Why compliance to national prescribing guidelines is important especially across sub-Saharan Africa and suggestions for the future

There are concerns with high prevalence rates for both infectious and non-infectious disease in sub-Saharan Africa, as well as patients with joint co-morbidities. This requires consideration of multiple guidelines simultaneously to improve the care of patients. Adherence to guidelines is increasingly seen as a key criteria for assessing the quality of prescribing in ambulatory care versus the WHO/INRUD targets. These typically represent activity (volume) or performance (cost) indicators rather than quality indicators. However, guideline adherence is currently variable across sectors, diseases areas and African countries. Factors impacting on adherence rates include their routine availability, ease of access and referencing, the extent of consensus on their content, extent of training of their use, monitoring of subsequent prescribing against agreed suggestions and whether regularly updated. Multiple initiatives are typically more successful with changing prescribing habits versus single approaches. Any quality indicators developed as part of prescribing targets must be robustly developed, accepted by physicians and practical to administer. We are likely to see a growth in robust guidelines and indicators across Africa to reduce morbidity and mortality from both infectious and non-infectious diseases.