Palliative care in Malawi: a scoping review

Abstract

Background Universal access to palliative care remains a distant goal in many low resource settings, despite the growing evidence of its benefits. The unmet need for palliative care is evident in Africa, but great strides in palliative care development have occurred in several African countries. Located in sub-Saharan Africa, Malawi has been regarded as an exemplar of progress in this area that is achievable in a low resource region. This scoping review examined the literature on the development and state of palliative care in Malawi according to the pillars of health care policy, medicine availability, education, implementation, research activity, and vitality of professionals and advocates. Methods A scoping review was conducted of the MEDLINE, Embase, Global Health, CINAHL, Web of Science and PsycINFO databases, as well as grey literature sources. Articles were included if they explored any aspect of palliative care in Malawi. Results 114 articles were identified that met the inclusion criteria. This literature shows that Malawi has implemented diverse strategies across all pillars to develop palliative care. These strategies include creating a national stand-alone palliative care policy; integrating palliative care into the curricula of healthcare professionals and developing training for diverse service providers; establishing systems for the procurement and distribution of opioids; implementing diverse models of palliative care service delivery; and launching a national palliative care association. Malawi has also generated local evidence to inform palliative care, but several research gaps were identified. Conclusions Malawi has made considerable progress in palliative care development, although initiatives are needed to improve medicine availability, access in rural areas, and socioeconomic support for patients and their families living with advanced disease. Culturally sensitive research is needed regarding the quality of palliative care and the impact of therapeutic interventions.

Measuring palliative care integration in Malawi through service provision, access, and training indicators: the Waterloo Coalition Initiative

“…As of 2017, mapping of palliative care development and integration into public facilities showed that Malawi was one of two African nations to achieve an advanced stage of integration (stage 4b), alongside Eswatini (then known as Swaziland) [ 6 , 37 ]. Other developments since the WCI include Malawi’s launching of a standalone policy for palliative care, integration of palliative care into medical and nursing curricula, and a supply chain mechanism for opioid distribution [ 38 ]. Other limitations include our inability to obtain baseline data for hospital and health center referrals, opioid availability, or proportion of time that opioids were available.…”