Innovating to improve primary care in less developed countries: towards a global model

One of the biggest problems in global health is the lack of well trained and supported health workers in less developed settings. In many rural areas there are no physicians, and it is important to find ways to support and empower nurses and other health workers. The Knowledge Translation Unit of the University of Cape Town Lung Institute has spent 14 years developing a series of innovative packages to support and empower nurses and other health workers. PACK (Practical Approach to Care Kit) Adult comprises policy-based and evidence-informed guidelines; onsite, team and case-based training; non-physician prescribing; and a cascade system of scaling up. A series of randomised trials has shown the effectiveness of the packages, and methods are now being developed to respond cost-effectively and sustainably to global demand for implementing PACK Adult. Global health would probably benefit from less time and money spent developing new innovations and more spent on finding ways to spread those we already have.

[1]  J. Lawn,et al.  Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise , 2008, The Lancet.

[2]  N. Binkin,et al.  Integrated management of childhood illness: what have we learned and how can it be improved? , 2012, Archives of Disease in Childhood.

[3]  M. Mugford,et al.  The Social Support and Family Health Study: a randomised controlled trial and economic evaluation of two alternative forms of postnatal support for mothers living in disadvantaged inner-city areas. , 2004, Health technology assessment.

[4]  Robert E Black,et al.  Improving quality and efficiency of facility-based child health care through Integrated Management of Childhood Illness in Tanzania. , 2005, Health policy and planning.

[5]  R. Dorrington,et al.  RAPID MORTALITY SURVEILLANCE REPORT 2011 , 2012 .

[6]  E. Bateman,et al.  Effect of educational outreach to nurses on tuberculosis case detection and primary care of respiratory illness: pragmatic cluster randomised controlled trial , 2005, BMJ : British Medical Journal.

[7]  Bohn Stafleu van Loghum,et al.  Online … , 2002, LOG IN.

[8]  Igor Rudan,et al.  Primary health care: making Alma-Ata a reality , 2008, The Lancet.

[9]  Fiona Ross,et al.  Working together for health , 2007, Journal of interprofessional care.

[10]  M. E. Hoque,et al.  Effect of the Integrated Management of Childhood Illness strategy on childhood mortality and nutrition in a rural area in Bangladesh: a cluster randomised trial , 2009, The Lancet.

[11]  Guilbert Jj.  The World Health Report 2006: working together for health. , 2006 .

[12]  J M Grimshaw,et al.  Effectiveness and efficiency of guideline dissemination and implementation strategies , 2004, International Journal of Technology Assessment in Health Care.

[13]  A D Oxman,et al.  Educational outreach visits: effects on professional practice and health care outcomes. , 2007, The Cochrane database of systematic reviews.

[14]  Paul Corrigan,et al.  Innovate or die , 2012, BMJ.

[15]  R. Scherpbier,et al.  Programmatic pathways to child survival: results of a multi-country evaluation of Integrated Management of Childhood Illness. , 2005, Health policy and planning.

[16]  Max O Bachmann,et al.  Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial , 2012, The Lancet.

[17]  German Cockroaches In,et al.  INTEGRATED MANAGEMENT OF , 1984 .

[18]  R. Moy,et al.  Integrated management of childhood illness (IMCI) , 1998, Journal of tropical pediatrics.

[19]  Max O Bachmann,et al.  Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trial , 2011, BMJ : British Medical Journal.

[20]  S. Gove,et al.  Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. , 1997, Bulletin of the World Health Organization.

[21]  E. Bateman,et al.  Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial , 2012, Implementation Science.

[22]  L. Fairall,et al.  A Morbidity Survey of South African Primary Care , 2012, PloS one.

[23]  E. Bateman,et al.  Cost‐effectiveness of educational outreach to primary care nurses to increase tuberculosis case detection and improve respiratory care: economic evaluation alongside a randomised trial , 2010, Tropical medicine & international health : TM & IH.

[24]  Barry Burciul,et al.  Strengthening health human resources and improving clinical outcomes through an integrated guideline and educational outreach in resource-poor settings: a cluster-randomized trial , 2010, Trials.

[25]  Max O Bachmann,et al.  Cost‐effectiveness of nurse‐led versus doctor‐led antiretroviral treatment in South Africa: pragmatic cluster randomised trial , 2013, Tropical medicine & international health : TM & IH.

[26]  J. Shipley.  NATIONAL HEALTH INSURANCE IN SOUTH AFRICA , 1928 .

[27]  B. Mayosi,et al.  Health and health care in South Africa. , 2015, The New England journal of medicine.

[28]  D. Panke.  The United Nations General Assembly , 2013 .

[29]  E. Bateman,et al.  Building capacity for antiretroviral delivery in South Africa: A qualitative evaluation of the PALSA PLUS nurse training programme , 2008, BMC health services research.

[30]  E. Bateman,et al.  Effectiveness of antiretroviral treatment in a South African program: a cohort study. , 2008, Archives of internal medicine.

[31]  B. Mayosi,et al.  Health and health care in South Africa--20 years after Mandela. , 2014, The New England journal of medicine.

[32]  J. Narain.  Prevention and control of noncommunicable diseases: Guidelines for primary health care in low-resource settings , 2013 .

[33]  W. Katon,et al.  TEAMcare: An Integrated Multicondition Collaborative Care Program for Chronic Illnesses and Depression , 2011, The Journal of ambulatory care management.

[34]  N. Daniels,et al.  Health and health care , 2014 .

[35]  M. Schull,et al.  From PALSA PLUS to PALM PLUS: adapting and developing a South African guideline and training intervention to better integrate HIV/AIDS care with primary care in rural health centers in Malawi , 2011, Implementation science : IS.

[36]  Richard K. Thomas,et al.  Health and Health Care , 1992 .

[37]  J. Duffus.  Morbidity survey. , 1973, Indian journal of public health.