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BMJ Glob Health. 2018 Oct 23;3(Suppl 5):e001079. doi: 10.1136/bmjgh-2018-001079. eCollection 2018.

Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Nigeria.

Author information

Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
BMJ Global Health, BMJ, London, UK.
Health Resources International West Africa, Calabar, Nigeria.
National Primary Health Care Agency (NPHCDA), Abuja, Federal Capital Territory, Nigeria.


Nigeria, in its quest to strengthen its primary healthcare system, is faced with a number of challenges including a shortage of clinicians and skills. Methods are being sought to better equip primary healthcare clinicians for the clinical demands that they face. Using a mentorship model between developers in South Africa and Nigerian clinicians, the Practical Approach to Care Kit (PACK) for adult patients, a health systems strengthening programme, has been localised and piloted in 51 primary healthcare facilities in three Nigerian states. Lessons learnt from this experience include the value of this remote model of localisation for rapid localisation, the importance of early, continuous stakeholder engagement, the need expressed by Nigeria's primary healthcare clinicians for clinical guidance that is user friendly and up-to-date, a preference for the tablet version of the PACK Adult guide over hard copies and the added value of WhatsApp groups to complement the programme of face-to-face continuous learning. Introduction of the PACK programme in Nigeria prompted uptake of evidence-informed recommendations within primary healthcare services.


health policy; health systems; public health; treatment

Conflict of interest statement

Competing interests: We have read and understood BMJ policy on declaration of interests and declare that AA, CJR, RVC, LF, EB, AD, RC are employees of the KTU. TE is a contractor for both KTU and BMJ, London, UK. EB reports personal fees from ICON, Novartis, Cipla, Vectura, Menarini, ALK, 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 licence PACK content. The KTU and BMJ cofund core positions, including a PACK Global Development Director (TE) 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 healthcare as envisaged in the Declaration of Alma Ata during its 40th anniversary.

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