South–South partnership inspires formation of Knowledge Translation Unit in Brazil

The University of Cape Town’s (UCT) Knowledge Translation Unit (KTU) is hard at work, assisting its Brazilian partners to establish the Unidade de tradução de conhecimento (UTC) – a Brazilian KTU – to ensure that primary healthcare workers in that country provide patients with the highest standard of care.

The formation of the UTC comes a few years after the KTU’s Practical Approach to Care Kit (PACK) was piloted in healthcare facilities in Brazil. PACK has provided valuable support to doctors, nurses and other healthcare professionals working on the frontline, as well as their patients. The UTC will be located at the prestigious Fiocruz Foundation – one of the world’s leading public health research institutions.

Holy grail for healthcare workers

PACK helps healthcare practitioners diagnose and manage common conditions and is considered the ‘holy grail’ for thousands of primary healthcare workers in South Africa, Brazil, Malawi, Botswana, Nigeria and Ethiopia. There are also plans in place to roll it out in Indonesia. PACK covers 40 common symptoms and 20 conditions, such as cardiovascular disease, respiratory disease, tuberculosis (TB), HIV/AIDS, women’s health, and end-of-life care, which are all integrated into one handbook. It’s also accompanied by a training programme, which was optimised for online use during the COVID-19 pandemic. PACK continues to play an integral role in helping South Africa’s Department of Health consolidate and action the large number of new clinical guidelines released each year.

“We are thrilled to be taking our partnership with colleagues in Brazil to the next level.”

“We are thrilled to be taking our partnership with colleagues in Brazil to the next level. Establishing the UTC is testament to the work our Brazilian colleagues have led in Florianópolis, where they have trained doctors and nurses who have taken PACK to other areas in the country. It’s also a wonderful validation of our model – combining academic work and service implementations that have sustained PACK in South Africa for more than 15 years, ensuring it’s always updated and evolving to meet new challenges,” said KTU director, Professor Lara Fairall.

Standardise and streamline delivery

The first step in the formation process is working alongside colleagues in Brazil to adapt the Florionópolis version of PACK to suit a much wider audience – a massive undertaking in a country of more than 200 million people, diverse geographical regions and a varied workforce.

“PACK covers adult health needs in primary healthcare, and so the guide and training will continue to do this.”

According to KTU programme manager, Daniella Georgeu-Pepper, the plan is to mentor the UTC team to update and adapt their existing PACK guide; establish and host an online school; and alter the existing training package to suit the needs of clinicians serving patients in primary healthcare facilities in the Curitiba, Porto Alegre, Campo Grande and Fortaleza municipalities. She said these cities have been handpicked to represent Brazil’s diversity and create hubs from where PACK can be scaled further regionally. And because this initiative forms part of the CDC-funded A Hora é Agora (The Time Is Now) Programme, developed to expand services for people living with HIV, the initial roll-out programme will place a strong focus on HIV/AIDS, TB and mental health topics. But other themes intrinsic to the PACK programme will also be included.

“PACK covers adult health needs in primary healthcare, and so the guide and training will continue to do this. The training systematically builds clinicians’ confidence in using the guide, which allows them to pivot quickly to other areas of need, like non-communicable diseases,” Georgeu-Pepper said.

Designed to adjust

The KTU has been working alongside its Brazilian partners since 2016, when the municipal Primary Healthcare Department (PHCD) in Florianópolis first approached the unit for assistance. At the time the PHCD felt the region lacked appropriate strategies to standardise and strengthen the quality of care in its primary healthcare facilities. Ultimately, Georgeu-Pepper said, the PHCD’s goal was to address common presentations in primary care through promoting the use of evidence-based medicine. She said the PHCD recognised that the PACK programme would strengthen their primary healthcare services. And because PACK resources are designed to be amended and to fit country-specific health needs and objectives, their burden of disease, and to support available policies and resources, the wheels to collaborate were set in motion. Since then, the KTU has supported the PHCD in different ways, collaborating on research and developing resources on how healthcare workers and patients needed to respond to the COVID-19 pandemic.

“And so, a partnership between the PHCD and the KTU officially started and now goes back several years. During this time, we entered a collaborative process of mentorship and partnership, between us in South Africa and healthcare workers in Florianópolis, and it all sprouted the development of the UTC,” she said.

“This South–South partnership is a big step towards improving primary healthcare in low- to-middle-income countries like ours. We are proud of it and excited for what’s to come, including those opportunities for us to continue to learn from our colleagues in Brazil.”