The PACK Adult Global guide provides a generic ‘framework’ that can be customised to meet the needs of primary healthcare systems in individual countries or states.
Primary healthcare is key to achieving the United Nations-led Sustainable Development Goals and the broader goal of “health for all” by providing accessible, affordable and effective healthcare. Yet in many low and middle income countries, primary healthcare is constrained by a lack of adequately skilled and supervised health workers.
The Knowledge Translation Unit is a health systems research unit that has spent 16 years developing the PACK programme to empower health workers in primary healthcare. The PACK programme consists of 4 pillars: 1) the PACK Guide 2) the PACK training programme, 3) health systems intervention and strengthening and 4) monitoring and evaluation of the PACK implementation.
The PACK Guide is a clinical decision tool that enables healthcare practitioners to manage symptoms and diagnose conditions commonly seen in primary care including infectious diseases, non-communicable diseases, women’s health, mental health and end-of-life care.
Its comprehensive scope promotes delivery of integrated primary care, rather than care through “vertical programmes”.
PACK is based on WHO guidelines, strengthened with the latest global research evidence as appraised, graded, sourced and synthesised by BMJ Best Practice.
BMJ Best Practice content underpins more than 80% of PACK recommendations and its robust updating processes will facilitate an annual update of the PACK Guide.
The PACK programme has been implemented and scaled up throughout the nine provinces in South Africa. It is now used in more than 2,000 clinics across the country, by over 20,000 primary care health workers.
The Knowledge Translation Unit has conducted formal evaluation of the programme through 4 pragmatic trials and has published the outcomes of this research in 11 papers.
There has been considerable interest from countries outside of South Africa in adopting the PACK programme to strengthen primary care service delivery. PACK is designed to be localised to local clinical protocols, policy and practice, and where necessary translated.
PACK has previously been localised for Botswana and Malawi and currently pilot implementations are underway in Florianopolis, Brazil and in three states of Nigeria.
The Knowledge Translation Unit has developed a mentorship package to support the in-country localisation of PACK.
BMJ and the Knowledge Translation Unit partnered in 2015 to address this need, and to enable global use of the PACK programme in keeping with their strongly aligned strategic goals of "improving primary care, especially in underserved communities" and “enabling a Healthier World". It is to this end that the PACK Global Adult 2016/17 was launched.
Dr Tracy Eastman, Director of PACK Global Development at BMJ said: "The growing burden of non-communicable disease and mental illness in low and middle income countries means it is crucial that healthcare workers have access to the latest evidence based recommendations to diagnose and treat patients effectively across the full spectrum of integrated primary care needs and services. We are delighted to be able to provide the global edition of the PACK Adult guide that can be customised to help meet the specific needs of local communities, as part of the BMJ’s Global Health outreach programme."
Professor Lara Fairall, Head of the KTU, commented: “The KTU team is committed to improving primary healthcare, focusing on the most underserved communities globally. We hope that by launching the PACK Adult Global guide as an eBook this will raise awareness of the PACK programme and how it can empower primary care clinicians. We encourage primary healthcare workers to utilise the PACK principles and approach to support their teams, strengthen their health systems and provide the highest quality, integrated, team based primary healthcare services, no matter where they work.”
