A Comparison of Frameworks Evaluating Evidence for Global Health Interventions

Evidence-based decision-making is critical to informing policy in global health interventions and programs. Existing frameworks for evaluating evidence that were developed or recommended for community or public health decision-making vary in their criteria and application. We compared how different community or public health evidence frameworks assessed the same body of evidence for three advocated global health interventions and find there can be substantial differences in the rating of evidence, which could contribute to differences in policy recommendations. All current frameworks emphasize effectiveness, and have shortcomings on other important factors into policy decision-making such as costs, implementation issues, context, and sustainability. As global health policymakers move towards evidence-based approaches, we find a gap between what is currently available and the needs for an evidence framework appropriate for application to a global health setting in a low- and middle-income country context. More work is needed to either adapt one or more existing frameworks, or to develop an entirely new framework to meet the needs of policymakers and others responsible for implementing global health interventions.