South Africa is one of the leading countries in Africa that has realised the social economic benefits of this speciality of medicine. Malawi and Uganda have also integrated palliative care into their mainstream health care systems.
One of the challenges is that stigma has affected the acceptability of palliative care. Very often people believe that palliative care is only suitable for people who are dying. This isn’t entirely true. Palliative care is also about helping people deal with the effects of having an incurable disease.
I witnessed this myth a few years ago when dealing with a patient diagnosed with stage four cancer who needed medicine to control pain. But he declined pain medication because he associated palliative care with death.
The use of the commonly used phrase “there is nothing more we can do for you” negates the critical role of controlling advance symptoms of a disease as well as providing quality health care and support for families.
A number of developed countries have shown that these myths can be overcome. But most countries in Africa have no palliative care facilities available as part of the health system.
This needs to change because palliative care is recognised as a health right by the World Health Organisation. The WHO resolution 67 of 2014 requests governments to integrate palliative care in the mainstream health care system. Countries such as Malaysia, Costa Rica and South Africa have done well in integrating palliative care.
Countries at the forefront
Countries can learn the integration models from the US and European countries where integration is advanced and the field has grown exponentially. But it has to be tailor made to their setting and context.
Uganda became the first country in Africa to recognise liquid morphine as an essential drug for treating pain. It also set a precedent in Africa by allowing palliative care nurses to prescribe it.
In Kenya, palliative care has grown from one hospice in 1991 to 70.
Three models of palliative care are found in Kenya. There are stand alone hospices. They are independent facilities with autonomous administrative and decision making arms. Most of them are found in the headquarters of former provinces.
There are also hospital based palliative care units. They are part of the public, private or mission run health facilities. They provide their services to patients that seek treatment in the hospitals.
And there are palliative care consultation teams. They are found at the in patient and out patient departments in a hospital.
What needs to be done
Building integrated palliative care services begins by ensuring policies are in place, essential medicines are available and checking that comprehensive education on palliative care is delivered.
All this is necessary to guarantee the availability of specialist services to the sickest patients in the health care systems.
The integration of palliative care can be done in three ways;
- policy formulation
Palliative care is an integral component of quality health care. Governments should recognise it as an essential factor in health care provision and this establish clear policies, guidelines, pathways and protocols for proper access.
This should be done by creating awareness at the primary health care level and refer appropriately based on the patient needs.
- public awareness
The importance of timely access of palliative care should be taught to all cadres of health workers and the general public.
Improving doctor’s skills and knowledge significantly improves access to palliative care.
- Avail drugs and other treatment forms
Medicines used by patients in palliative care programmes should be appropriately prescribed and availed. The use of strong medicines to control severe pain is highly recommended.
There is a need to have sustained public awareness for patients and their families on the benefits of timely palliative care.
Governments need to develop, strengthen and implement appropriate palliative care policies and integrate palliative care services at all levels of health care provision. They should update essential drug lists to include those used in palliative care.
Domestic funding and training of staff in palliative care should also be prioritised.
Partnerships with non-governmental organisations, civil society, governments and patients organisations should also be strengthened to support the provision of palliative care.