Clinical practice guidelines were adapted and implemented meeting country-specific requirements--the example of Kazakhstan.

OBJECTIVES: In a twinning partnership between the Canadian Society for International Health and Kazakhstan's Ministry of Health, a project to build capacity and a process for the adaptation and implementation of international clinical practice guidelines (CPGs) was undertaken.

STUDY DESIGN AND SETTING: A pragmatic CPG adaptation process was developed that took into consideration national and local contexts. A 15-step process ranging from topic prioritization to copyright clearance to final Ministry of Health approval was developed. An implementation strategy was developed and piloted in three local regions using a five-step approach.

RESULTS: High-quality international CPG candidates were identified for all topics; forty-two CPGs were adapted locally by the clinical working groups. Three CPGs using 21 recommendations were implemented locally. Many challenges were identified including priority setting, obtaining permission to use and translate guidelines into Russian and producing high-quality translations, and organizational barriers during implementation. Facilitators included tools to guide the process and the creation of working groups.

CONCLUSION: We describe a process of large-scale adaptation of international CPGs with the pilot implementation of selected adapted CPGs and recommendations. Further evaluation and monitoring are required to ensure its integrity.