The Creation of the Oxford-Egypt EBHC Alliance

Egypt is the 14^th most populated country in the world and the third most populated in Africa with approximately 110 million inhabitants. Egypt's healthcare system is currently undergoing rapid transformation towards universal health coverage in line with Egypt’s Vision 2030 to achieve the health- and education-related sustainable development goals (SDGs) as part of the national agenda for sustainable development.

The concepts of Evidence-Based Medicine (EBM) were introduced to Egypt more than 20 years ago, yet limited formal EBM content has been integrated into medical school curricula at the undergraduate level, and particularly on the postgraduate level. Recent national efforts focused on clinical practice guidelines through Egypt’s national programme for guideline development and adaptation, reflecting Egypt’s transformation into an evidence-based healthcare ecosystem. More than ever before, there is an urgent need to make evidence-informed decisions in health policy and practice to improve population health outcomes in Egypt with optimal allocation and utilisation of resources, guided by high-quality trusted research evidence. Hence, we need to strengthen national capacities and expertise in evidence-based healthcare/medicine (EBHC/EBM), provide formal EBM content in medical education, and help translate research evidence into practice.   

With that in mind, I (Ranin), as a DPhil student in EBHC at Oxford’s CEBM back then, met with David while attending the Teaching Evidence-Based Practice (TEBP) course in September 2022 and expressed my sincere interest and enthusiasm to create an international partnership between Oxford’s CEBM and leading Egyptian universities, research centres, and healthcare organisations in Egypt. Motivated by my passion and dedication to research and education and coupled with my willingness to promote EBHC in my home country, I worked with David to create an Oxford–Egypt Evidence-Based Healthcare (EBHC) Alliance. Two years later, the hard work paid off and the creation of the Oxford–Egypt EBHC Alliance will be introduced during the TEBP course this September in Oxford.*  

This partnership has five principal aims:

1. To advance the education and teaching of evidence-based healthcare/medicine in Egypt;
2. To conduct joint research in health priority health areas in Egypt to generate high-quality trusted evidence to better inform health policy and practice decisions in Egypt;
3. To promote culture, tools, and skills of evidence-based healthcare in teaching university hospitals and healthcare providers across Egypt;
4. To foster national and international collaborations with like-minded academics, educators, and health scientists for developing and delivering high-quality teaching, training, and research programmes in evidence-based healthcare/medicine.
5. To establish a centre of excellence for Evidence-Based Healthcare in Egypt

The Oxford Centre for Evidence-Based Medicine (CEBM) is supporting this evolutionary initiative to help transform the healthcare landscape in Egypt through evidence-based practices. Together we seek to foster EBHC teaching, research, and practice in Egypt and the broader Middle East and Africa (MEA) region.

The ‘Ankh’, also known as the ‘Key of Life’ symbol “☥” is an ancient Egyptian hieroglyphic symbol that is thought to have originated in the pre-dynastic period of ancient Egypt, around 4000 BC. In ancient Egypt, the ankh was used as a symbol of life and power and was believed to have the power to give life, both in the physical and spiritual sense. Being rooted in our Egyptian history and culture, I was eager to add the ‘Key of life ☥’ symbol to the Alliance’s logo to signify the transformative role the Alliance will play in reviving (bringing life to and strengthening) the field of EBHC in Egypt through this partnership with Oxford’s CEBM. The slogan of the Oxford–Egypt EBHC Alliance is, ‘Your key (☥) to trusted evidence in healthcare for Egypt and the region’.

For me, creating the Oxford–Egypt EBHC Alliance is a dream coming true and I am super-excited to take the first steps in my dream seeing the light of day, with the creation of the Alliance. I am motivated and committed to becoming a beacon of change by transferring Oxford’s CEBM knowledge and skills in EBHC/EBM to advance EBHC education, research and practice in Egypt. I am looking forward to connecting with interested like-minded academics, researchers, clinicians and policymakers in Egypt to work together towards achieving this goal.

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As a child of the '90s growing up in England, two things were inescapable: shell suits, popularised by the World Cup Italia 90 England team, and the music of Oasis. Their recent reunion announcement certainly brought back nostalgic memories. Amongst words similar to reunion is “Alliance”, defined as “a relationship among people, groups, or states that have joined together for mutual benefit or to achieve some common purpose.” When searching for the term ‘alliance’, most results relate to conflict (or its avoidance). Yet, alliances are foundational to many human endeavours, music being a good example.

