Box 8Template for the summary of considerations related to the strength of the recommendations with explanations for completing the template

RecommendationWhich recommendation?
InterventionWhat is the intervention?
Quality of the evidence□ High
□ Moderate
□ Low
□ Very low
The higher the quality of the evidence, the stronger the recommendation.
If the evidence quality is ‘low’ or ‘very low’, consider more carefully the other criteria below in deciding the strength of the recommendation.
Values and preferences□ No significant variability
□ Significant variability
This refers to values placed by health workers, policy-makers, patients and other stakeholders on the intended outcomes of the interventions.
If there is wide variability between the values and preferences of various stakeholders, the intervention is less likely to have a strong recommendation.
Magnitude of effect in critical outcomes□ Large effect (RR>2 or RR<0.5)
□ Small effect (0.5<RR<2)
This refers to the potential of the intervention to have large effects. The effects can be enhanced by being combined with other interventions. Consider which potential associations (or ‘bundles’) can enhance effects.
The larger the potential effects and the longer the time period of the potential effects, the more likely the intervention is to have a strong recommendation.
Balance of benefits versus disadvantages□ Benefits outweigh disadvantages
□ Benefits and disadvantages are balanced
□ Disadvantages outweigh benefits
Benefits refer to the intended positive effects of an intervention .
Disadvantages refer to the potentially negative effects of an intervention as well as its unintended effects.
The fewer the potentially negative effects there are, the more likely the intervention is to receive a strong recommendation.
Resource use□ Less resource intensive
□ More resource intensive
The resources needed for the implementation of a recommendation may include financial resources, human resources, and infrastructure or equipment. Ideally, the cost of the benefits of an intervention should be reasonable, affordable and sustainable. It should be remembered that capital costs, such as those required for infrastructural development, may be initially high but may also yield long-term benefits.
Generally, interventions that incur higher incremental or recurrent costs are less likely to be strongly recommended.
Feasibility□ Yes, globally
□ Yes, conditionally
Political commitment and wide stakeholder engagement are prerequisites for interventions. The ‘technical’ feasibility of interventions also depends on sufficiently functional organizational and institutional structures to manage, follow through, and monitor the implementation of the recommendation. The elements of technical feasibility vary considerably by country and by context; where these elements are likely to be functional across a wide variety of settings it is more likely that interventions will receive strong recommendations.
Recommendation direction□ In favour of the intervention
□ Against the intervention
Overall ranking□ Strong recommendation
□ Weak recommendation
Strength of the recommendation.

From: Annex 3, Summary of the considerations related to the strength of the recommendations (Balance Worksheets)

Cover of WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage
WHO Recommendations for the Prevention and Treatment of Postpartum Haemorrhage.
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