The partnership between the University of Edinburgh, the African Palliative Care Association (APCA), and the Makerere University Palliative Care Unit (MPCU) works on strengthening and integrating palliative care into national health systems through a public health primary care approach in 4 African countries to meet the targets of MDG goal 6.
Due to the large burden of disease in Africa, there is a need for culturally appropriate, holistic palliative care, which includes effective pain and symptom management. However, palliative care provision is inconsistent, rarely integrated into mainstream health systems, often sporadic, and geographically specific. As of 2007, almost half of all African countries have no identified palliative care activity, and only four provide services that are integrated with mainstream service providers. Past research has identified limited opioid availability, lack of healthcare worker skills, and limited linkages between hospitals and communities as barriers to essential palliative care provision. More recent consultations done by the APCA identified the need to build on health workers capacity and to integrate systems in order to meet the various palliative care needs.
A Chief Executive of a hospital explains the state of end-of-life care before the programme started: ‘Up until now we sent home patients who were dying, with the words “discharged to hospice at home” knowing that there was nothing more we could do in hospital, but also knowing that there was no hospice at home. It was our way of coping.’
The University of Edinburgh is working with APCA and MPCU in four different countries (Rwanda, Uganda, Kenya, and Zambia) on both the policy and health system levels to bring much needed palliative care to suffering patients.
Through mentoring, the partnership has been supporting health workers in three hospitals in each of the four countries with training in symptom relief and holistic pain assessment. Pre-training and post-training tests have shown immediate increase in knowledge of palliative care. Hospitals are also working on developing improved referral systems based on guidelines with better documentation. Many of the health workers are encouraged to record progress anecdotally using a Most Significant Change (MSC) prompt, and many have recorded greater confidence in their ability to deliver palliative care.
Dr. Liz Grant from the University of Edinburgh comments on the programme: ‘Through the programme a system of comprehensive care is being built. A system that establishes a pathway of care for all those with palliative care needs that includes an assessment of physical, social and spiritual needs, and ensures that patients are not just neglected or lost from care.’
A large component to this partnership is advocacy. The partnerships work with national and local government to have palliative care recognised in their health plans. Workshops have been delivered to raise awareness about palliative care, and as a result, local leaders have incorporated palliative care into district budgets and work plans. The partnership also uses various media outlets to raise awareness. Finally, the partnership has also been working on making opioids, particularly oral morphine, more available, affordable, and accessible.