Project SAGE is an innovative partnership which aims to enhance the quality of primary healthcare by engaging in a stakeholder-driven process to improve the standards of local clinical guideline development, adaptation, contextualisation and, ultimately, implementation.
Project SAGE has been made possible as a result of a three-year (2014-2016) Flagship Grant from the South African Medical Research Council (SAMRC).
Project SAGE can be divided into three phases – mapping, development, and capacity building. These three phases include the following project stages - stakeholder mapping, local guideline quality evaluation, an assessment of global guideline implementation strategies, and identification of implementation enablers and constraints in South Africa.
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Email: Principal Investigator or Tel: +27 21 938 0508
Project SAGE is an innovative partnership which aims to enhance the quality of primary health care by engaging in a stakeholder-driven process to improve the standards of local clinical guideline development, adaptation, contextualisation and, ultimately, implementation.
The Institute of Medicine (IOM) defines clinical practice guidelines as statements that include recommendations intended to optimise patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options [IOM 2011). High-quality, evidence-informed guidelines can bridge the gap between policy, best practice, local context and patient choice to enable quality outcomes.
Little is known about the quality or amount of clinical practice guideline activity in South Africa, despite the diverse contexts of care found across the country and the limited resources available to underwrite healthcare for all. In addition, each international guidelines development group has its own processes, and each comes highly recommended - and with no way to select what is most relevant for various contexts.
There is an urgent need for centralised concentration of effort to support efficient guidelines use in SA, to improve healthcare processes, costs and outcomes. We need local research, involving stakeholders with recognised expertise, to improve the flow of information regarding quality guideline development; adaptation or contextualisation; effective implementation; and evaluation. SAGE will bring together SA clinicians, academics, managers, policy makers, patients and other end-users to identify and address barriers to improve clinical behaviours, uptake of evidence and patient care.
Cochrane South Africa
Cochrane South Africa, an intramural research unit of the South African Medical Research Council (SAMRC) is part of the international Cochrane Collaboration a non-profit organisation operating worldwide, which disseminates up-to-date reviews on the effects of healthcare interventions in order to ensure healthcare decision making within Africa will be informed by high-quality, timely and relevant research evidence.
Health Systems Research Unit (HSRU), South African Medical Research Council
The main purpose of the Health Systems Research Unit (HSRU) is to conduct health systems research to develop and improve the organisation, efficiency, effectiveness and impact of health systems on population health. The unit is at the forefront of conducting both qualitative and quantitative health systems research in South Africa and across the continent.
Centre for Evidence-Based Health Care
The Centre for Evidence-based Health Care (CEBHC) is a coordinating and directive institution for research and training at the Faculty of Medicine and Health Sciences of Stellenbosch University in the field of evidence-based health care. Core activities of the CEBHC include research, teaching and knowledge translation. The CEBHC has a dedicated Biostatistics Unit.
International Centre for Allied Health Evidence, University of South Australia
Established in 2002, the International Centre for Allied Health Evidence (iCAHE) is located at the University of South Australia and is a Member of the Sansom Institute. iCAHE works locally, nationally and internally to achieve its mission .iCAHE’s research teams conduct qualitative and quantitative primary and secondary allied health research and iCAHE researchers inform and deliver evidence-based practice in all allied health undergraduate, postgraduate and continuous professional development programmes.
Our Research Team works together to deliver all project outputs.
Dr Tamara Kredo
SAGE Project Coordinator
Senior Specialist Scientist and Deputy Director, Cochrane SA
Specialist in clinical pharmacology with a particular interest in EBHC practice and training, rational therapeutics and CPGs related to infectious diseases. Her current research focuses on conducting relevant Cochrane Reviews in priority areas to serve policymakers, including World Health Organisation (WHO) HIV guideline developers. She is also extra-ordinary lecturer in the Departments of Interdisciplinary Health Sciences and of Pharmacology at the University of Stellenbosch. She is an associate fellow of the College of Medicine of South Africa in Clinical Pharmacology with a particular interest in evidence-based health care practice and training, rational therapeutics and clinical practice guidelines. She is certified trainer with the WHO’s Global Learning Opportunities within the Vaccine Quality division, and was the director of the South African Collaborating Center for delivering training for the region on behalf of WHO, which she continues to do working with the Medicines Control Council of South Africa. During 2011/2012 she was a Trustee on the Board of the Guideline International Network, a global network, including 93 organisations and 120 individual members representing 44 countries from all continents. The Network supports evidence-based healthcare and improved health outcomes by reducing inappropriate variation throughout the world. Her current research focuses on conducting relevant Cochrane reviews in priority areas in infectious diseases including health systems questions, and on the evaluation of the quality, content and adaptation of clinical practice guidelines within the Southern African Development Community (SADC) and WHO, where a recent publication revealed the strengths and weaknesses of the current Guidelines Review Committee within WHO.