Coincidentally, another child of the 90s is Evidence-Based Medicine (EBM), which represents an alliance formed around a common purpose that has achieved great things. Introduced out of McMaster’s University in 1992, EBM was an alliance of 31 clinical academics seeking to revolutionise medical education by systematically training doctors on the skills of finding, understanding and applying empirical research to clinical decision-making. Further alliances soon formed around a shared understanding of this much-needed change. Such was the success of these alliances you’ll be hard-pressed to find many medical education programmes that do not include the education of (at least some) EBM skills and competencies.

Sir Muir Gray recognised the value of EBM early on. In 1994, as director of NHS Research and Development for Anglia and Oxford Regional Health Authority, he initiated EBM’s development in the UK by inviting David Sackett, one of the original McMaster alliance, to Oxford. With a startup grant, David established the Oxford Centre for Evidence-Based Medicine (CEBM) in 1995. One of his first initiatives was drafting the CEBM “Prospectus” - a blueprint outlining CEBM’s raison d’être with collaboration as a core theme. This spirit of collaboration was embodied by the 12 individuals who formed a founding alliance of the Centre and led to the creation of what I affectionately call the Glastonbury of EBM courses - the Oxford Teach the Teachers course (now known as Teaching Evidence-Based Practice [TEBP]).

30 years later the CEBM continues to honour this collaborative spirit. As the current leader of the TEBP course, I am honoured and continually humbled by the collective efforts of its tutors. My mission has expanded to support the development of EBHC education and research beyond Oxford. In 2014, I proudly supported two Oxford medical students in establishing a centre for EBM in their home country of Lithuania. Later, I was thrilled to assist Brazilian academics in forming the first Oxford-Brazil EBM Alliance. Today, I am equally ecstatic to support Dr Ranin Soliman, a recent Oxford EBHC DPhil graduate, in her endeavour to establish the first Oxford-Egypt EBHC Alliance in Egypt.

I am excited to be part of the creation of the Oxford-Egypt EBHC Alliance. It is a further example that underscores the lasting impact of the connections and capacity building that occur when individuals come to Oxford to study Evidence-Based Healthcare. These experiences inspire them to advance EBHC education in their own countries. I'm honoured to contribute to this initiative, knowing it will help advance healthcare standards and build vital capacities in Egypt and beyond.

David

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*The first planned activity of the Alliance will be an intensive workshop for clinicians, healthcare practitioners and researchers. This workshop will take place in Cairo, Egypt, provisionally, during Spring 2025, led by Professors from Oxford alongside tutors, and facilitators from Egypt to carry out the teaching and facilitating the workshops.  To mark the creation of the Oxford-Egypt EBHC Alliance, we will be holding a free event on the evening of September 18^th at Rewley House in Oxford. Details on how to join us are available here: https://www.conted.ox.ac.uk/events/view/the-oxford-egypt-ebhc-alliance

The Alliance’s founding members are Dr Ranin Soliman [1] and Dr David Nunan [2]; the advisory/honorary members are Professor Carl Heneghan [3] and Professor Sir Muir Gray [4], and a contributing facilitator is Dr. Nancy Bolous. [5]

[1] School of Life and Medical Sciences, University of Hertfordshire, Hosted by Global Academic Foundation (GAF), New Administrative Capital, Egypt.

[2] Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

[3] Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

[4] Centre for Evidence-Based Medicine (CEBM), Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.

[5] Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, US.

Dr Ranin Soliman is an Oxford EBHC DPhil graduate, an Assistant Professor of Evidence-based Practice at the School of Life and Medical Sciences at the University of Hertfordshire, hosted by Global Academic Foundation in Egypt, and the Head of the Health Economics and Value unit at Children’s Cancer Hospital Egypt.

Dr David Nunan is a Senior Research Fellow and Departmental Lecturer in the Nuffield Department of Primary Care Health Sciences, Director of the MSc in EBHC Teaching and Education and the Postgraduate Certificate in Teaching Evidence-Based Health Care, and a Supernumerary Fellow at Kellogg College.