Neil thank you for sharing this study. It is particularly important to us in the PACK Nigeria Programme Pilot team as we have been waiting to scale up the Programme after a very successful and impactful world bank assisted pilot two years ago in 2017. During the contract discussions for the scale up one major point was sustainability of this useful quality improvement tool, when the world bank assistance ends. So, we have a tool that all stakeholders agree will improve the quality of care and outcome of PHC in the country but the team, CHW, patients and families, the population is still waiting to scale up a successful pilot, two years after the pilot, on account of domestic ability to continue after external support.
The good news is that Data from the pilot demonstrates that the gains made from scalding up the tool can sustain the Programme in the long term as the population enjoys the improved quality of care. The gains will come from many indicators: reduced polypharmacy; reduced unnecessary lab testing; reduced printing costs as all the cadres use 'one guide' in PACK Programme (and not multiple guides); increase accuracy of diagnosis and of treatment; etc etc.
Countries can increase support and domestic funding for CHW by implementing evidence informed quality improvement tools like PACK (PACK = Practical Approach to Care Kit). The gains made from better practices and outcome can ensure long term sustainability, even after external funding dries up.
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: www.hriwestafrica.com Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.
Email: jneana AT yahoo.co.uk