Since 1999, the PACK Adult programme is a health systems strengthening intervention that aims to support health mangers and clinicians simplify, standardise and streamline the delivery of primary care.
The essential components of the programme are the PACK Adult guide and a training programme that aims to embed the use of the guide in everyday clinical practice.
The PACK Adult guide is a comprehensive clinical approach to the adult patient that covers over 500 symptoms, syndromes, diagnoses and conditions. The guide is designed as a clinical decision support tool for use in each consultation and starts with screening and a symptom-based approach, guides the diagnosis of common conditions, including priority chronic conditions and facilitates the routine care of the patient with one or several chronic conditions.
The content is underpinned by an evidence base sourced through BMJ’s evidence synthesis product Best Practice and is aligned to World Health Organization guidance and essential medicines lists. This evidence base provides a streamlined mechanism for updating and maintaining the content of the guide and allows the KTU to publish in conjunction with the BMJ an annual edition of the PACK Global Adult guide. This guide then serves as a template for localisation to any resource-constrained setting. The localisation of the clinical content ensures that the guidance is clinically relevant to the setting for which it is intended and complies with local policy, resources and health worker skill sets. Read more about the PACK Localisation package and process, and the implementation in several LMICs.
The development and design of the PACK guide is described in PACK Collection paper Cornick R, Picken S, Wattrus C, et al. The Practical Approach to Care Kit (PACK) guide: developing a clinical decision support tool to simplify, standardise and strengthen primary healthcare delivery. BMJ Glob Health 2018;0:e000962. doi:10.1136/ bmjgh-2018-000962
The PACK approach to training adopts an adult education methodology during educational outreach on-site training sessions delivered by government employed Facility Trainers. Using a cascade model of implementation, government-employed Master Trainers are capacitated to manage and maintain the PACK programme and train and support Facility Trainers. The aim of the training is to embed the use of the guide in everyday clinical practice and thus the training is not once off, but ongoing, providing opportunities for regular updates and keeping the programme alive in the system.
The development and design of the PACK training programme is described in PACK Collection paper Simelane M, Georgeu-Pepper D, Anderson L, et al. The Practical Approach to Care Kit training: A health system based educational programme. In press 2018 BMJ Global Health as part of the PACK Collection.
The development, maintenance and localisation of the PACK guide provides multiple opportunities for health system strengthening – ensuring medication, investigation and equipment are available, expanding clinician scope of practice, task sharing, improving referral pathways are examples.