Table 1 Process principles

1. Prioritization

The guidance fits in properly and is consistent with current health system priority areas within all applicable system levels and sectors by targeting a priority topic/jurisdiction/population [4, 5, 53–59]. The guidance addresses these specific local priority areas with a clearly documented/demonstrated need and also informs policy decisions on how to further prioritize across competing areas [4, 53, 54, 59, 60]. The origin of the mandate to develop the guidance [59] is also reported (for example, guidance that is mandated by a top official like the Minister of Health is considered to be of high priority).

2. Relevance

The guidance recommendations should be relevant to, appropriate to, and valid for the health system issue being addressed and relevant to the target population [5, 55–57, 60–63]. The recommendations are relevant to the setting within which the guidance will operate, the institutional needs of that system/sub-system, as well as local, national, and potentially global needs [54, 64–68].

3. Timeliness

The recommendations are available in a timely manner in relation to when the policy decisions are made or timely in relation to the health system issue being addressed [55, 56, 61, 69, 70]. The guidance is timely and usable by the broad range of health systems stakeholders [53, 68, 71] since some policy decisions are sometimes made within crucial corresponding time frames or as windows of opportunity open and close [4, 62].

4. Scope

The guidance is comprehensive and covers all relevant/appropriate (direct and indirect) health system levels, sub-systems, and sectors [5, 8, 56, 61, 63, 71, 72]. This also includes the various relevant sub-systems/components (hospitals, regional health authorities, and public health units etc.) within the health system. Identifying the scope is important because these various components are interlinked, interdependent, and interact at various interfaces for overall health system performance [53, 55, 58–60, 71–74].

5. Transparency

Systematic, replicable, and transparent processes are applied in developing and reporting the guidance [52, 61, 75, 76]. These processes are systematic and transparent enough for the methods of development/reporting of the guidance to be reproducible [59, 74]. In order to paint a clear picture to knowledge users and target populations, sufficient details on these processes are provided [5, 54, 63, 65, 67].

6. Evidence- based

The best available research evidence informs the recommendations [4, 5, 54, 55, 57, 58, 60, 61, 63, 69–71, 73–77]. The type(s) of evidence that was used to generate the guidance is/are stated, and this can range from well-established scientific methodologies or it can also be non-experimental (for example, colloquial evidence, anecdotal evidence, or preliminary models) [8, 62, 63, 70, 75, 78]. The evidence is context sensitive enough to resonate with local realities [4, 5, 54, 56, 57, 60, 61, 63, 69–71, 74, 75].

7. Stakeholder involvement

Alternative views on the policy issue and the complementary expertise of a multidisciplinary group of relevant stakeholders are considered in the development of the guidance [4, 5, 8, 53–55, 58–64, 67–69, 71, 75–77, 79]. Guidance developers, those involved in the implementation and evaluation of the guidance, and those who will be affected by the guidance recommendations are involved in the development process [54, 56, 57, 66, 71, 74, 80].

8. Ethical

The recommendations reflect considerations of an ethical lens [4, 8, 54, 56, 76] and align with applicable ethical principles and values (for example, equity, equality, human rights, liberty, efficiency, autonomy, dignity, beneficence) [8, 55, 63, 65, 74, 80, 81]. The guidance adequately promotes fairness and equality in terms of age, ability, culture, gender, socioeconomic status, religion, occupation, language, ethnicity, race, or sexual orientation among the target population [60, 61, 66, 69, 79, 82].

9. Outcomes

The guidance describes all the anticipated effects/outcomes as well as the appropriate indicators that can be used to measure the effects/outcomes [8, 54, 57, 58, 66, 67, 74, 75]. Adequate rationale regarding the choice of the outcomes and the indicators selected is provided [8, 58]. Considering potential uncertainties that may result, alternative outcomes and outcome indicators are also identified. Performance thresholds, targets, and standards that are considered acceptable are also identified [8, 58, 65–67, 76].

10. Competing interests

A declaration of competing interests (for example, financial, academic, professional) by the guidance developers, whether direct or indirect, is/are made in advance [57, 74, 80]. The author’s positions, roles, and affiliations are clearly stated [65]. Any reported or identified conflicts of interest are managed, with a description of the approaches used to curb any influence clearly documented [57, 80]. It is also clear that the views of any funding body involved have not influenced the development process of the guidance [65].

11. Presentation

The recommendations are clear, succinct, unambiguous, and presented in a readable and consistent format [57, 60, 76, 81], with key recommendations easily identifiable [53, 57, 58, 66]. The guidance is presented in a manner that is uniform, user-friendly, and easy to navigate [4, 53, 61, 64, 68, 80]. It contains an executive summary, full text, a complete list of relevant references, a glossary of terms, and full meaning of abbreviations and contact information of authors. Words or phrases denote an aspirational rather than a mandatory intent [80].