Where PACK is used
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South Africa
2011 - current
Adult Primary Care (APC)
formerly Primary Care 101 (PC101)
PACK - Practical Approach to Care Kit
Adult and Child versions
The PACK programme is a proudly South African product, initiated, developed and evaluated in the Western Cape of South Africa in 2011 for public sector primary care. It started out as a pragmatic randomised trial in 2 Western Cape Districts.
It has since been introduced throughout primary care facilities in South Africa and is now firmly embedded in the national health system as Adult Primary Care (APC), where it is an indicator for the Ideal Clinic Initiative. It is current and relevant with annual editions of the APC/PACK guide and training package published since 2014 to reflect updated national and provincial policy and guidelines.
Brazil
2015 - current
PACK Brasil Adulto (Florianópolis)
PACK Brasil Adulto (Campo Grande)
The PACK programme was identified by the Florianópolis municipality in Brazil as part of its primary care reforms in 2014. Between 2015 and 2017, the PACK Global package was localised, translated and evaluated in Brazilian primary care services. The PACK Brazil Florianópolis guide was the first localisation process to be completed almost exclusively remotely. Its first edition was launched in 2016. New versions in 2017, 2018 and 2020 reflected evidence, policy and practice updates. Between 2020 and 2022, a special edition of the PACK Brazil guide was developed focusing on the diagnosis and management of COVID-19.
In 2022, ENSP/Fiocruz, the U.S. CDC, and the KTU initiated a partnership to expand the PACK programme, supported by the A Hora é Agora (AHA) project, to Brazilian municipalities. aims to standardise HIV, TB, and mental health services in primary care and create a support mechanism by ENSP/Fiocruz. Funded by PEPFAR, ENSP/Fiocruz established the Knowledge Translation Unit Brazil (the UTC). The KTU provides technical support to the AHA project for PACK programme implementation in the municipalities of Curitiba, Florianópolis, Porto Alegre, Campo Grande, and Fortaleza. In 2023, the PACK Brazil guide for 2023/24 was launched for Campo Grande, Florianópolis, and Fortaleza.
Indonesia
2022 - current
The KTU has worked closely with the Ministry of Health of Indonesia to prepare the PACK programme to form part of the World Bank-funded National Health Insurance Reforms and Results Program in order to improve the quality of primary health care. In December 2023, the policy-aligned Bahasa-Indonesian version of the PACK guide (called the ‘Panduan Praktis Tata Laksana Klinis Pasien Dewasa di Fasilitas Kesehatan Tingkat Pertama) was published.
Preparations are currently underway for a rapid scale-up of the programme across Indonesia’s 10 000 primary care facilities in 2024/2025.
Ethiopia
2016 - current
The Ethiopian Federal Ministry of Health was introduced to the PACK programme by counterparts from South Africa and Botswana in 2016. They recognised the PACK’s potential as a tool to support their ongoing primary healthcare transformation efforts. Localisation of the PACK guide and training materials included review of around 30 local clinical guidelines and policies in relation to the evidence-based guidance of the PACK Global Adult guide.
The Ethiopian Primary HealthCare Clinical Guidelines (EPHCG) was published in 2017 and rolled out to primary care facilities around the country. Since then, the programme has been updated twice and continues to support primary care reform initiatives in Ethiopia.
Nigeria
2016 - current
PACK was introduced into Nigeria as part of efforts to improve primary healthcare worker clinical competence. It was localised in 2016 by HRI West Africa in conjunction with local health departments and under mentorship of the KTU to reflect Nigerian clinical protocols and practice. It was published in hard copy and interactive digital versions and piloted in Ondo, Adamawa and Nasarawa States.
Following evaluation of the pilot, the PACK Nigeria guide’s content was updated and expanded to include child care and the PACK Nigeria programme was introduced into selected facilities in Bauchi State. Currently, the State Government is considering scaling up to all primary care facilities across the State.
Botswana
2013 - 2014
In conjunction with the Botswana Ministry of Health Non-Communicable Diseases Directorate and the University of Botswana’s Family Medicine and Public Health Department, the KTU led the year-long localisation process of the PACK guide in Botswana to become the Botswana Primary Care Guidelines. Extensive consultations were held with local clinicians, managers and representatives from relevant health programmes during its development. This led to expansion and updating of the primary level Essential Drug List in Botswana. As per the Ministry of Health priorities, the guide was adjusted to comply with the World Health Organisation PEN guidelines and an end-of-life component was added to support local palliative care initiatives. The guide was initially piloted in Maun and Mahalapye. It has since been updated by the Ministry of Health.
Higher Education
PACK’s reach has grown to extend beyond national health departments and into higher education. Higher education institutions have access to APC/PACK training on the KTU Online School. Where possible, the KTU supports curriculum design, implementation and student evaluation at nursing and medical schools. The SURMEPI study showed that students exposed to the PACK guide during their primary care clinical rotations perform significantly better in their exams.
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