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. 2018 Oct 26;3(Suppl 5):e001088.
doi: 10.1136/bmjgh-2018-001088. eCollection 2018.

Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries

Ruth Cornick  1 , Camilla Wattrus  1 , Tracy Eastman  1 , Christy Joy Ras  1 , Ajibola Awotiwon  1 , Lauren Anderson  1 , Eric Bateman  1 , Jorge Zepeda  2 , Merrick Zwarenstein  3 , Tanya Doherty  4 , Lara Fairall  1
Affiliations

Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries

Ruth Cornick et al. BMJ Glob Health. .

Abstract

Developing a health system intervention that helps to improve primary care in a low-income and middle-income country (LMIC) is a considerable challenge; finding ways to spread that intervention to other LMICs is another. The Practical Approach to Care Kit (PACK) programme is a complex health system intervention that has been developed and adopted as policy in South Africa to improve and standardise primary care delivery. We have successfully spread PACK to several other LMICs, including Botswana, Brazil, Nigeria and Ethiopia. This paper describes our experiences of localising and implementing PACK in these countries, and our evolving mentorship model of localisation that entails our unit providing mentorship support to an in-country team to ensure that the programme is tailored to local resource constraints, burden of disease and on-the-ground realities. The iterative nature of the model's development meant that with each country experience, we could refine both the mentorship package and the programme itself with lessons from one country applied to the next-a 'learning health system' with global reach. While not yet formally evaluated, we appear to have created a feasible model for taking our health system intervention across more borders.

Keywords: health policy; health systems; keywords; public health.

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Conflict of interest statement

Competing interests: We have read and understood BMJ policy on declaration of interests and declare that RC, CW, AA, CR, LA, EB and LF are employees of the KTU. T Eastman is a contractor for both KTU and BMJ, London, UK. JZ is an ex-employee of the City Health Department, Florianópolis, Brazil and a current holder of full-time PhD studentship from the Brazilian research agency CNPq. MZ is an employee of the Centre for Studies in Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. TD is an employee of the South African Medical Research Council. EB reports personal fees from ICON, Novartis, Cipla, Vectura, Cipla, Menarini, ALK, ICON, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, and grants for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann le Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca. All of EB’s fees and clinical trials are for work outside the submitted work. EB is also a Member of Global Initiative for Asthma Board and Science Committee. Since August 2015 the KTU and BMJ have been engaged in a non-profit strategic partnership to provide continuous evidence updates for PACK, expand PACK related supported services to countries and organisations as requested, and where appropriate license PACK content. The KTU and BMJ co-fund core positions, including a PACK Global Development Director, and receive no profits from the partnership. PACK receives no funding from the pharmaceutical industry. This paper forms part of a Collection on PACK sponsored by the BMJ to profile the contribution of PACK across several countries towards the realisation of comprehensive primary health care as envisaged in the Declaration of Alma Ata, during its 40th anniversary.

Figures

Figure 1
Figure 1
Timeline for in-country PALSA PLUS and Practical Approach to Care Kit (PACK) localisations.
Figure 2
Figure 2
Step-by-step mentorship of PACK programme localisation and initial implementation. PACK, Primary Approach of Care Kit; KTU, Knowledge Translation Unit; M&E, Monitoring and evaluation.
Figure 3
Figure 3
Applying learnings from one localisation to the next.
See this image and copyright information in PMC

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