Ethiopian primary healthcare clinical guidelines 5 years on-processes and lessons learnt from scaling up a primary healthcare initiative

Many effective health system innovations fail to reach those who need them most, falling short of the goal of universal health coverage. In the 5 years since the Federal Ministry of Health in Ethiopia localised the Practical Approach to Care Kit (PACK) programme to support primary care reforms, PACK...

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Published in:	BMJ global health Vol. 9; no. Suppl 3; p. e013817
Main Authors:	Kibret, Aklog Getnet, Belete, Wondosen Mengiste, Hanlon, Charlotte, Ataro, Israel, Tsegaye, Kiflemariam, Tadesse, Zelalem, Feleke, Meseret, Abdella, Megersa, Wale, Meseret, Befekadu, Kassahun, Bekele, Alemayehu, Georgeu-Pepper, Daniella, Ras, Christy-Joy, Fairall, Lara R, Cornick, Ruth Vania
Format:	Journal Article
Language:	English
Published:	England BMJ Publishing Group LTD 01-10-2024 BMJ Publishing Group
Subjects:	Clinical practice guidelines COVID-19 Curricula Disease Ethiopia Health care Health facilities Humans Innovations Medical personnel Mental disorders Mental health Online instruction Pandemics Practice Guidelines as Topic Primary care Primary Health Care Quality improvement Trainers Training Workers Ethiopia Health systems Public Health Global Health Health systems evaluation
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Summary:	Many effective health system innovations fail to reach those who need them most, falling short of the goal of universal health coverage. In the 5 years since the Federal Ministry of Health in Ethiopia localised the Practical Approach to Care Kit (PACK) programme to support primary care reforms, PACK has been scaled-up to over 90% of the country's primary care health centres. Known as the Ethiopian Primary Healthcare Clinical Guideline (EPHCG), the programme comprises a comprehensive, policy-aligned clinical decision support tool (EPHCG guide) and an implementation strategy to embed comprehensive, integrated care into every primary care consultation for individuals over 5 years of age, while addressing barriers to streamlined primary healthcare delivery. We describe the components of the EPHCG programme and the work done to establish it in Ethiopia. Yamey's framework for successful scale-up is used to examine the programme and health system factors that enabled its scale-up within a 5-year period. These included high-level ministry leadership and support, a cascade model of implementation embedded in all levels of the health system, regular EPHCG guide and training material updates and strategies to generate stakeholder buy-in from managers, health workers, patients and communities. Challenges, including stakeholder resistance, training fidelity and quality and procurement of medicines and diagnostic tests, are described, along with efforts to resolve them. Insights and learnings will be of interest to those implementing PACK programmes elsewhere, and managers and researchers responsible for design and delivery of health systems strengthening innovations at scale in low-income and middle-income countries.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2059-7908 2059-7908
DOI:	10.1136/bmjgh-2023-013817