COVID-19: time to rethink palliative care strategy in resource-poor settings

Abstract

The Coronavirus pandemic (COVID-19) presents an unprecedented impact on healthcare facilities and health professionals globally, especially in resource-poor settings, including Africa. This article aims to highlight the challenges of providing palliative care in Africa and to forecast what this means in light of the public health issues surrounding COVID-19. According to the Coronavirus in Africa tracker (BBC News, 2020), there are 925,369 confirmed cases of COVID-19 reported in Africa, out of which 19,605 are confirmed deaths as of 31 st July 2020. While 577,947 cases are reported to have recovered, there remains a high number of active confirmed cases of 327, 818 in the continent. These numbers could be higher, but are underreported, due to ineffective reporting systems, the capacity to diagnose on a large scale, and people not recognising the symptoms of COVID-19. With the anticipation that COVID-19 will have devastating effects on Africa (Hopman et al, 2020; Nkengasong and Mankoula, 2020), this will cause a surge in the need for palliative care and medical supplies. The World Health Organization (2018) defines palliative care as any support that improves the quality of life of patients and their families experiencing life-threatening illnesses, through the prevention and relief of suffering, whether physical, psychosocial or spiritual care. In this context, palliative care will mean the care for COVID-19 patients, particularly for those cases where conventional treatment is ineffective and/or life-supporting measures are unsuccessful; that is, the patients whose health conditions have declined to the extent that any life-supporting treatment is failing, and the persons become labelled as terminally ill. Universal health coverage goals consider Palliative care as a critical component; however, palliative care has not been given the needed attention in African countries, and this disproportionate attention results in significant health-related suffering at the end of life (

National and international non-therapeutic recommendations for adult palliative and end-of-life care in times of pandemics: A scoping review

“…Governments must recognize the hospice and palliative care sector as an integral component of the healthcare systems’ response to pandemics (WHO, 2018; Costantini et al, 2020; Laxton et al, 2020; Mercadante, 2020; Salifu et al, 2020) and the need for ongoing education and training offered to healthcare workers (WHO, 2018). Collaborative relationships between generalist and specialist providers of palliative care have to be developed and better understood to inform national policy and to evolve recommendations for service delivery during future pandemics (Mitchell et al, 2020).…”

“…Governments must recognize the hospice and palliative care sector as an integral component of the healthcare systems' response to pandemics (WHO, 2018;Costantini et al, 2020;Laxton et al, 2020;Mercadante, 2020;Salifu et al, 2020) and the need for ongoing education and training offered to healthcare workers 8…”

Cuidados paliativos, cuidados de fin de vida y COVID-19: revisión de alcance

“…La evaluación de los pacientes debe hacerse de manera regular, concisa y rápida 65 para anticipar situaciones de crisis 26,43 . De otra parte, se deben fortalecer las relaciones con los pacientes para promover su confianza en los profesionales de enfermería 45,66 . Frente a los cuidados no farmacológicos se destacaron los cambios de posición, el cuidado de la cavidad bucal y el uso de elementos para regular la temperatura 27 .…”

Transfer and transitioning between palliative care settings

“…For example, vulnerable patients and families may be required to wear a face mask or be isolated to protect them from infection (15). Equally, health institutions need to plan for a surge in the number of palliative care patients beyond their capacity (16). The World Health Organization (WHO) has recommended that palliative care should be integrated into all settings of health care to enhance the provision of quality primary health care (PHC), and to realise the achievement of universal health coverage (UHC).…”