Chapter 4. Dissemination, applicability, research gaps and future updates of the guideline and recommendations (4.1, 4.2)
This guideline will be published digitally (both an interactive web-based version and a traditional document available online for download) and in print; see further information in Annex 11.
Translation of the guideline into Spanish (in collaboration with the Pan American Health Organization [PAHO]), French and Portuguese is planned. Translations into other United Nations languages will be developed as needed.
Several derivative products will be developed based on this updated and consolidated guideline:*
- operational guidance containing details on implementation of the recommendations, including strategic considerations for improving access to quality abortion care for youth;
- informational materials, such as posters highlighting selected recommendations, which can be placed in health-care facilities and other appropriate places;
- pocket charts/cards for health workers, providing the updated recommendations for medical and surgical abortion and post-abortion contraception, and referral cards for referring individuals to other health-care services (adapted for use by different types of health workers and for different literacy levels);
- user-friendly decision-support tools for health-care providers and policy-makers, created with the input of end-users who will be engaged in the process of determining how best to translate the guidance for this purpose (the tools may include digital decision tools in the format of a mobile application [app]);
- case studies on quality abortion care in different humanitarian settings, to demonstrate and highlight the relevant considerations and requirements;
- operational guidance on medical management of select clinical indications, such as miscarriage.
* Note: Where applicable, WHO will collaborate with relevant United Nations agencies in the dissemination efforts. For example, WHO will collaborate with the Office of the United Nations High Commissioner for Human Rights (OHCHR) to disseminate guidance and tools to support application of a human rights-based approach to sexual and reproductive health, as well as respond to country requests for technical assistance to implement these approaches.
4.2 Implementation and impact evaluation of the guideline
Implementation of this guideline requires a multifaceted approach. After the initial publication, translation and dissemination efforts on regional, national and local levels (see Annex 11), it will be important to apply active techniques such as conducting workshops and training programmes to familiarize users with the guideline. Engagement by WHO team members with managers and staff of health-care facilities to build reminders about the latest guidance into their clinical support systems will also be crucial. With regard to policy and programme planning, it will be important to work with policy-makers and national and local health officials to ensure implementation of the adopted recommendations at all levels of the health system. Engaging with national ministries and WHO country offices to contextualize the guidelines may facilitate adaptation of the guideline. It is anticipated that the main barrier to implementation of this guideline will be the subject matter – quality abortion care – which is a sensitive and stigmatized topic. This means that it is all the more important to work with stakeholders, including government, policy-makers and advocates for safe and legal abortion, to inform them about the guideline and facilitate open dialogue about the realities of abortion in their country. Using the Global Abortion Policies Database will facilitate these discussions (116).
Process and impact evaluation will be ongoing during the first year of implementation of this guideline, focusing on the accessibility, acceptance, use, impact and generalizability of the guideline and its recommendations. As an assessment of document uptake, the engagement with the interactive online version of the guideline, the number of downloads of the document from the WHO website, and the number of hard copies of the guidance requested and distributed through the document centre will be monitored.
A year after publication, an evaluation of the immediate impact of the guidelines will be undertaken in the form of an online survey. This will be conducted through WHO regional and country offices and through selected respondents from other user groups (e.g. professional societies, NGOs) in order to gauge utilization in-country and whether and how any of the recommendations in the guideline have been implemented or have influenced policy decisions. This short-term impact evaluation will also include an assessment of barriers to effective implementation, which will be important feedback for derivative products and future modifications.