INTRODUCTION:
The Practical Approach to Care Kit (PACK) programme is a health system strengthening strategy designed to support primary care reforms in low- and middle-income countries. Developed by the Knowledge Translation Unit (KTU) in South Africa over two decades in collaboration with policymakers, managers, and health workers, PACK provides a comprehensive, symptom-based clinical decision support guide aligned with local policies, resources, and disease burden (1). PACK implementation includes e-learning content designed for completion by individuals or facility teams that embed the guide into routine care while addressing broader health system challenges (2). Since 2015, PACK has been localised and implemented in South Africa, Nigeria, Ethiopia, Brazil, and Indonesia (3-5) and these countries have formed a PACK collaboration.

METHODS:
The collaboration convenes regularly, both online and in person, to share lessons on clinical content localisation, training delivery, programme scale up, and health system strengthening activities reported by ministries of health across the diverse LMIC settings implementing PACK.

RESULTS:
Evidence-based guidance, integrated training, and collaborative approaches can drive primary care reforms and health system strengthening in multiple LMIC health systems. Localised PACK programmes ensure that the guide is more than clinical decision support, acting as a central reference for scope of practice delineation, levels of care and mandated services. Regular PACK update processes catalyse discussions between different levels of the health system, embedding its role as a facilitator of systems change and its ownership by local stakeholders.

CONCLUSIONS:
The PACK collaboration has demonstrated the value of south-to-south learning, adapting PACK to local contexts, and fostering partnerships to support scale-up and sustainability. These lessons will support policymakers, health leaders, clinicians, and others translating evidence into practice within learning health systems.