Now in its 33rd year, HRI Global, the final iteration of preceding organisations was established in 1991, (, purposefully, to support work to strengthen the health system in Nigeria, and the subregion of West Africa. The success of Its programmes and products are due to its resilience and home-grown content for resource poor countries. HRI Global’s commitment to contributing to strengthening the health system of Nigeria, has seen it grow and gain the trust and respect of health leaders, health workers, patients and other stakeholders with whom it has past and present relationships. HRI Global prides itself in context-informed, evidence informed and proof-of-concept programmes which currently are: i) ‘The 12-Pillar Clinical Governance Programme (12-PCGP)’ and ii) ‘The PACK Nigeria for PHC programme’ :-    




The PACK Nigeria for PHC.    (The Practical Approach to Care Kit (PACK) for primary health care in Nigeria

12-Pillar Clinical Governance 

Courses  (12-pcgp courses) 


Context-informed, evidenced based solution homegrown in Nigeria for whole health sector and system strengthening in Low and Middle Income Countries like Nigeria.

provides a single, integrated, comprehensive, evidence-informed clinical guide to support all cadres working in primary healthcare in Nigeria: 

The Courses are designed to equip participants with in-depth understanding of the 12 pillars of clinical governance for LLMICs. 


‘Protecting Patients, Supporting Health Workers In Tandem’

Using algorithm enables all PHC clinicians (junior community health extension workers (JCHEWs), community health extension workers (CHEWs), community health officers (CHOs), nurses, midwives and medical officers) work as a quality team, including making appropriate referrals.

The 12-Pillars collectively shape the quality, safety, and effectiveness of health care delivery in the unique context of LLMICs.


Policy / Law; Funding Mix; Infrastructure; Equipment; Utilities (24/7 power and potable water); and Ambience (24/7 sanitation and Hygiene); Education & Training; Clinical Effectiveness; Risk Management; Staff and Staff Management; Patient & Public Involvement; ICT; Audit / Research;

The logic model for PACK is that providing clear actionable point of care clinical guide to the whole clinical team, that is, accompanied by a customised continuous programme of case-based on-site in-service training, and supportive supervision, improves clinical competence, encourages teamwork and task-sharing and effects health system change through prompting standardisation of care, including the supply of essential equipment, medicines and tests, and pathways for referral.

The Certificate Course (CC) comprises written resource for each pillar, essay-type questions for assessment and a dissertation. The Postgraduate Diploma course in addition to the CC content shall include video sessions, each lasting about 15 minutes dedicated to each of the pillars, a dissertation on a topic related to 12-Pillar Clinical Governance, and in-person observership in an approved facility to last a total of 4-weeks (either in one stretch or in four-weekly-sandwich-stints).


Continues in 2024

Continues in 2024


Further Information

i. Joseph Ana. 12-Pillar Clinical Governance and Good Medical Practice: transforming the whole health sector and system. Journal of Medical Standards & Ethics, 2023; Vol.1 (1): 12-18

ii. Ana J. 'Whole System Change of Failing Health Systems’ (4-year experience in cross river state, Nigeria)’. 2009. ISBN:978-978-49487-0-8

iii. Smith, R. Richard Smith is impressed, ‘How to rebuild global health: Joseph Ana’s book describes how he turned around the failing health system in a southern Nigerian state. BMJ 2010; 341 doi:

iv. Trivedi, B. Is Bijal Trivedi is impressed, ‘INSPIRING LIVES - Joseph Ana - Health Commissioner on a Mission. “He made healthcare accessible to everyone in the state’, In: Scientific American (fall- June, 2010. Page 30

v. Scally G, Donaldson LJ. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ. 1998; 317(7150): 61-65. doi: 10.1136/bmj.317.7150.61



1Report on the First phase of the implementation of PACK Nigeria programme for primary healthcare in Borno State: covers Master Trainers and Facility Trainers training for  19 primary Health Centres. from 2nd to 13th October, 2023. Authors: Ana, J. et al  


2Report on the Introduction Phase of the PACK Nigeria Programme in 20 Bauchi State Primary Health Centres, from November 2020 to August 2021

Authors: Ana, J. et al  

3 Using a mentorship model to localise the Practical Approach to Care Kit (PACK): from South Africa to Nigeria. BMJ Global Health Oct 2018, 3 (Suppl 5) e001079; DOI: 10.1136/bmjgh-2018-001079




©Centre for Clinical Governance Research and Patient Safety @ hri-global/ 11jan2024 


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