Best Practice in Wound & Lymphoedema Care in Low-Resource Settings

1. Best Practice in Wound & Lymphoedema Care in Low-Resource Settings • A Framework for the Development of Guidelines & Recommendations for Capacity Building at the Country Level • Guidelines Working Group Members: Erik Post, MD, Working Group Leader, • Laura Bolton, PhD • Pierre Brantus, MD • Hugh Cross, PhD, Pod. • Mary Jo Geyer, PhD, PT • David Keast, MD • Rob Snyder, DPM

2. Opinion of Experts in Low-Resource Settings Experience of Clinicians in Low-Resource Settings Evidence in Literature Synthesis of Information The Wound & Lymphoedema Best Practice Pathway1 1. Modified from Keast D and Orstead H. The Pathway to Best Practice, Wound Care Canada, Vol. 4, No. 1, 2006, Guest Comentary Best Practice Guidelines Practice Recommendations Educational Recommendations Org/Policy Recommendations Reference Guides Curricula & Training Materials Algorithms Local Resources Patient Risk Factors ID & Modify Barriers ID & Promote Bridges Best Practice in Low-Resource Settings

3. Publications & Project Reports Low-Resource Settings Experience of Clinicians in Low-Resource Settings Evidence in Literature WHO White Paper Examples of Key FeaturesWound & Lymphoedema Best Practice Pathway1 1. Modified from Keast D and Orstead H. The Pathway to Best Practice, Wound Care Canada, Vol. 4, No. 1, 2006, Guest Comentary Modified Best Practice Guidelines Practice Recommendations Educational Recommendations Org/Policy Recommendations Patient & Provider Quick Ref Guides: CAWC Curricula & Training Materials: ILEP, GAELF, IDF Validated Algorithms: VUCI, PUCI, etc. Local Resources Patient Risk Factors ID & Modify Barriers ID & Promote Bridges Best Practice in Low-Resource Settings

4. Project Planning & Implementation Don’t confuse guideline development with planning processes and/or operational activities for building capacity in wound and lymphoedema services

5. Framework for Planning 1. Perform a thorough situation analysis • Conduct a site visit • Review existing health system structure • Review existing practices • Compare existing practices to current best practices • Standardize curricula, training materials & references • The guidelines drive this process!!

6. Framework for Planning 1. Perform a thorough situation analysis (continued) • Establish priority needs • Identify local champions • Identify “bridges” to the health care system 2. Identify potential interventions 3. Define indicators & monitoring tools 4. Define all steps: quantify targets & timelines

7. Framework for Planning 5. Identify tools for supervision 6. Select approach for community involvement 7. Identify resources for initial implementation 8. Develop a strategic plan 9. Develop an operational plan

8. Implementing an Operational Plan 1. Select priority area for implementation • Set level of implementation • Complete a focused situation analysis: emphasis on available resources, literacy, language, local support, active partners 2. Implement Operations • Social Mobilization • Training • Related activities

9. Implementing an Operational Plan 3. Build on existing community interventions • Define roles to strengthen links & coordination with partners • Community Health Centers • Outreach services • Self-care groups

10. Implementing an Operational Plan 4. Link the program to the community & the health system • Provide regular feedback to the community RE progress on outcomes • Periodically review priorities & experience in implementation through evaluation & monitoring • Provide follow-up & supervision of providers • Promote services 5. Improve access to quality wound & lymphedema care