ERNA Steering Group Member and Education for Health Chief Executive Monica Fletcher can be seen here (centre, in red) representing the voice of Allied Health Care Professionals (on behalf of ERNA) and Education (on behalf of Education for Health) at the Global Alliance against Respiratory Disease (GARD) in the WHO Geneva Headquarters on 30 and 31 January, 2017.

WHO is now recognising the importance of Chronic Respiratory Diseases as part of their Non Communicable Disease Strategy (NCD) and that it is time to put chronic respiratory disease on the global map as one of the key priorities and focus at a global, regional and national level. The meeting was aimed at discussing how GARD could support the scaling up management of Chronic Respiratory Diseases (CRD) across the globe.

Monica has been proud to represent the voice of nurses around the Globe at GARD meetings for many years as part of the global planning group. The role of nurses and other AHPs such as pharmacists is now clearly being recognised as being key in the care and management of people with long term respiratory problems.

Monica said: "It is not just in developed countries such as UK, Australia and US that the role of nurses in managing respiratory diseases is recognised increasingly they are becoming key deliverers of care across Africa and South America."

Professor Eric Bateman, Cape Town, South Africa, attended the meeting and shared work relating to PACK (Package of Care Kit).

He said: "One of the highlights of the GARD meeting was a review of progress being made with the PACK (Package of Care Kit) approach developed in South Africa and now being implemented in other countries.

"Based in the WHO Practical Approach to Lung Health (PAL), PACK provides a clinical management guide and training programme to support and upskill nurses and other “frontline clinicians” (including doctors) in under-resourced primary care facilities. PACK, which has been developed over 16 years through a process of rigorous formative research, has been adopted by the Health Department in South Africa as the centrepiece for the rejuvenation of primary care services in that country. Over this period tens of thousands of nurses have been trained and continue to be trained, and almost half a million copies of the paper version of the guide have been distributed. They are intended to be used on every patient during every consultation.

"The PACK guide supports teamwork by clearly identifying on each page the tasks that may be performed by nurses and those that require a doctor. In most resource-constrained countries, primary care is nurse-led, so PACK encourages task-sharing and often expanded authorisation for nurse prescribing. The PACK guide covers all the major conditions and reasons for which adult patients consult primary care facilities. A version for children is nearing completion, and versions for Brazil and Nigeria are currently being piloted in several states.

"The enthusiastic uptake of PACK by nurses and educators (it now forms part of the curriculum in all nursing colleges and for training of medical students in medical schools in South Africa) is its comprehensive content, integrated format and easy-to-follow illustrated algorithms. In brief, nurses appreciate that it is designed around their needs and for their empowerment, and many attest its value in providing confidence in clinical encounters, and improvement of their clinical skills. The PACK guide is updated annually and adapted for local country use to accommodate changing policies, evidence and guidelines.

"PACK is a demonstration project of GARD, and is anticipated to be a valuable innovation in many developing (and developed) countries. The KTU website http:/www.knowledgetranslation.co.za contains a video and useful information about PACK, including the BMJ Publications address for viewing or obtaining a copy of PACK Adult Global."