Table 1

Comparing in-country localisations of PALSA PLUS and Practical Approach of Care Kit (PACK) programmes

Brazil (Minas Gerais)MexicoThe GambiaMalawiBotswanaBrazil (Florianópolis)NigeriaEthiopia
Name of local programme PAL GARD Brasil
(Practical Approach to Lung Health/Global Alliance against Respiratory Disease)
Accion Integrada Por La Respiration/
Integrated Action for Respiration
PALSA PLUS GambiaPractical Approach to Lung Health and HIV/AIDS in Malawi (PALM PLUS)Botswana Primary Care GuidelinePACK Brasil Adulto—Versão FlorianópolisPACK Adult NigeriaEthiopian Primary Healthcare Clinical Guidelines
Driver of innovation Need to improve diagnosis and management of respiratory diseaseNeed to improve diagnosis and management of respiratory diseaseNeed to implement PAL to address TB epidemicNeed to provide clinical support for integration of TB and HIV careNeed to prioritise and integrate non-communicable disease care in primary careNeed for integrated clinical guidance as part of primary care system overhaulNeed for clinical decision support for primary care health workersNeed for a standardised package to guide integration of communicable and non-communicable disease clinical care
Localisation model Independent modelIndependent modelRegional technical support—consultancy modelConsultancy modelConsultancy modelMentorship modelMentorship modelMentorship model
Localiser Local respiratory physiciansLed by local respiratory physicians with input from respiratory health stakeholdersMinistry of Health National TB programme supported by WHO Gambia officeLocalising NGO partner in collaboration with Ministry of HealthUniversity Family Medicine department collaborating with Ministry of Health Non-Communicable Diseases directorateMunicipal primary care teamLocalising partner with close ties to Ministry of HealthFederal Ministry of Health Primary Care directorate
Funding source Minas Gerais Province Health AuthorityUnknownThe Global Fund to Fight AIDS, TB and Malaria Round 9International Development Research Centre; Canadian International Development AgencyUnited States’ HRSA (Health Resources and Services Administration) funded Medical Education Partnership InitiativeSowerby FoundationNigerian State Health Investment ProjectUnited Kingdom’s National Institute of Health Research
Research Small study of family physician management of respiratory cases, not yet publishedNonePilot study in two health regions39 Cluster randomised trial40
A study of health worker satisfaction41
Ministry of Health-led evaluation underway focussing on non-communicable disease carePragmatic randomised controlled trial42
Process evaluation—study submitted for publication 2018
Pretraining and post-training evaluationImplementation research planned to evaluate the integration of depression and non-communicable disease care
Impact on health system Prompted ‘RESPIRA Minas’: an extensive respiratory health intervention for all levels of careUnknownUnknownUnknownExpansion of Botswana essential medicines listImproved interprofessional collaboration and task sharing between nurses and doctors;
Improved healthcare worker morale
Pilot showed some reduction in polypharmacyNot yet implemented
Adoption by government Yes
State level
National level
Federal level
National level
Municipal level
Federal and state level
Federal level
Current status No longer active: project shelved by State Authority, reason unclear.No longer widely active due to health system fragmentation: various authorities leading on different aspects of respiratory health, TB and primary care at both State and Federal level meant the absence of a unifying lead for the programme.No longer active, reason unclearNo longer active: political instability and funding constraints prevented further implementation and scale up.ActiveActiveActive—post pilot, embarking on scale-upActive—starting country-wide implementation