Antibiotic Stewardship: Twenty Years in the Making (4) PACK (Practical Approach to Care Kit)

5 February, 2019

Very interesting posting from David Neal.

The PACK (Practical Approach to Care Kit) Nigeria Pilot in 2017 that involved 354 primary health care clinicians in three states from three of the six geopolitical zones of Nigeria resulted in improvement in user confidence and clinical competence (diagnosis and treatment accuracy rates) but also importantly a reduction in poly pharmacy and inappropriate patient testing. Before the introduction of PACK the clinicians remarked that they added an antibiotic to the anti malaria drug ("just in case there was also typhoid"). Following the recommendations in PACK they prescribed only the anti malaria drug (ACT) once a rapid diagnostic test was positive.

We are seeking support for a larger trial alongside the expected scale up of PACK Nigeria to establish the extent of the economic impact of such positive changes in prescribing and patient testing Nigeria health system.

Joseph Ana


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Implementing Organisation: PACK Nigeria Programme for PHC

Publisher: Medical and Health Journals; Books and PeriodicSorry als.

Nigeria: 8 Amaku Street, State Housing & 20 Eta Agbor Road, Calabar.

Tel: +234 (0) 8063600642

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group:

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