It really depends but essentially you need to understand and synthesize evidence but I think it's good to look at NICE in UK and their approach of developing clinical guidelines! See link below:

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.nice.org.uk/media/default/About/NICE-Communities/Public-involvement/Developing-NICE-guidance/Factsheet-1-contribute-to-developing-clinical-guidelines.pdf&ved=2ahUKEwiBo6eky7mIAxWwTkEAHYxvFtMQFnoECBYQBg&usg=AOvVaw3121Trq_TuSyvhMGirN2FL

Creating and approving local clinical guidelines in developing countries involves several key steps and criteria to ensure they are tailored to the local context and effectively address the unique health challenges. Here are the main steps and criteria:

Steps to Create Local Clinical Guidelines

Criteria for Approval

i ) Scientific Rigor: The guidelines should be based on high-quality evidence and follow a transparent, systematic development process. ii)Relevance and Applicability: The guidelines must address the specific health needs and challenges of the local population. They should be feasible to implement within the local healthcare system and resource constraints. iii) Stakeholder Involvement: The development process should involve input from a broad range of stakeholders to ensure the guidelines are acceptable and practical. iv) Clarity and Usability: Recommendations should be clearly articulated and easy to understand and apply in clinical practice. v) Ethical Considerations: The guidelines should respect local cultural values and ethical standards.

vi) Sustainability: Consideration should be given to the long-term sustainability of the guidelines, including ongoing training and support for healthcare providers.

By following these steps and criteria, developing countries can create and approve clinical guidelines that are tailored to their unique contexts and improve healthcare outcomes.

The creation and approval of local clinical guidelines in developing countries, where international guidelines are inadequate, involve several essential steps and criteria. These countries often face challenges such as resource limitations, epidemiological, cultural, and social differences, and lack of infrastructure, requiring an adapted process to their specific realities. The following are the main steps and criteria involved:

1. Identifying Needs and Local Context Analysis

• Gap Identification: Assess whether the available international guidelines are not applicable or if there are specific gaps in the recommendations regarding the epidemiological, cultural, and economic conditions of the country.
• Situational Analysis: Conduct an analysis of the local health conditions, including epidemiology, health system capabilities, available resources, and the culture and practices of the population. This step also involves collecting local data to understand the main health problems that need to be addressed and what adaptations are necessary.

2. Formation of the Development Committee

• Selection of Experts: Form a committee composed of experts from different areas, including physicians, public health professionals, health economists, pharmacists, and community representatives. This helps ensure that the guideline development considers different perspectives.
• Inclusion of Stakeholders: Include stakeholders such as representatives of non-governmental organizations, health managers, and patients to ensure their voices are heard and that the guidelines meet different needs.

3. Review of Scientific Evidence and Contextual Adaptation

• Search and Assessment of Evidence: Review the available scientific literature, including international guidelines, to identify evidence-based recommendations that can be adapted. If there is no local evidence, it is important to seek comparable studies in similar contexts.
• Cultural and Economic Adaptation: Assess the applicability of the recommendations in light of the economic resources, available infrastructure, local culture, and traditional health practices. The guidelines must be practical and feasible, considering the resource and infrastructure limitations of local health systems.

4. Development of Recommendations

• Contextualizing Clinical Practice: Develop recommendations that are specific and relevant to local clinical practice. This involves considering the accessibility of medications, availability of technology, and the training of health professionals.
• Grading Recommendations: Use a methodology such as GRADE (Grading of Recommendations Assessment, Development and Evaluation) to grade the strength of recommendations, considering both the quality of evidence and applicability in the local context. Weak or flexible guidelines may be more appropriate in contexts where resources vary significantly.

5. Public Consultation and Peer Review

• Stakeholder Consultation: Submit the guidelines for public consultation, including health professionals, managers, patients, and other stakeholders, to ensure that the recommendations are practical and accepted by those who will implement or be affected by them.
• Technical Peer Review: Peer review by independent experts helps ensure that the recommendations are based on best practices and that any biases are identified and corrected.

6. Pilot Testing and Evaluation

• Pilot Implementation: Before approval and large-scale dissemination, it is important to test the guidelines in a pilot area or health unit. This helps identify operational obstacles and implementation challenges that can be addressed before scaling up.
• Impact Evaluation: Evaluate the effectiveness of the guidelines in the pilot, analyzing health outcomes, adherence of professionals, and resource impact. Feedback from health professionals and patients involved in the pilot is essential for making necessary adjustments.

7. Formal Approval

• Submission to Regulatory Bodies: Submit the guidelines to health regulatory bodies or the Ministry of Health for formal approval. This involves ensuring that the guidelines align with current legislation and are integrated into the national health system.
• Formalization of Guidelines: After approval, the guidelines must be formalized through regulations or norms, ensuring their legitimacy and integration into the public health system.

8. Dissemination and Training

• Training of Professionals: Promote training of health professionals to ensure effective implementation. This includes in-person and distance training, as well as guides and support materials that facilitate guideline adoption.
• Communication Campaigns: The guidelines should be disseminated through communication campaigns that reach all levels of the health system, from managers to grassroots professionals. Ensuring that the information is clear and accessible is essential to promote adherence.

9. Monitoring and Continuous Review

• Implementation Monitoring: Monitor guideline implementation through performance indicators, such as professional adherence and clinical outcomes. This helps identify failures or barriers that may be hindering the application of recommendations.
• Periodic Review and Update: Guidelines need to be regularly reviewed and updated, especially in contexts where health conditions or available resources can change rapidly. Periodic review also allows for the incorporation of new scientific evidence.

Necessary Criteria for Development and Approval

The creation of local clinical guidelines in developing countries is a complex process that requires a collaborative approach adapted to the specific context of each country. Considering cultural differences, resource limitations, and the reality of the health system is essential to ensure that the guidelines are effective and contribute to improving the health indicators of the population.

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