Nigeria, in its quest to strengthen its primary healthcare system, is faced with a number of challenges including a shortage of clinicians and skills. Methods are being sought to better equip primary healthcare clinicians for the clinical demands that they face. Using a mentorship model between developers in South Africa and Nigerian clinicians, the Practical Approach to Care Kit (PACK) for adult patients, a health systems strengthening programme, has been localised and piloted in 51 primary healthcare facilities in three Nigerian states. Lessons learnt from this experience include the value of this remote model of localisation for rapid localisation, the importance of early, continuous stakeholder engagement, the need expressed by Nigeria’s primary healthcare clinicians for clinical guidance that is user friendly and up-to-date, a preference for the tablet version of the PACK Adult guide over hard copies and the added value of WhatsApp groups to complement the programme of face-to-face continuous learning. Introduction of the PACK programme in Nigeria prompted uptake of evidence-informed recommendations within primary healthcare services.
- health policy
- health systems
- public health
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Handling editor Seye Abimbola
Contributors CS led on engagement between BMJ, KTU, OPM and Nigerian authorities, and recruited JA as the in-country lead. AA and CJR provided content and training mentorship from the KTU with oversight by RVC and LF. TE provided overall support on engagement and project management. PA oversaw the activities of the HRI team (IU, U-OE, OA and TSE) under JA’s leadership. AD, RC and AA assisted with the monitoring and evaluation with support from LF and EB. AA wrote the first draft of the manuscript. All authors contributed intellectual content, edited the manuscript and approved the final version for submission.
Funding The PACK Nigeria pilot was funded through the Nigerian State Health Investment Project (NSHIP). This is a World Bank-assisted initiative led by Nigeria's NNPHCDA that uses a performance-based financing approach to drive improvements in the quality of care in primary health centres in Adamawa, Nasarawa and Ondo states. It has subsequently been extended to cover five other states in north-eastern Nigeria. The localisation of the PACK Nigeria guide and training resources was funded through a central NSHIP technical assistance budget managed by Oxford Policy Management. The implementation of the pilot at the state level was paid for by each state out of their own NSHIP budget.
Competing interests We have read and understood BMJ policy on declaration of interests and declare that AA, CJR, RVC, LF, EB, AD, RC are employees of the KTU. TE is a contractor for both KTU and BMJ, London, UK. EB reports personal fees from ICON, Novartis, Cipla, Vectura, Menarini, ALK, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca and grants for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann le Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA and AstraZeneca. All of EB’s fees and clinical trials are for work outside the submitted work. EB is also a member of Global Initiative for Asthma Board and Science Committee. Since August 2015, the KTU and BMJ have been engaged in a non-profit strategic partnership to provide continuous evidence updates for PACK, expand PACK-related supported services to countries and organisations as requested and where appropriate licence PACK content. The KTU and BMJ cofund core positions, including a PACK Global Development Director (TE) and receive no profits from the partnership. PACK receives no funding from the pharmaceutical industry. This paper forms part of a collection on PACK sponsored by the BMJ to profile the contribution of PACK across several countries towards the realisation of comprehensive primary healthcare as envisaged in the Declaration of Alma Ata during its 40th anniversary.
Patient consent Not required.
Ethics approval Nigerian National Health Research and Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.
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