The Federal Ministry of Health, Ethiopia, recognised the potential of the Practical Approach to Care Kit (PACK) programme to promote integrated, comprehensive and evidence-informed primary care as a means to achieving universal health coverage. Localisation of the PACK guide to become the ‘Ethiopian Primary Health Care Clinical Guidelines’ (PHCG) was spearheaded by a core team of Ethiopian policy and technical experts, mentored by the Knowledge Translation Unit, University of Cape Town. A research collaboration, ASSET (heAlth Systems StrEngThening in sub-Saharan Africa), has brought together policy-makers from the Ministry of Health and health systems researchers from Ethiopia (Addis Ababa University) and overseas partners for the PACK localisation process, and will develop, implement and evaluate health systems strengthening interventions needed for a successful scale-up of the Ethiopian PHCG. Localisation of PACK for Ethiopia included expanding the guide to include a wider range of infectious diseases and an expanded age range (from 5 to 15 years). Early feedback from front-line primary healthcare (PHC) workers is positive: the guide gives them greater confidence and is easy to understand and use. A training cascade has been initiated, with a view to implementing in 400 PHC facilities in phase 1, followed by scale-up to all 3724 health centres in Ethiopia during 2019. Monitoring and evaluation of the Ministry of Health implementation at scale will be complemented by indepth evaluation by ASSET in demonstration districts. Anticipated challenges include availability of essential medications and laboratory investigations and the need for additional training and supervisory support to deliver care for non-communicable diseases and mental health. The strong leadership from the Ministry of Health of Ethiopia combined with a productive collaboration with health systems research partners can help to ensure that Ethiopian PHCG achieves standardisation of clinical practice at the primary care level and quality healthcare for all.
- public health
- health policy
- health systems
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YMF and CH are joint first authors.
Handling editor Seye Abimbola
Contributors DT and DG led the initial PACK localisation in Ethiopia, which was subsequently continued by YM. SE, TT, SS, WW and YM were members of the PACK core technical team in Ethiopia. TA and MW are involved in phase 1 implementation of PACK. CH was a PACK content reviewer for mental health. MJP, CH and DT are investigators on ASSET. TE led on engagement between the BMJ, KTU and the Ethiopian FMoH. AA, CW, SCP, LA 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. LF, CH, YM, DT and MJP conceptualised the paper. YM and CH wrote the first draft. All authors contributed intellectual content, edited the manuscript and approved the final version for submission.
Funding KTU’s mentorship of the Ethiopian localisation work and the ASSET research programme are supported by the UK's National Institute of Health Research (NIHR) using Official Development Assistance (ODA) funding (NIHR Global Health Research Unit on Health Systems Strengthening in Sub-Saharan Africa at King's College London (16/136/54)). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care, England. TD's time was supported by the South African Medical Research Council. The Ethiopian core technical team were funded by USAID through the JSI Urban Health Strengthening Project. Two of the incountry PACK guide review meetings were funded by ICAP (International Centre for AIDS care and treatment Programme), Columbia University Mailman School of Public Health.
Competing interests The authors have read and understood the BMJ policy on declaration of interests and declare that AA, CJR, RVC, LF, SCP, CW and LA are employees of the KTU. TE is a contractor for both KTU and BMJ, London, UK. Since August 2015 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. KTU and BMJ cofund core positions, including a PACK Global Development Director (TE), and receive no profits from the partnership. TD is an employee of the South African Medical Research Council. 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.
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