How can we ensure that new evidence translates into healthcare policy updates and patient care?
This is one of the key aims that the Knowledge Translation Foundation (KTF) looks to resolve.
As healthcare systems confront rising disease burdens, workforce shortages, and rapidly evolving clinical evidence, this question is arguably more relevant than ever.
While medical research output has accelerated dramatically over the past two decades, implementation inside real-world healthcare systems often lags far behind.
For frontline healthcare workers managing large patient volumes under significant resource constraints, keeping pace with fragmented guidelines, circulars, and treatment updates has become increasingly difficult.
It is in this context that the PACK (Practical Approach to Care Kit) programme has emerged as a significant model for bridging the gap between evidence generation, policy development, and clinical implementation.
Originally developed in South Africa and now adapted across multiple countries globally, PACK was designed not only as a clinical guideline, but as a continuously updating system for translating evolving evidence into practical frontline care.
The core problem for health systems
According to Lara Fairall, Scientific Director of the Knowledge Translation Foundation (KTF), the core problem facing many health systems today is no longer the absence of evidence, but the growing complexity of applying it consistently at scale.
“Guidelines which were once built to actually change practice and support people to implement knowledge are now in themselves becoming a barrier to care,” she explained during a recent engagement with international health officials visiting the KTF.
The challenge is partly one of volume.
“When I started working in this field, there were about 600,000 life sciences publications a year,” said Fairall.
“Now it’s somewhere between two-and-a-half and three million annually, and it’s growing even faster. It’s mushroomed, and it’s become really difficult to find the evidence that you must now implement in practice.”
For clinicians working in overstretched public health systems, that pace of change creates operational strain that conventional policy mechanisms often struggle to absorb.
Healthcare workers may be expected to navigate multiple standalone disease guidelines alongside regular policy circulars, programme updates, and interim treatment directives. This is all while delivering care in high-pressure environments.
“If you are a healthcare worker, you’re receiving national guidelines and all these circulars,” Fairall noted. “Most people simply won’t read them.”
This issue is particularly felt in primary healthcare settings, where clinicians are required to manage patients with multiple overlapping conditions during short consultations.
Fairall described how her own experience working in frontline primary care revealed a major disconnect between medical training, evidence, and the realities of healthcare delivery. “I saw huge gaps between what I had just been taught and what was being practiced,” she said.
“You had to understand how to keep professionals updated while they were seeing hundreds of patients.”
Developing PACK
Those experiences helped shape the development of PACK, which integrates evidence-based guidance across conditions into a single decision-support framework designed for everyday clinical use.
Rather than relying on fragmented disease-specific manuals, the programme consolidates guidance for HIV, tuberculosis, non-communicable diseases, mental health, maternal health, and other conditions into integrated clinical pathways.
Importantly, the programme is updated continuously through structured revision cycles that align evolving evidence with frontline implementation.
That process reflects a broader shift taking place globally within implementation science and health systems strengthening.
Policymakers and researchers are increasingly recognising that producing evidence alone is insufficient if health systems lack the operational infrastructure to absorb and implement it effectively.
Fairall argues that implementation itself must be treated as a core part of healthcare system design. “It’s not enough to scale something and then think you are done,” she said. “You’ve got to think about designing for both scaling and sustaining.”
Simultaneous pressures
That challenge is especially relevant in low- and middle-income countries (LMICs), where health systems must often respond simultaneously to infectious disease pressures, rising rates of non-communicable disease, workforce shortages, and rapidly changing treatment protocols.
South Africa, for example, continues to manage one of the world’s largest HIV treatment programmes while also confronting growing multimorbidity across its population.
“We have about 7.8 million people living with HIV and one of the largest antiretroviral programmes globally,” Fairall explained.
At the same time, non-communicable diseases are rising rapidly and patients increasingly present with multiple overlapping conditions.
Traditional healthcare models can struggle to manage that complexity efficiently.
PACK’s integrated approach addresses this by supporting clinicians through unified guidance systems that bring together evidence, policy, and practical implementation into a single operational framework.
The programme has also evolved beyond adult care into child and adolescent healthcare, reflecting growing recognition of the importance of life-course approaches to health policy.
“We realised there were major gaps in adolescent care,” said Fairall.
Fairall said the move into adolescent healthcare exposed major gaps in how health systems manage young people, particularly around mental health, chronic illness transitions, sexual and reproductive healthcare, consent policies, and long-term treatment continuity.
And that integration extends beyond evidence alone.
Indeed, effective knowledge translation requires alignment between clinical evidence, health policy, legislation, digital infrastructure, and implementation training.
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Knowledge translation and digital innovation
The KTF’s model combines guideline development with digital innovation, implementation support, and training infrastructure to help healthcare workers stay up to date as evidence evolves.
One area of growing focus is the move toward digital systems capable of managing version control, implementation tracking, and real-time updating.
“We realised we couldn’t continue depending entirely on external technology providers,” Fairall explained.
“So we started building our own in-house digital capacity.”
This adaptation by the KTF comes as broader changes are taking place across global health systems where digital infrastructure is becoming increasingly central to evidence implementation and healthcare delivery.
Yet despite advances in digital health, Fairall argues that organisational structure remains equally important.
From her perspective, sustainable evidence translation depends on close collaboration between governments, academic institutions, and implementation-focused organisations.
Indeed, long-term knowledge translation depends on strong collaboration between governments, academic institutions, and implementation-focused organisations, with sustainable evidence translation requiring all three parts of the system to work in alignment.
South-to-South
The conversations around PACK also points to another emerging trend in global healthcare: stronger collaboration among countries across the Global South.
For decades, many LMICs have often engaged more directly with institutions and funders in Europe or North America than with one another.
Fairall believes that the dynamic is beginning to shift.
“Instead of talking mainly to the Global North, we should also be learning directly from each other,” she said. “Many of our health systems are dealing with very similar challenges.”
As healthcare systems globally attempt to modernise while managing increasing operational complexity, the ability to continuously bridge evidence, policy, and implementation will become even more critical.
In that context, the significance of guidelines like PACK will shine, demonstrating how healthcare systems can institutionalise evidence translation itself and make continuous adaptation part of everyday clinical practice, rather than an occasional policy exercise.
What has your experience been with PACK? How have you and your clinic/organisation managed with knowledge translation? Reach out and let us know so that we can feature your insights.
By Joey Latief, Communications Officer, Knowledge Translation Foundation
