Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Brazil

Abstract

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.

Addressing the quality and scope of paediatric primary care in South Africa: Evaluating contextual impacts of the introduction of the Practical Approach to Care Kit for children (PACK Child)

“…The implementation and training elements of PACK Child are modelled on and complement PACK Adult [18], which was trialled and scaled up in South Africa to over 30 000 clinicians in more than 3500 clinics [21][22][23], using a systematic, educational outreach training strategy and cascade model of implementation [19]. PACK is also being implemented in Botswana [24], Brazil [25], Nigeria [26] and Ethiopia [27], is available globally through a partnership with BMJ (pack.bmj.com) and is being localised for piloting in China [17].…”

Effects of PACK guide training on the management of asthma and chronic obstructive pulmonary disease by primary care clinicians: a pragmatic cluster randomised controlled trial in Florianópolis, Brazil

“…PACK was localised to the Brazilian context, and specifically for municipal primary healthcare clinics in the city of Florianópolis, between 2014 and 2016, with leadership by local primary care doctors mentored by the KTU 17. Florianópolis has a population of 486 000 and was the first Brazilian municipality to provide universal health coverage under the auspices of the national Family Health Strategy.…”

Assistência obstétrica/neonatal: ampliação da prática clínica do enfermeiro na Atenção Primária

“…Together with the University of Cape Town (South Africa) and with support of the British Medical Journal of Brazil (BMJ), its content was adapted to the local reality by PHC professionals. (18,19) Returning to the Theoretical Model, it must be understood in the light of Complex Thought, that is, beyond its structure. Results cannot be understood as cause-and-effect.…”