CHWs (124) Family physicians (7) PACK (Practical Approach to Care Kit) (5)

3 July, 2019

Sian, you are right PACK (Practical Approach to Care Kit) tries to mimic how patients present to the clinic and the subsequent practitioner-patient interaction, which is why it is symptom based (patient presentation) and algorithm navigation (to arrive at differential diagnosis of the patient in front of the practitioner). In Nigeria for instance it has brought all the cadres into interaction and cooperation (JCHEWs, CHEWs, CHO, Nurses, Midwives, Doctors) using one Guide (unlike when every cadre had their own distinct guide separate from the other cadres).

One spin off in Nigeria is that where PACK Nigeria is in use there is multidisciplinary team working in harmony, respect for what each cadre brings to quality care and appropriate and timely referral after necessary stabilization of the patient, knowing cadre limits based on their curriculum of training and policy documents.

Inter professional disharmony in the health system in Nigeria is such a huge problem and it hinders health system strengthening and quality care, that there has been at least three Presidential Committees by the Federal Government on the problem, seeking solution. PACK Nigeria by making all cadres work together seamlessly provides a veritable way to integrate care amongst cadres, harmoniously.

Joseph Ana

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 and the HIFA working group on Community Health Workers.

Email: jneana AT