Dr Sara Cooper
Senior Scientist, , Cochrane SAMRC
Dr Sara Cooper is a Senior Scientist in Cochrane at the SAMRC. She holds a Bachelor’s (Honours) degree in Psychology and a Master’s in Public Health from the University of Cape Town (UCT) and a PhD in medical sociology from the London School of Hygiene & Tropical Medicine. Her interests include the application and explanatory potential of social science theories and methodologies within health research, policy and practice, and how qualitative health research can be both ‘critical’ and ‘applied’. Her most current research focuses on these issues in the realm of long-term chronic illnesses, including mental illness, HIV/AIDS, diabetes and obesity. Sara has extensive experience in conducting and building capacity for critical qualitative health research in sub-Saharan Africa (SSA), having worked on as a senior qualitative researcher on a number of global public health projects. Highlights include the DFID-funded Mental Health and Poverty Project (MHaPP) which examined mental health systems in SSA; the NIH-funded study which explored experiences of mental illness in people living with HIV in Zimbabwe (the TENDAI study); and the UKMRC-funded Formative and Process Evaluation study of an RCT evaluating the effectiveness of an mHealth intervention to support treatment adherence for people with type-2 diabetes in SSA (StAR2D study). Sara is also an Honorary researcher in the Division of Social & Behavioural Sciences in the School of Public Health at UCT and on the editorial board of Critical Public Health.
Biostatistics Unit, Stellenbosch University
Michael McCaul is a registered emergency care practitioner and is passionate about pre-hospital emergency care and research, having worked as an operational paramedic locally and internationally. Michael holds a BTech in Emergency Medical Care (DUT) and an MSc in Clinical Epidemiology from Stellenbosch University. He is undertaking a PhD in Public Health focusing on strengthening guideline development for emergency care. He is currently working as a researcher at the Biostatistics Unit, much of his work involves undergraduate and postgraduate teaching, biostatistics consultation, knowledge translation and research.
Ms Amber Abrams
Senior Scientist, Cochrane SA
Amber Abrams completed her undergraduate degree in 2004 at Columbia University, and her MPhil degree programme entitled HIV/AIDS and Society in 2008. Ms Abrams has managed the field research of the Human Science Research Council and the University of Connecticut two-year joint project collecting data on stressors linked to risk taking amongst those living with HIV/AIDS and was research assistant for a project that explored the Life-worlds of Street Children using human geography and participatory methods. Ms Abrams has worked at Cochrane SA at the SAMRC as project manager and senior scientist for the Pan African Clinical Trials Registry (PACTR) since 2009. Ms Abrams is currently working on her PhD, which explores health-seeking behaviours at the boundaries of protected areas in northern Limpopo through the University of Kent. Ms Abrams has been working part-time on Project SAGE since June 2014, and is excited to be a part of this important and novel initiative!
Prof Taryn Young
SAGE Project Partner, Stellenbosch University
Director of the Centre for Evidence-based Health Care at Stellenbosch University and Consultant/Senior Specialist Scientist to Cochrane SA, is an epidemiologist with a specialist degree in public health (Fellow of the College of Public Health Medicine, College of Medicine of SA), also holds an MMed Public Health, and has considerable expertise in the field of EBHC. She has experience in enhancing the capacity of policymakers to understand and use best evidence, and has an extensive profile in teaching and training evidence-based healthcare including providing planning, coordinating, implementing and evaluating training to healthcare professionals at undergraduate and postgraduate level. She has coordinated international collaborative projects which facilitate the use of best evidence in healthcare policy and practice, conducted many systematic reviews and provided intensive training, mentorship and editorial support to authors of Cochrane and other systematic reviews. She leads the coordination of the Effective Health Care Research Consortium in Africa (funded by DFID), as well as the Policy BUDDIES project (funded by WHO) which aims to enhance evidence-informed policy development.
Prof Quinette Louw
SAGE Project Partner, Stellenbosch University
Professor in the Division of Physiotherapy, Stellenbosch University. She is also an adjunct professor at the University of South Australia and affiliated with the International Centre of Allied Health Evidence. She has extensive experience in teaching systematic reviews and evidence-based healthcare to under- andpostgraduate students. She has convened the Evidence Based Clinical Guideline module for the past five years. Recently she played a pivotal role in expanding and updating this module, which is part of the Masters in Clinical Epidemiology degree at Stellenbosch University. She has published 60 peer-reviewed publications and successfully supervised 38 masters and five doctoral candidates. A number of the students conducted projects related to evidence-based guidelines and she is currently supervising a doctoral candidate who will contextualise primary healthcare, evidence-based clinical guidelines for chronic pain. She regularly presents seminars on evidence-based care for specific allied healthcare conditions.
