Overview

The Practical Approach to Lung Health (PAL) is one of the strategies intended to overcome the challenge posed by weak health systems. This initiative is aimed at managing respiratory patients in primary health care settings while expanding TB detection and good-quality TB services. PAL focuses on the most prevalent respiratory diseases at first-level health facilities – pneumonia, acute bronchitis and other acute respiratory infections, TB, and chronic respiratory conditions including chronic bronchitis, asthma and chronic obstructive pulmonary disease.

This manual was developed by WHO to assist country institutions – health and other government ministries, social security agencies, nongovernmental organizations – that want to introduce the PAL strategy into case-management practices in primary health care. It describes a phased process of promotion, technical guideline development and adaptation, pilot testing, managerial planning and implementation. The standards and recommendations represent a synthesis of the observations and experience gathered in primary health care settings in 10 countries in all regions of the world in the past six years.

The manual provides practical guidance to health managers whose efforts are crucial to the achievement of global TB control goals and national targets for case- management of respiratory conditions. It will also be helpful for health care providers at both first-level health care facilities and the first referral level.

Contents

• Foreword
• Development of the manual and acknowledgements
• Acronyms and abbreviations
• Introduction: Scope and objectives of the manual
• 1. Enlisting support to initiate the PAL strategy
  • PAL promotion document
  • Advocacy seminars
  • Political commitment
  • Organizational structure
  • National working group on PAL
  • The PAL strategy in the context of health sector reform
• 2. Estimating the burden of respiratory diseases
  • The growing problem of respiratory diseases
  • Mortality
  • Morbidity
  • Respiratory diseases in outpatient services
  • Treatment practices
• 3. Assessing the capabilities of the health infrastructure to implement the PAL strategy
  • Introduction
  • Demographic, socioeconomic and epidemiological information
  • Current status of the TB programme
  • Burden of respiratory diseases in the community
  • Information on the health system
  • Clinical practices regarding respiratory diseases
  • Conclusions of the situation analysis
• 4. Developing standard PAL clinical guidelines
  • Working methods
  • Technical guidelines for first-level health facility staff
  • Technical guidelines for the first referral level
  • Essential medical supplies
  • Choice of essential medicines
• 5. Communication activities in a PAL strategy
  • Who is responsible for health education of patients and their families?
  • Advising and counselling patients and their families on immunization
  • Advising and counselling patients with acute respiratory infections
  • Advising and counselling TB patients and their families
  • Advising and counselling about HIV for patients with respiratory infections, particularly pneumonia or TB
  • Advising and counselling asthma patients and their families
  • Advising and counselling COPD patients and their families
• 6. Formulating a PAL information system
  • Essential information : the outpatient register
  • Lists of respiratory disease diagnoses
  • Register of TB suspects
  • Information instruments on treatment of respiratory diseases
  • Summary of forms for registering information in PHC services
• 7. Developing PAL training materials
  • Why develop training materials?
  • To whom are training materials addressed?
  • What are the objectives of a PAL training workshop?
  • What documents are needed?
  • Participant's module
  • Facilitator's module
• 8. Testing the clinical guidelines and operational procedures
  • Objectives of the feasibility study
  • Establishment of a central-level coordination group for the feasibility study
  • Development of the study protocol
  • Selection of the study method
  • Selection of study sites
  • Selection of the season
  • Phases of the feasibility study
  • The baseline or “before” survey
  • The impact or “after” survey
  • Analysis of data
  • Funding the feasibility study
  • Report of results
• 9. Developing a national expansion plan
  • Establishment of a central subunit for coordination of the extension plan
  • Revised technical guidelines and the information instruments
  • Training of trainers for implementation of the PAL strategy
  • Equipment and essential drugs for implementation of the PAL strategy
  • Plan for the expansion programme
  • Budget for the expansion plan
• 10. Organizing systematic supervision, monitoring and evaluation
  • Organization of PAL supervision
  • Evaluation of PAL implementation results
• Annex Source documents

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