BMJ PACK

BMJ PACK Stakeholder Meeting 12 April 2016 held in the Conference Room of NPHCDA, Abuja, Nigeria.

1          PACK Content

All parties agreed that the localised version of PACK for Nigeria will be an integrated guideline, covering the scope of practice for the following cadres in a single decision-support tool:

  • JCHEW
  • CHEW
  • CHO
  • Midwife
  • Medical Officer.

At the request of the Registrar of the Nursing and Midwifery Council of Nigeria nurses will not be included and will not be asked to use PACK at this stage.

We agreed that the scope of practice for each cadre will be clearly delineated through the use of colour-coding. BMJ will endeavour to design PACK to be as accessible as possible to colour-blind users.

Finally we agreed that once localisation has been completed the PACK guideline will be approved by NPHCDA before the formal pilot can begin. Dr Olubaju will confirm with Dr Ihebuzor what the approval process will entail.

2          Target Conditions

The localised PACK guideline will be comprehensive and cover all 40 symptoms and 20 chronic conditions. In the short-term, for the purposes of the pilot, we agreed to limit the training and any evaluation of clinical performance to the following conditions:

  • Acute diarrhoea with severe dehydration
  • Malaria with anaemia
  • Pneumonia
  • Tuberculosis
  • Type 2 diabetes
  • Hypertension

3          Facilities and staff

We agreed that 12 facilities in each state would be selected according to the following criteria:

  • Located in the NSHIP pre-pilot LGA
  • Offering the full MPA service package

All facilities will have access to power. Each SPHCDA will confirm which facilities will be included in the pilot and the numbers of eligible clinical staff by cadre

Although the localised PACK guideline will include Medical Officers, we do not expect any MOs to be present in the pilot facilities.

Joseph Shu of OPM moderated discussions on bonus payments for staff participating in the pilot. It was decided that OPM, SPHCDAs and NPHCDA will conclude how best to incorporate the PACK Pilot in the existing bonus payment (PBF) structure of the NSHIP programme.

4          Evaluation

We agreed that BMJ will conduct a qualitative survey as initial training is delivered and a second survey at the end of the pilot in order to gauge clinicians’ views on:

  • Participation in and reaction to PACK training
  • Usage of and reaction to the PACK guideline (paper and digital)

We agreed that the SPHCDAs, as funders, will consider how they want to measure the success of the pilot and decide what additional data they wish to capture pre- and post-pilot and how this can be done.

5          Points of Contact

We agreed that the NSHIP Project Coordinators will be BMJ’s primary contact in each state. All emails will also copy in Dr Olubaju and Dr Ihebuzor, ED.

6          Next Steps

Localisation

BMJ and OPM hope to have the contract covering PACK localisation signed by the end of April. This will enable the localisation process to begin at the beginning of May. We currently anticipate that localisation could be completed by the end of October. We will be able to firm up this date once we’ve started the full localisation process and have clarity about the approval process.

Pilot Planning

As soon as BMJ has signed contracts with all 3 SPHCDAs, BMJ will schedule a planning trip to each state. We will familiarise ourselves with the local teams and facilities and jointly develop detailed implementation and communication plans.

Summary of Actions

  1. Dr Olubaju to confirm with Dr Ihebuzor what the approval process for the localised version of PACK will entail;
  2. BMJ and OPM to sign contract covering localisation;
  3. Each SPHCDA to review BMJ draft contract and come back to BMJ with any comments;
  4. Each SPHCDA to confirm which facilities will be included in the pilot and the numbers of eligible clinical staff by cadre;
  5. OPM, SPHCDAs and NPHCDA will conclude how best to incorporate the PACK Pilot in the existing bonus payment (PBF) structure of the NSHIP programme.
  6. The SPHCDAs will consider how they want to measure the success of the pilot and decide what additional data they wish to capture pre- and post-pilot and how this can be done.