Dr Karen Daniels
SAGE Project Advisor
Health Systems Research Unit, SAMRC
Karen is a Specialist Scientist in the Health Systems Research Unit at the SAMRC. Her education background combines training in the liberal arts (BA Hons) with that of public health (MPH, DrPH). As a social scientist she has expertise in qualitative research and has training and experience in the fields of health policy and systems research, gender analysis and systematic reviews. Her research approach includes both quantitative studies of effectiveness and qualitative studies of experience. Research highlights include a study of knowledge translation for policies and guidelines in three African countries (South Africa, Zimbabwe, Mozambique). This work was the basis for her MPH thesis and won the BMC Research Award in 2010. Part of her DrPH has looked at the extent to which research on gender has been translated into policies for lay health workers in South Africa. Currently, Karen teaches a seminar on knowledge translation into policy and guidelines as part of the Health Policy and Planning module in the MPH course at the University of Cape Town. Karen also leads the South African Initiative for Reviews on Health Systems and Policy Research.
Prof Karen Grimmer
SAGE Scientific Director
International Centre for Allied Health Evidence, University of South Australia (iCAHE)
Karen is the Director and founder of the International Centre for Allied Health Evidence, University of South Australia, Australia, Professor Extraordinaire at Stellenbosch University, Adjunct Professor, University of Santo Tomas, Manila, Philippines; and Adjunct Professor, Nova Southeastern University, Florida. Karen has been working in academia since 1995, and is an experienced educator and researcher in health-service delivery quality. Her clinical background is as a physiotherapist in rural Australian primary healthcare settings. Her PhD is in epidemiology and biostatistics, and she has a Graduate Certificate in Health Economics. She recently published her 230th peer-reviewed paper. Karen has been a keynote speaker at international and national conferences each year for the last decade, and has attracted students to her research centre from around the world. Her research passion is making current best evidence palatable and useable by clinicians, administrators, policy-makers and consumers by identifying the best way of presenting information from evidence synthesis, so that barriers to evidence uptake are broken down.
The Team receives executive support from:
Ms Debra Kay, Strategic support (iCAHE)
In addition to its Research Team, Project SAGE has a Management Group and a Strategic Advisory Group.
The role of the management group is to oversee the effective implementation of the project and ensure:
- All contract obligations are met, on time and within budget.
- Strategic partnerships are identified and sustained.
- Maximum benefit to the quality of primary health care services in South Africa.
- Dissemination of project outcomes for global benefit.
The Group is chaired by Project SAGE PI, Dr Tamara Kredo, from Cochrane SA and Group Members are Prof. Taryn Young, Prof. Quinette Louw.
All project procedures are collaboratively developed and signed off by this group. They meet monthly and communicate between meetings, as required.
Strategic Advisory Group
The Strategic Advisory Group provides strategic advice on project design, implementation, analysis and partnerships, to maximise project benefit to policy makers, clinicians and the community. The Strategic Advisory Group meets two to three times per year, as mutually agreed.
- Ms Jeanette Hunter, Deputy Director General Primary Health Care, Department of Health
- Mr Gavin Steel, Chief Director, Essential Drugs List, Department of Health
- Dr Peter Barron, Technical Advisor, Department of Health, Health Sciences Department, University of Stellenbosch
- Mrs Ina Diener
- Prof. Jimmy Volmink, Dean, Faculty of Medicine and Health Sciences, University of Stellenbosch; Director Cochrane SA/SAMRC
- Prof. Jeremy Grimshaw, Senior Scientist, Ottawa Hospital Research Institute, Canada
- Dr Simon Lewin, Senior Researcher, Ottawa Hospital Research Institute, Norway
- Dr Tamara Kredo, Deputy Director and Senior Specialist Scientist, Cochrane SA/SAMRC
- South African Primary Care Clinical Practice Guideline Implementation and Use: Gaps & Opportunities (Policy Brief)
- South African Primary Care Clinical Practice Guideline Development: Gaps & Opportunities (Policy Brief)
- Guidelines Toolkit - The Guidelines Toolkit was developed by the SAGE project. It t provides a free comprehensive guideline resource which draws on the available and current up-to-date leading benchmark literature pertaining to clinical guidelines. The toolkit describes how to search for guidelines, how to develop guideline questions, and how to adopt, adapt or conceptualise existing clinical guidelines.
