Afr J Emerg Med: Guidance we can trust? The status and quality of prehospital clinical guidance in sub-Saharan Africa: A scoping review (2)

12 October, 2020

Neil, thank you for sharing this exciting study.

It goes to show how important it is for research to be recurring and continuous, because evidence changes with development and time.

The main aim of introducing PACK which you kindly mentioned in your comments, to Nigeria in 2015 was a study result initiated by the Federal Ministry of Health and National Primary Health Care Development Agency assisted by World Bank Nigeria that showed very low average diagnostic accuracy rates ( 37%), and treatment accuracy rates (17%) amongst clinicians in PHC, and that most did not use existing guides because they did not consider them user friendly. The pilot of PACK Nigeria in 2017 by 354 clinicians in 51 PHCs showed that over 90% ot the users used the guide in most consultations and 73% used it in all consultations because ‘PACK is User-friendly’.

(Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Nigeria DOI: 10.1136/bmjgh-2018-001079).

The message is that in this era of evidence based practice there should be more resources to do, re-do, do and re-do research.

Joseph Ana


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Standards and Quality Monitor and Assessor

National Implementing Organisation: PACK Nigeria Programme for PHC

Publisher: Medical and Health Journals; Books and Periodicals.

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

Tel: +234 (0) 8063600642

Website: email: ;

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