AJRH: Adherence to maternal and child health guidelines in Nigeria (5) Practical Approach to Care Kit (PACK)

15 December, 2022

Hello All, compliments of the season.

I read the article and thought I should share the publication of our intervention in 2017, now in the scale up hase, to address the challenges of clinicians using a Guide at the point of care in PHCs in Nigeria:  

Using a mentorship model to localise the PracticalApproach to Care Kit (PACK): from South Africa to Nigeria. BMJ Global Health Oct 2018, 3 (Suppl5) e001079; DOI: 10.1136/bmjgh-2018-001079   


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

Authors: Ajibola Awotiwon, CharlieSword2, TracyEastman1,2, Christy JoyRas1, Prince Ana3, Ruth VaniaCornick1, Lara Fairall1, Eric Bateman1, Audry Dube1, Robyn Curran1, InemesitUdoekwere3, Unyime-ObongEssien3, Okorie Assem3, TheresaSylvester Edu3, Hajia BintaIsmail4, OlalekanOlugbenga Olubajo4, Joseph Ana


Nigeria, in its quest to strengthen its primary healthcare system, is faced with anumber of challenges including a shortage of clinicians and skills. Methods arebeing sought to better equip primary healthcare clinicians for the clinicaldemands that they face. Using a mentorship model between developers in SouthAfrica and Nigerian clinicians, the Practical Approach to Care Kit (PACK) foradult patients, a health systems strengthening programme, has been localisedand piloted in 51 primary healthcare facilities in three Nigerian states.Lessons learnt from this experience include the value of this remote model oflocalisation for rapid localisation, the importance of early, continuousstakeholder engagement, the need expressed by Nigeria’s primary healthcareclinicians for clinical guidance that is user friendly and up-to-date, apreference for the tablet version of the PACK Adult guide over hard copies andthe added value of WhatsApp groups to complement the programme of face-to-facecontinuous learning. Introduction of the PACK programme in Nigeria prompteduptake of evidence-informed recommendations within primary healthcare services.

Summary box

- Nigeria’s National Health Policy aims to strengthen primary healthcare but is faced with a number of constraints including a shortage of staff and clinical skills of available staff. Methods are being sought to better equip primary healthcare clinicians for the clinical demands they face, in particular to improve on accuracy of diagnosis and accuracy of treatment (clinical competence).

- The global version of the Practical Approach to Care Kit for adult patients (PACK Adult) guide and training materials were localised for use in Nigeria and piloted over a period of 18 months using a mentorship model involving frequent electronic communication between developers in South Africa and Nigeria.

- A critical success factor in this project was extensive continuous engagement between a respected local partner with a long track record of improving health systems in Nigeria and key local stakeholders.

- An evaluation conducted after initial training and implementation of the PACK Nigeria Adult programme confirmed a strongly favourable response from clinicians and policy makers and high usage of the guide during consultations.

- Availability of medicines, equipment and tests was facilitated through the introduction of a fully localised, standardised guide promoting uniform clinical practices'.

In 2020-2021, PACK Nigeria programme was introduced to Bauchi State PHC and evaluation reports have replicated the same successes recorded in the 2017 Pilot.

Joseph Ana

Prof Joseph Ana

Lead Senior Fellow/ medicalconsultant.

Center for Clinical Governance Research &

Patient Safety (ACCGR&PS) @ HRI GLOBAL

P: +234 (0) 8063600642

E: info@hri-global.org

8 Amaku Street, State Housing, Calabar,Nigeria.


HIFA profile: Joseph Ana is the Lead Senior Fellow/Medical Consultant at the Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria, established by HRI Global (former HRIWA). He is a member of the World Health Organisation’s Technical Advisory Group on Integrated Care in primary, emergency, operative, and critical care (TAG-IC2). As the Cross River State Commissioner for Health, he led the introduction of the Homegrown Quality Tool, the 12-Pillar Clinical Governance Programme, in Nigeria (2004-2008). For sustainability, he established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria. His main interest is in whole health sector and system strengthening in Lower, Low and Middle Income Countries (LLMICs). He has written six books on the 12-Pillar Clinical Governance programme, suitable for LLMICs, including the TOOLS for Implementation. He served as Chairman of the Nigerian Medical Association’s Standing Committee on Clinical Governance (2012-2022), and he won the Nigeria Medical Association’s Award of Excellence on three consecutive occasions for the innovation. He served as Chairman, Quality & Performance, of the Technical Working Group for the implementation of the Nigeria Health Act 2014. He is member, National Tertiary Health Institutions Standards Committee of the Federal Ministry of Health. He is the pioneer Secretary General/Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers. (http://www.hifa.org/support/members/joseph-0 http://www.hifa.org/people/steering-group). Email: info AT hri-global.org and jneana AT yahoo.co.uk

On Wednesday, 14 December 2022 at 15:02:56 GMT-5, Shabina Hussain, USA <hussain.shabina@gmail.com> wrote:

Hi Neil and All,

Reading through this article [ https://www.ajol.info/index.php/ajrh/article/view/238420 ] it is clear that there is an unmet need of training of healthcare providers who serve in these PHCs. All the providers and specifically, CHEWs may need evidence based training and monitoring.

I am wondering what if any initiatives are out there to improve the skills of the healthcare professionals to provide evidence based care in this population.


Shabina Hussain, MPH WA, USA

HIFA profile: Shabina Hussain is an independent global health consultant and is based in the USA. Professional interests: Maternal & Child Health, Family Planning, Reproductive & Sexual Health, women's rights, survival of girl child, poverty eradication, Prevention of Infectious diseases. hussain.shabina AT gmail.com

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