- SAGE Close-Out Report
- SAGE 2014-2018 - Final Report
- SAGE 2014-2018 - Summary Report
- Project SAGE Guidelines Resource Page
- Sage brochure available in eBook format
- SAGE Newsletter
- SAGE Summit Report
- GRADE Training Workshop Report
- Scoping project: Evaluating clinical guideline coordination units globally
- News on the SAGE Summit has been published by Africa Health News see: http://africahealthnews.com/valuable-discussions-guidelines-development-implementation/
- Journal articles on SAGE
- Dizon JM, Grimmer K, Machingaidze S, McLaren P, Louw Q. Mapping South African allied health primary care clinical guideline activity: establishing a stakeholder reference sample. Health Research Policy and Systems. 2016 Oct 10;14(1):77. DOI: 10.1186/s12961-016-0145-9 [Original]
- Dizon JM, Machingaidze S, Grimmer K. To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development. BMC Research Notes. 2016 Sep 13;9(1):442. DOI: 10.1186/s13104-016-2244-7 [Original]
- Dizon JM, Grimmer K, Louw Q, Machingaidze S, Parker H, Pillen H. Barriers and enablers for the development and implementation of allied health clinical practice guidelines in South African primary healthcare settings: a qualitative study. Health research policy and systems. 2017 Sep;15(1):79. DOI: 10.1186/s12961-017-0243-3 [Original]
- Dizon JM, Grimmer K, Louw Q, Kredo T, Young T, Machingaidze S. South African Guidelines Excellence (SAGE): Adopt, adapt, or contextualise? South African Medical Journal. 2016 Dec 1;106(12):1177-1178. DOI: 10.7196/SAMJ.2016.v106.i12.11374 [Other]
- Grimmer K, Machingaidze S, Dizon J, Kredo T, Louw Q, Young T. South African clinical practice guidelines quality measured with complex and rapid appraisal instruments. BMC Research Notes. 2016 Apr 27;9(1):244. DOI: 10.1186/s13104-016-2053-z [Original]
- Kredo T, Abrams A, Young T, Louw Q, Volmink J, Daniels K. Primary care clinical practice guidelines in South Africa: qualitative study exploring perspectives of national stakeholders. BMC Health Services Research. 2017 Aug;17(1):608. DOI: 10.1186/s12913-017-2546-z [Original]
- Kredo T, Cooper S, Abrams A, Muller J, Volmink J, Atkins S. Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa. BMC Health Services Research. 2018 Dec 14;18(1):965. DOI: 10.1186/s12913-018-3778-2 [Original]
- Kredo T, Cooper S, Abrams A, Daniels K, Volmink J, Atkins S. National stakeholders' perceptions of the processes that inform the development of national clinical practice guidelines for primary healthcare in South Africa. Health Research Policy and Systems. 2018 Jul;16(1):68. DOI: 10.1186/s12961-018-0348-3 [Original]
- Kredo T, Bernhardsson S, Machingaidze S, Young T, Louw Q, Ochodo E, Grimmer K. Guide to clinical practice guidelines: The current state of play. International Journal for Quality in Health Care. 2016 Feb; 28(1): 122-8. Epub 2016 Jan 20. DOI: 10.1093/intqhc/mzv115 [Review]
- Louw Q, Grimmer K, Dizon JM, Machingaidze S, Parker H, Ernstzen D. Building capacity in primary care rehabilitation clinical practice guidelines: A south african initiative. Health Research Policy and Systems. 2018 Dec;16(1):96. Epub 2018 Sep 29. DOI: 10.1186/s12961-018-0368-z [Original] .
- Louw Q, Dizon JM, Grimmer K, McCaul M, Kredo T, Young T. Building capacity for development and implementation of clinical practice guidelines. South African medical journal. 2017 Aug 25;107(9):745-6. DOI: 10.7196/SAMJ.2017.v107i9.12527 [Original]
- Machingaidze S, Grimmer K, Louw Q, Kredo T, Young T, Volmink J. Next generation clinical guidance for primary care in South Africa - credible, consistent and pragmatic. PLoS One. 2018 Mar;13(3):e0195025.
- DOI: 10.1371/journal.pone.0195025 [Original]
- Machingaidze S, Kredo T, Louw Q, Young T, Grimmer K. South African Guidelines Excellence (SAGE): Clinical practice guidelines – quality and credibility. South African Medical Journal. 2015 Sep:105(9):743-5. DOI: 10.7196/SAMJnew.7697 [Original]