Strengthening the quality of paediatric primary care in South Africa: Preliminary work for a pragmatic randomised trial.

低收入和中等收入国家在提供儿童保健初级保健方面存在重大差距：卫生工作者在为5岁以上儿童或患有哮喘等日益常见的长期疾病的儿童看病时，几乎没有提供方便用户的指导，预防性保健（如接种疫苗和生长检查）没有顺利地与病童服务相结合，导致对儿童、其照料者和卫生工作者的护理脱节。开普敦的知识翻译股为成人初级保健制定了一项卫生系统干预措施（实用护理方法包- PACK），已在整个南非的卫生服务中根深蒂固，并正在非洲其他地方和南美洲进行试点。PACK包括临床指南、一揽子培训以及政策和管理层面的工作，为系统和卫生工作者的实施做好准备。该单位进行了严格的实施科学研究，表明PACK改善了护理和患者的预后。PACK成功的原因在于，它采用了一种全面、简单的临床护理方法，同时解决了使改善初级保健变得困难的系统问题。与《英国医学杂志》的合作伙伴关系正在帮助将PACK介绍给全球受众（www.pack.bmj.com）。针对上述差距和使用PACK Adult的人的要求，KTU现在与南非西开普省的地方政府合作，开发了第一版PACK Child临床指南，并计划与PACK Adult一起在几个国家实施。然而，在推出之前，我们需要解决两件事：一是如何在一个拥有多个其他项目和优先事项且能力有限的系统中最好地实施“儿童福利计划”；二是如何最好地评估“儿童福利计划”是否确实改善了儿童的护理和健康。这笔基金赠款将支持全教会：-制定和试行儿童保健系统干预一揽子计划。-设计研究方案以评估PACK儿童健康系统干预措施。-建立一个PACK儿童咨询委员会。这些活动中的每一项都将利用从决策者到护士和医生再到儿童本身的利益攸关方，以确保PACK儿童卫生系统干预措施及其评价符合那些将使用并从中受益的人的需求。

There are important gaps in the primary care delivery of child health in low and middle income countries: there is little user-friendly guidance for health workers seeing children over the age of 5 or those with increasingly common long term conditions like asthma, and preventive care (like vaccinations and growth checks) is not smoothly integrated with sick-child services, making for disjointed care for children, their caregivers and health workers. The Knowledge Translation Unit in Cape Town has developed a health systems intervention for adult primary care (Practical Approach to Care Kit - PACK) that has become entrenched in health services throughout South Africa and is being piloted elsewhere in Africa and in South America. PACK comprises a clinical guide, a training package and work at policy and management level to prepare the system and the health worker for its implementation. The unit has conducted rigorous implementation science studies showing that PACK improves care and patient outcomes. The reasons for PACK's success are that it takes a comprehensive, simple approach to clinical care while tackling the systems issues that make improving primary care difficult. A partnership with the British Medical Journal is helping take PACK to a global audience (www.pack.bmj.com). In response to the gaps described above and to requests from those using PACK Adult, the KTU has now developed the first version of the PACK Child clinical guide in collaboration with local government in the Western Cape province of South Africa, and plans to implement it alongside PACK Adult in several countries. Before rollout, however, we need to work out two things: One, how best to implement the PACK Child programme in a system that has multiple other programmes and priorities - and limited capacity - and two, how best to evaluate whether PACK Child does indeed improve the care and health of children. This Foundation Grant will support the KTU to:- Develop and pilot the PACK Child health systems intervention package. - Design the research protocol to evaluate the PACK Child health systems intervention.- Establish a PACK Child Advisory Board.Each of these activities will draw on stakeholders from policy makers to nurses and doctors to children themselves to ensure that the PACK Child health systems intervention and its evaluation speaks to the needs of those who will use and benefit from it.