PACK in Ethiopia – Ethiopian Primary Health Care Clinical Guidelines
In 2016, the Ethiopian Federal Ministry of Health was introduced to the PACK programme by counterparts from South Africa and Botswana. PACK’s potential as a tool for health system strengthening in Ethiopia within the context of its ongoing primary health care transformation was recognised immediately. The process of adapting the PACK programme to the Ethiopian context to become the Ethiopian Primary Health Care Clinical Guidelines (Ethiopian PHCG) then began, with a view to scaling up nationally.
The Ethiopian Federal Ministry of Health embarked on a formal partnership with the KTU, King’s College London (KCL) and Addis Ababa University to assist with the localisation of the guide, associated training materials and initial training, and to develop and evaluate health system strengthening interventions to support the Ethiopian PHCG implementation.
Due to the strong impetus to complete localisation within a period of months, a core team of eight Ethiopian technical experts worked fulltime on the localisation, mentored by the KTU, particularly facilitating the consolidation of existing local guidelines and policies with the evidence-informed recommendations of PACK, and supporting integration of new content. Around 30 Ethiopian clinical guidelines were reviewed in relation to the evidence-based guidance in PACK Global Adult before the Ethiopian PHCG was finalised. A series of four consultative workshops was conducted with a broader stakeholder group of clinicians, including primary health care nurses and health officers, emergency surgical officers, surgeons and other medical specialists.
The PACK training materials were also localised for the Ethiopian setting. Training cases were selected to emphasise areas where primary care health workers might have limited experience like in the areas of non-communicable diseases and mental health, as well as priority programmes such as antenatal care. Ethiopia localising team also opted to include training cases that integrate clinical communication skills.
The first phase of Ethiopian PHCG implementation will involve sequential roll-out to 400 health centres across all regions and city administrations in Ethiopia using a cascade model with three levels of trainers: national master trainers, regional/zonal/district master trainers and facility trainers. Training of national master trainers occurred in Addis Ababa in January 2018 and enjoyed high-level support. The next step was to train master trainers from regions, zones and districts where first phase implementation will occur, and this began in September 2018. This will be followed by the training of facility trainers who will then lead weekly health centre-based training sessions, which will extend over a period of about 12 weeks.