Remote development of a localised package of care to support primary healthcare clinicians in Nigeria: A case study




Poster session 4 Saturday: Evidence implementation and evaluation


Saturday 16 September 2017 - 12:30 to 14:00


All authors in correct order:

Awotiwon A1, Ras C1, Bateman E1, Cornick R1, Fairall L1, Ana J2, Eastman T1, Sword C3, Ana P2, Udoekwere I2, Essien U2, Assem O2, Edu T2
1 Knowledge Translation Unit, University of Cape Town Lung Institute, South Africa
2 Health Resource International West Africa, Nigeria
3 British Medical Journal (The BMJ), United Kingdom
Presenting author and contact person

Presenting author:

Ajibola Awotiwon

Contact person:

Abstract text
Background: The Practical Approach to Care Kit, PACK, is a programme designed to equip clinicians to diagnose and manage common adult conditions in primary care. Developed in South Africa by the Knowledge Translation Unit (KTU) and evaluated in several pragmatic trials, it comprises an integrated clinical management guide, a case-based training programme, methods for monitoring and evaluation and health system strengthening. A generic version has been developed for global use.
A recent assessment of Nigeria’s primary healthcare clinicians showed low clinical competence in diagnosis and treatment of tracer conditions.

Objectives: To localise the PACK programme to the needs of Nigeria’s primary healthcare through a remote mentoring programme.

Methods: The KTU mentored an interdisciplinary team of six Nigeria-based doctors and community health practitioners over a period of 6 months through an iterative process of adaptation of the PACK Global Adult guide, checking each recommendation for relevance and alignment with local treatment guidelines. The process involved an introductory workshop and three user-engagement workshops in Nigeria, and a training programme in South Africa.

Results: The development of the PACK Nigeria Adult guide and training materials involved the electronic exchange of each page of the PACK Global Adult guide between the KTU and the Nigeria-based team. Iterations of each page ranged from 3 to 16. We identified and incorporated local priority conditions. The training materials which included a step-by-step manual for Lead/Master Trainers, Facility Trainers and the case-based curriculum, were localised for local priority conditions.
The programme is being piloted in 3 states in Nigeria, results of which will inform further improvements that may be applied when nationwide roll-out is required.

Conclusions: This process of localising the PACK Global Adult programme for Nigeria’s primary healthcare provided valuable insights and will serve as a model for facilitating remote development of a relevant, integrated policy and evidence-aligned management guide and training programme in other countries with similar needs.