The contribution of the Practical Approach to Care Kit programme for primary healthcare to health systems process goals: reflections from four low- and middle-income countries
1
School of Life Course & Population Sciences, King's College London, London, United Kingdom
2
Knowledge Translation Unit, Department of Medicine, University of Cape Town, Cape Town, South Africa
3
Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
4
Secretaria Municipal da Saude, Florianopolis, Brazil
5
Unidade de Tradução do Conhecimento, National School of Public Health Sergio Arouca, FioCruz, Rio de Janiero, Brazil
6
School of Medicine, Keele University, Keele, United Kingdom
7
HRI Global, Calabar, Nigeria
8
Community Engagement and Primary Health Care Lead Executive Office, Ethiopia Ministry of Health, Addis Ababa, Ethiopia
9
Primary Healthcare, National Department of Health, Pretoria, South Africa
10
Joint Strategic Needs Assessment, City of Bradford Metropolitan District Council Public Health, Bradford, United Kingdom
Popul. Med. 2026;8(Supplement Supplement 1):A1811
ABSTRACT
INTRODUCTION:
Strong health systems are essential to deliver primary healthcare. The Practical Approach to Care Kit trains health workers to manage common presentations in primary care. A key feature is localised clinical decision support that spans infectious diseases, NCDs, mental illness and maternal and child health. PACK is implemented in South Africa, Brazil, Ethiopia and Nigeria.
METHODS:
We convened government and academic stakeholders to reflect on how PACK contributes, or doesn’t, to health systems process goals defined by the Health System Strengthening Evaluation Collaborative. These are a set of 22 desirable attributes of a well-functioning health system arranged in four domains: (i) ownership, participation and accountability; (ii) learning and resilience; (iii) use of resources; and (iv) service delivery. The purpose was to compare experiences across countries, better understand system-wide effects and identify elements which could be strengthened. Examples were drawn from literature, technical manuals and reports, and discussed during a series of online meetings.
RESULTS:
Stakeholders identified examples of how PACK contributed to multiple process goals across all four domains. Effects were both intended and unintended. Some notable examples that were reported across all four countries included: (i) facilitation of team working and learning across cadres of health workers, levels of care and between clinicians and managers (intended, extent unintended), (ii) facility-led efforts to strengthen supply of essential medicines and tests (unintended); (iii) response to health system shocks (unintended); and (iv) widening participation of health workers in Ministry-led health system reforms to strengthen primary care (intended). Areas of relative weakness included poor integration with monitoring and evaluation systems and limited engagement with communities.
DISCUSSION:
PACK is catalysing multiple system-wide effects and participation by a wide number and range of health workers with similar impacts described across diverse settings. It highlights the potential of educational interventions to drive health systems strengthening.
Strong health systems are essential to deliver primary healthcare. The Practical Approach to Care Kit trains health workers to manage common presentations in primary care. A key feature is localised clinical decision support that spans infectious diseases, NCDs, mental illness and maternal and child health. PACK is implemented in South Africa, Brazil, Ethiopia and Nigeria.
METHODS:
We convened government and academic stakeholders to reflect on how PACK contributes, or doesn’t, to health systems process goals defined by the Health System Strengthening Evaluation Collaborative. These are a set of 22 desirable attributes of a well-functioning health system arranged in four domains: (i) ownership, participation and accountability; (ii) learning and resilience; (iii) use of resources; and (iv) service delivery. The purpose was to compare experiences across countries, better understand system-wide effects and identify elements which could be strengthened. Examples were drawn from literature, technical manuals and reports, and discussed during a series of online meetings.
RESULTS:
Stakeholders identified examples of how PACK contributed to multiple process goals across all four domains. Effects were both intended and unintended. Some notable examples that were reported across all four countries included: (i) facilitation of team working and learning across cadres of health workers, levels of care and between clinicians and managers (intended, extent unintended), (ii) facility-led efforts to strengthen supply of essential medicines and tests (unintended); (iii) response to health system shocks (unintended); and (iv) widening participation of health workers in Ministry-led health system reforms to strengthen primary care (intended). Areas of relative weakness included poor integration with monitoring and evaluation systems and limited engagement with communities.
DISCUSSION:
PACK is catalysing multiple system-wide effects and participation by a wide number and range of health workers with similar impacts described across diverse settings. It highlights the potential of educational interventions to drive health systems strengthening.
| eISSN: | 2654-1459 |
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