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Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Brazil
  1. Camilla Wattrus1,
  2. Jorge Zepeda2,
  3. Ruth Vania Cornick1,
  4. Ronaldo Zonta3,
  5. Matheus Pacheco de Andrade3,
  6. Lara Fairall1,
  7. Daniella Georgeu-Pepper1,
  8. Lauren Anderson1,
  9. Tracy Eastman1,4,
  10. Eric D Bateman1,
  11. Alvaro A CRUZ5,
  12. Max O Bachmann6,
  13. Sonia Natal7,
  14. Tanya Doherty8,
  15. Rafael Stelmach9
  1. 1 Knowledge Translation Unit, University of Cape Town Lung Institute, Observatory, South Africa
  2. 2 LIHS, University of Leeds, Leeds, UK
  3. 3 City Health Department, Florianópolis, Brazil
  4. 4 BMJ Publishing Group, Knowledge Centre, London, UK
  5. 5 Federal University of Bahia, Salvador, Brazil
  6. 6 Norwich Medical School, University of East Anglia, Norwich, UK
  7. 7 Federal University of Santa Catarina, Florianópolis, Brazil
  8. 8 South African Medical Research Council, Cape Town, South Africa
  9. 9 Pulmonary Division - Heart Institute (iCor), University of São Paulo Medical School, Sao Paulo, Brazil
  1. Correspondence to Dr Camilla Wattrus; camilla.wattrus{at}


Brazil’s Sistema Único de Saúde, or Unified Health System policy, has delivered major improvements in health coverage and outcomes, but challenges remain, including the rise of non-communicable diseases (NCDs) and variations in quality of care across the country. Some of these challenges may be met through the adaptation and implementation of a South African primary care strategy, the Practical Approach to Care Kit (PACK). Developed by the University of Cape Town’s Knowledge Translation Unit (KTU), PACK is intended for in-country adaptation by employing a mentorship model. Using this approach, the PACK Adult guide and training materials were localised for use in Florianópolis, Santa Catarina, Brazil, as part of an initiative to reform primary care, expand care for NCDs and make services more accessible and equitable. The value of the collaboration between the KTU and Florianópolis municipality is the transfer of skills and avoidance of duplication of effort involved in de-novo guide development, while ensuring that materials are locally acceptable and applicable. The collaboration has informed the development of the KTU’s PACK mentorship package and led to a relationship between the groups of developers, ensuring ongoing learning and research, with the potential of assisting the further scale-up of PACK in Brazil.

  • public health
  • health policy
  • health systems

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  • Handling editor Seye Abimbola

  • Contributors LF, JZ: established the partnership between the KTU and the Florianópolis Health Department, with support from EB, AC, RS, TE. LF: raised funding to cover the KTU contribution through a grant provided by the Peter Sowerby Foundation. JZ: obtained approval from the relevant Health Department officials to cover the Florianópolis Health Department contribution. CW, RZ: led the localisation of the guide with support from RC, JZ, MA. RZ, MA: led on localisation of the training materials and training implementation, with support from the KTU training team, including DG-P, LA. MB, EB, RS, AC: are leading the randomised trial evaluation. SN: the process evaluation. CW: wrote the first draft of the paper. All authors contributed intellectual content, edited the manuscript and approved the final version for submission.

  • Funding Florianópolis Health Municipality for in-kind support, The Peter Sowerby Foundation for funding to support the evidence linkage and PACK Global Localisation Toolkit development in partnership with Brazil, and BMJ for overall project management support.

  • Competing interests We have read and understood BMJ policy on declaration of interests and declare that CW, LF, TE, DGP, LA, RC and EB are employees of the KTU. TE reports grants from Peter Sowerby Foundation and personal fees from BMJ, during the conduct of the study. TD is an employee of the South African Medical Research Council. RZ and MA are employees of the City Health Department, Florianópolis, Brazil. JZ is an ex-employee of the City Health Department, Florianópolis, Brazil and a current holder of full-time PhD studentship from the Brazilian research agency CNPq. AC reports grants, personal fees and non-financial support from GSK, personal fees and non-financial support from AstraZeneca, personal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from MEDA, personal fees and non-financial support from Novartis, personal fees and non-financial support from EUROFARMA, personal fees and non-financial support from CHIESI, personal fees and non-financial support from Boston Scientific, outside the submitted work. EB reports grants to institution for clinical trials from Novartis, Boehringer Ingelheim, Merck, Takeda, GlaxoSmithKline, Hoffmann le Roche, Actelion, Chiesi, Sanofi-Aventis, Cephalon, TEVA, and AstraZeneca and personal fees from ICON, Novartis, Cipla, Vectura, Cipla, Menarini, ALK, ICON, Sanofi Regeneron, Boehringer Ingelheim and AstraZeneca, outside the submitted work, and is 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 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.