Accessing and understanding the evidence.

WHO regularly gathers, evaluates, and cites evidence to support its recommend dations. How this is done varies between departments, but highly centralized processes, complex methods and expert consultations are often used. WHO guidelines are distributed to health workers and policydmakers in developd ing countries, but few of these people have the opportunity to be involved in the process of choosing and weighing the evidence to formulate the guidelines that are ostensibly designed for their use. Such incomplete engagement may impede ownership of WHO recomd mendations, and thus be an obstacle to full implementation. In 2005 WHO published the Pocketbook of Hospital Care for Child dren,1 a comprehensive clinical resource for nurses and doctors in developing countries. The Pocketbook contains recommendations on the management of all common conditions, including sed rious infections, malnutrition, neonatal and surgical problems, injuries, burns and poisoning. These guidelines are an extension of the Integrated Management of Childhood Illness (IMCI) to the firstd referral hospital, providing consistency across all levels of health care systems. The Pocketbook aims to address many of the deficiencies in quality and safety of hospital care for children identified in recent years.2–4 However, the mere production of highdquality guidelines will not ensure implementation, or be sufficient to improve quality of care. A comprehensive approach to the impled mentation of the WHO Pocketbook includes training strategies and quality assessment tools. Another key comd ponent is a process of documenting, updating and disseminating evidence which engages doctors, medical students and nurses in countries throughout the