Improving the efficiency of evidence-based interventions

Evidence-based medicine aims to make clinical practice more scientific and empirically grounded in order to achieve safer, more consistent and costeffective care.1 It helps ensure that interventions are backed by evidence of sufficient quality to justify investment in implementation and scale-up. Since its introduction in the 1970s, the term ‘evidence-based intervention’ has moved from being an intellectual curiosity to a central component in conversations about health or behavioural interventions. There have been substantial successes with evidence-based medicine and policy development, but they are not without critics.2 Globally, randomised controlled trials (RCTs) are increasingly seen as the gold standard of programme evaluation, representing the best way to determine whether new interventions are effective.3, 4 Evidencebased medicine is built upon the foundation of the RCT. It is rare, particularly in clinical practice, for evidence other than that emanating from an RCT to be considered of sufficient evidentiary standard – despite the fact that a great deal of clinical practice remains based on professional experience and observation. Others argue that the ‘hegemony’ of the RCT marginalises intervention types that do not lend themselves to an RCT design.5