Key points
- WHO relies on groups of experts, drawn from many countries and disciplines, to advise it on priorities and emerging issues. STAGE plays that role for maternal, newborn, child and adolescent health and nutrition.
- Under USAID's Saksham project, we supported an effort to develop a national technical advisory group for maternal and child health, based at AIIMS New Delhi and chaired by an experienced member of STAGE. It did not become a formally constituted government body.
- It ran for about a year and a half and produced several policy papers for internal discussion. The experience offered practical lessons about what such groups need to continue.
Much of global health relies on a mechanism most people never hear about, the technical advisory group.
WHO has many expert advisory groups. Many of them bring together a small number of experienced people, such as clinicians, researchers, programme leaders and public health specialists, from different countries and health systems. They meet regularly, review evidence on a set of questions and advise WHO. In STAGE, for example, members serve in their individual capacity, not as representatives of their governments or institutions.
I find this a fascinating idea. Guidelines can reflect the assumptions, evidence and health system context in which they are developed. A group that brings together, say, a paediatrician from India, an epidemiologist from Brazil, a nutritionist from Kenya and a health systems researcher from Europe can examine a recommendation through several different experiences before it is finalised. That can help bring out assumptions, implementation challenges and differences in context that might otherwise be missed.
STAGE
For maternal, newborn, child and adolescent health and nutrition, WHO’s group is STAGE, the Strategic and Technical Advisory Group of Experts. WHO describes it as “the principal advisory group” to the organisation in this area. It was established by the Director-General in 2019 to “provide strategic and technical advice to WHO” and to “advise WHO on global priorities and emerging issues.” Its advice informs WHO’s work, which in turn can inform national policies and programmes. The decisions remain WHO’s.
Bringing the idea home
NTAGI showed what a national advisory group could do for immunisation in India. Under USAID’s Saksham project, we asked whether a similar approach could help with maternal, newborn, child and adolescent health and nutrition, an area with many programmes, many innovations and many decisions.
The initiative was an effort to develop a National Technical Advisory Group (NTAG) for MNCAH+N under a time-bound project. It was based at AIIMS New Delhi, with the head of the Department of Obstetrics and Gynaecology involved. It was chaired by an experienced expert who was a member of STAGE and had also played a leading role in NTAGI. The chair played an important role in convening experts across disciplines and organisations, including researchers and academics, non-profit organisations working in the field, and participants from government. The aim was to review evidence, innovations and practices, and to offer considered advice on what deserved to be taken forward.
My own role was a supporting one. I was part of a small, three-person programme management unit under Saksham that acted as the group’s secretariat until a formal one could be set up. That meant the operational work that keeps an advisory group running, including preparing background papers, framing the questions for each meeting, recording what was discussed and decided, and following up afterwards. It gave me a close view of how much happens between meetings, and how much a group of very senior people depends on someone keeping the threads together.
What happened
The group worked for about a year and a half and produced several policy papers for internal discussion. It did not become a formally constituted national advisory body. The work was supported through a time-bound project, and when that support ended, the arrangements needed to sustain the group were no longer in place.
I do not see this as a story of failure. For a year and a half, experts from academia, public health and related organisations came together to examine priorities in maternal and child health. In hindsight, the experience showed how important it is to plan for institutional continuity alongside the technical work, so that a promising initiative has a clear path to continue after its first funding period.
What I took from it
Supporting the group taught me three things that seem to matter when designing an advisory mechanism.
A clear mandate. WHO’s groups have a defined role and an established route for their advice. A national mechanism would need its own form of recognition and terms of reference, designed to fit the country’s governance arrangements and existing advisory bodies, rather than copying any one model.
A secretariat that can continue. Experts give their time, but they cannot also run the machinery. The secretariat is what turns meetings into advice and advice into follow-up, so it needs support that lasts beyond a single project.
A route from advice to decision. The value of an advisory group lies in what happens to its recommendations. A clear process for considering them can help connect advisory work with policy decisions.
I still think technical advisory groups are a useful mechanism for bringing the experience of many countries and careers to bear on shared problems. Supporting one up close made me appreciate both their value and how carefully they have to be set up to last.
Views are my own.