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

在低收入和中等收入国家，儿童健康的初级保健服务存在很大差距：为5岁以上儿童或哮喘等长期疾病日益常见的卫生工作者提供的指导很少，而且预防保健(如接种疫苗和发育检查)没有顺利地与患病儿童服务相结合，导致对儿童、其照顾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种保健系统干预措施(实用护理工具包)，这种干预已在整个南非的保健服务中根深蒂固，并正在非洲其他地方和南美洲试行。PACK包括临床指南、培训包以及政策和管理层面的工作，以使系统和卫生工作者为其实施做好准备。该单位进行了严格的实施科学研究，表明PACK改善了护理和患者结果。PACK成功的原因是它对临床护理采取了一种全面、简单的方法，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》的合作正在帮助Pack推向全球受众(www.pack.bmj.com)。为了应对上述差距和使用PACK成人的人的要求，KTU现已与南非西开普省的地方政府合作开发了第一版PACK儿童临床指南，并计划与PACK成人版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：第一，如何在一个有多个其他计划和优先事项--以及有限的能力--的系统中最好地实施Pack Child计划；第二，如何最好地评估Pack Child是否确实改善了儿童的护理和健康。这笔基金会赠款将支持KTU：-开发和试验PARK儿童健康系统干预一揽子计划。-设计评估儿童保健系统干预措施的研究方案。-建立儿童保护儿童咨询委员会。这些活动中的每一项都将吸引从政策制定者到护士、医生到儿童本身的利益相关者，以确保儿童保健系统干预措施及其评估符合那些将使用它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.