Integrating palliative care into national health systems in Africa: a multi–country intervention study

Abstract

BackgroundThe WHO is calling for the integration of palliative care in all health care settings globally.MethodsA 3.5–year program was implemented in 12 government hospitals, three each in Kenya, Rwanda, Uganda and Zambia. A four–pillared approach of advocacy, staff training, service delivery strengthening and international and regional partnership working was utilized. A baseline assessment was undertaken to ascertain needs, and 27 indicators were agreed to guide and evaluate the intervention. Data were also collected through surveys, interviews and focus groups.ResultsPalliative care was integrated into all 12 hospital settings to various degrees through concurrent interventions of these four approaches. Overall, 218 advocacy activities were undertaken and 4153 community members attended awareness training. 781 staff were equipped with the skills and resources to cascade palliative care through their hospitals and into the community. Patients identified for palliative care increased by a factor of 2.7. All 12 hospitals had oral morphine available and consumption increased by a factor of 2.4 over two years. Twenty–two UK mentors contributed 750 volunteer days to support colleagues in each hospital transfer knowledge and skills.ConclusionsIntegration of palliative care within different government health services in Africa can be achieved through agreed interventions being delivered concurrently. These include advocacy at Ministry, Provincial and District level, intensive and wide–ranging training, clinical and support services supported by resources, including essential medicines, and an investment in partnerships between hospital, district and community.

Pain workshop ESMO: Africa (response)

“…The WHO Planning and Implementing Palliative Care services published research conducted by the University of Edinburgh and Makerere University in their Integrate project (funded by a Tropical Health Education Trust and the UK’s Department of International Development), which set out templates to show how these implementation strategies can be integrated into health systems. 5 6 …”

Paediatric Palliative Care in Resource-Poor Countries

“…Studies have shown that strengthening palliative care is a key component of strengthening healthcare systems more generally, as the impact of changing attitudes, skills and knowledge extends beyond that of palliative care itself [ 17 ]. The Sustainable Development Goals (SDGs) set out 17 goals and 168 targets to end extreme poverty, fight inequalities and injustice, and protect our planet by 2030 [ 18 ].…”

United against cancer: prevention to end-of-life care—highlights from the Uganda Cancer Institute–Palliative Care Association of Uganda Joint International Conference on Cancer and Palliative Care and the 7th Palliative Care Conference, 24–25 August 2017, Kampala, Uganda

“…Since then the resolution has been used as an advocacy tool throughout the region to encourage member states to implement the resolution, ensuring that palliative care is ‘integrated’ within the health system. Emphasis has been put on the WHO building blocks for health systems strengthening [ 24 ], with the development of palliative care being recognised as a health systems strengthening approach, with examples being seen in various programmes, including the ‘ Integrate programme ’ in Uganda, Zambia, Kenya and Malawi [ 25 ]. Alongside this, there is a growing recognition of the need for Universal Health Coverage (UHC) – with palliative care being seen as an integral part of UHC.…”