BMJ: Practical tools for improving global primary care

Further to Chris Zielinski’s message (13 October) on the Know-do gap, and Richard Smith’s earlier message (PACK: A package to improve primary care in underserved areas) I was interested to read an editorial in the BMJ (16 October). Below are extracts. The full text is restricted-access.

‘The sustainable development goals launched last month commit the world to achieving universal health coverage by 2030. Achievement will depend on providing high quality primary healthcare… We need better integrated, concise, and user friendly materials that can help health workers manage the wide range of problems seen in primary care.’

‘The most widely implemented of these tools, the Integrated Management of Childhood Illness, covered the five commonest life threatening conditions in children under 5 years and has been adopted in more than 100 countries… two decades on the integrated management booklet remains the main resource for primary care workers caring for children in low and middle income countries.’

‘An example of a programme with wider coverage is the Practical Approach to Care Kit (PACK) developed over the past 15 years in primary care health services in South Africa.13 It is based on a concise (100 page) set of algorithms and checklists for the commonest 40 symptoms and 20 chronic conditions among adults presenting to primary care facilities in low and middle income countries. It integrates content on communicable diseases, non-communicable diseases, mental illness, and women’s health and uses short (1.5 hour) onsite training sessions to familiarise health workers with its content and to support scalable implementation.’

‘The studies also show that health workers use the tools regularly and feel empowered by them. Recently, the University of Cape Town and BMJ have partnered to address some of the shortcomings of such programmes… The partnership will also test new models for adapting PACK for sustainable use in other countries. Work is under way in Brazil, Nigeria, Uganda, and Bangladesh. It may even be useful in high income countries struggling with staff shortages in primary care.’

It is unclear whether PACK will be made available on an open access license, thereby allowing others to freely use, reproduce, adapt and translate the package as needed. If so, it could be a game-changer. If not, its impact will be limited.

CITATION: Lara Fairall, Kieran Walsh. Practical tools for improving global primary care

BMJ 2015; 351 doi: (Published 13 October 2015)

Cite this as: BMJ 2015;351:h5361

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