strength of recommendations (Box 1), has now been used to produce WHO guidelines for several topics. These include rapid advice guidelines for the pharmacological management of human H5N1 virus infection [6],[7] and guidelines on a single specific clinical topic such as psychosocially assisted pharmacological treatment of opioid dependence [8].
However, the GRADE approach has not yet been applied to develop recommendations that cover a broad range of conditions and interventions.
WHO is in the process of developing a model intervention guide within its mental health Gap Action Programme (mhGAP) [9]. The model intervention guide provides recommendations to facilitate care at first and second level facilities by the non-specialist health care providers in low- and middle-income countries (Box 2). These recommendations will be based on the GRADE approach.
To our knowledge, this is the first exercise involving a systematic evaluation of evidence in this area. Other initiatives, for example the recently published reviews of evidence for packages of care for mental, neurological, and substance use disorders in low- and middle-income countries, did not use GRADE methodology [10].
This paper describes the use and adaptation of the GRADE approach in developing the guidelines for the mhGAP model intervention guide.
