The concept of the 'at-risk newborns' (7)

16 January, 2023

Dear CHIFA members,

I wish to contribute to this is very important discussion about QI interventions and the effect of the severe shortage of various cadres of Human Resources for Health needed to successfully and impactfully execute QI plans. In Nigeria, for example, there are still whole hospitals with only one medical doctor ( she / he is the physician, surgeon, pathologist, and the specialist in all the various subdivisions of these specialisms), very few nurses and midwives, no pharmacist ( the hospital will have pharmacy technicians), no medical laboratory scientis ( they will have Lab Technicians), etc. In the Primary Health Centres (PHC), the situation is more challenging with Community Health Extension Practitioners providing all the care across disease types and conditions, mental health and injuries, child deliveries and care, facility management, etc, in over 95% of PHCs.

One answer to this common challenge in LLMICs is the introduction of tools like PACK (Practical Approach to care Kit) programme for PHC originally developed by Knowledge Translation Unit, University of Cape Town, South Africa: The PACK Global was then adapted to produce PACK Nigeria programme, a clinical decisiontool, localised in Nigeria by Nigerian practitioners for use in Nigeria inorder to provide a single comprehensive approach to adult and child care inprimary health care. PACK Nigeria provides an integrated, comprehensive, evidence-informed clinical guide to supportall cadres working in primary healthcare in Nigeria: junior communityhealth extension workers (JCHEWs), community health extension workers (CHEWs), communityhealth officers (CHOs), nurses, midwives and medical officers seeing patientsfrom one guide, rather than multiple cadre-specific conflicting guides. Colour-codingis used to clearly delineate the scope of practice of these different cadresand clarify referral pathways. This integration promotes a team-based approachto a patient’s care and enables patients to receive consistent care fromwhoever treats them. It is aligned with local Nigeria’s regulations, clinical protocolsand available diagnostic tests, equipment and medications: including thecurrent editions of Standing Orders (2015), the IMCI, National Task ShiftingPolicy, etc. In 2017 it was successfully piloted in first set of NSHIP states(Adamawa, Nasarawa and Ondo States). In 2019 PACK was discussed with the secondset of NSHIP states (Borno, Yobe, Gombe and Bauchi, Taraba) but could not beimplemented as NSHIP came to its project end. (For moreinformation: BMJGlobal Health Oct 2018, 3 (Suppl5) e001079; DOI: 10.1136/bmjgh-2018-001079) In2020, PACK was introduced to 20 PHCs in Bauchi State, awaiting wider scale up.

Did we meet obstacles on the way to introduce this evidence informed tool, a game-changer to the system, Yes. There is work on-going to convince policy makers, who by the way released the National Task Shifting anf Mixing Policy in 2014, that this is one way to manage HRH shortages in the country without compromising Quality of Care.

CHIFA 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. Joseph is a member of the HIFA Steering Group. Website: www.hriwestafrica.com Email :jneana AT yahoo.co.uk