Article Text

Download PDFPDF

The Practical Approach to Care Kit (PACK) training programme: scaling up and sustaining support for health workers to improve primary care
  1. Makhosazana Lungile Simelane1,
  2. Daniella Georgeu-Pepper1,
  3. Christy-Joy Ras1,
  4. Lauren Anderson1,
  5. Michelle Pascoe2,
  6. Gill Faris3,
  7. Lara Fairall1,
  8. Ruth Cornick1
  1. 1 Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
  2. 2 Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
  3. 3 Purposeful People Development, Cape Town, South Africa
  1. Correspondence to Makhosazana Lungile Simelane; khosi.simelane{at}


There is an urgent need to depart from in-service training that relies on distance and/or intensive off-site training leading to limited staff coverage at clinical sites. This traditional approach fails to meet the challenge of improving clinical practice, especially in low-income and middle-income countries where resources are limited and disease burden high. South Africa’s University of Cape Town Lung Institute Knowledge Translation Unit has developed a facility-based training strategy for implementation of its Practical Approach to Care Kit (PACK) primary care programme. The training has been taken to scale in primary care facilities throughout South Africa and has shown improvements in quality of care indicators and health outcomes along with end-user satisfaction. PACK training uses a unique approach to address the needs of frontline health workers and the health system by embedding a health intervention into everyday clinical practice at facility level. This paper describes the features of the PACK training strategy: PACK training is scaled up using a cascade model of training using educational outreach to deliver PACK to clinical teams in their health facilities in short, regular sessions. Drawing on adult education principles, PACK training empowers clinicians by using experiential and interactive learning methodologies to draw on existing clinical knowledge and experience. Learning is alternated with practice to improve the likelihood of embedding the programme into everyday clinical care delivery.

  • health systems
  • health policy
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Handling editor Seye Abimbola

  • Contributors GF, DGP, LA, CJR, MLS: are the members of the KTU training team that developed and maintain the PACK training materials and methodology. RC: head of the content team, provided full editorial support to the paper. LF: with support from the KTU leadership team, conceptualised the PACK approach. MLS: wrote the first draft of the paper. MP: provided mentorship support. All authors contributed intellectual content, edited the manuscript and approved the final version for submission.

  • Funding The development of the KTU training programme resulting in the PACK programme was funded by the University of Cape Town Lung Institute and the Chronic Disease Initiative in Africa (CDIA) through an award from the National Heart, Lung and Blood Institute for Global Health Activities in Developing Countries to Combat Non- Communicable Chronic Cardiovascular and Pulmonary Diseases. PACK receives no funding from the pharmaceutical industry.

  • Competing interests We have read and understood BMJ policy on declaration of interests and declare that RC, DGP, LA, CJR, MLS and LF are employees of the KTU. GF is an ex-employee of the KTU. MP is an employee of the University of Cape Town. 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 license PACK content. The KTU and BMJ co-fund core positions, including a PACK Global Development Director, 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 health care as envisaged in the Declaration of Alma Ata, during its 40th anniversary.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.