Paper short abstract:

This presentation reflects on the use of qualitative evidence in the WHO's guidelines for task shifting in maternal and newborn health programs. While evidence-based medicine conflicted with key aspects of qualitative research paradigms, important openings and opportunities were nonetheless present.

Paper long abstract:

Systematic reviews of qualitative evidence—or ‘qualitative evidence syntheses’ (QES)—have become an important form of knowledge production within ‘evidence-based medicine’ (EBM) and ‘evidence-informed policymaking’. QES proponents argue these reviews promote ‘health systems thinking’ and better understanding of local process and context in global health policy- and decision-making. EBM’s detailed technical procedures, however, do not fit well with conventional qualitative research paradigms. There are concerns that subjecting qualitative research to EBM’s logics and practices might fatally compromise its epistemological integrity and political impact. This presentation addresses these concerns via a case study of the WHO’s OptimizeMNH guidelines for task shifting in maternal and newborn health programs. When I joined the team developing these health systems-oriented guidelines, I wondered whether including qualitative research would broaden of the forms of reason, experience and judgment informing global health policy, or instead, be another disheartening example of how modern bureaucratic systems coopt, standardize, and complexity-reduce alternative logics. While the integration of qualitative evidence did come at some cost to the depth and critical insights of the evidence we were reviewing, there were also important ways in which the technical procedures of evidence-based medicine were open to adaptation and transformation. The formal inclusion of qualitative evidence syntheses in these global guidelines did not represent—or produce—a dramatic about-turn in global health policy’s hegemonic discourses and practices. It did reveal, however, that powerful systems of health governance like the WHO and evidence-based medicine are not inevitably closed, but in fact open to change, in often unpredictable ways.