All of APCA’s work is in palliative and comprehensive chronic care in Africa and is guided by its 10-year strategic framework 2020-2030 which is in alignment with the UHC 2030. Our work is partnership-based, with development partners, trusts and foundations, the private sector corporate social responsibility departments, donors, national, regional, and global organisations, academia, and governments.
Integration is one of the main objectives in this framework that focuses on palliative and comprehensive chronic care
Strengthening health systems across Africa by integration of palliative and comprehensive chronic care
Under this we focus on improving access to essential but internationally controlled palliative care medicines, national palliative care policies, human resources development and education, and palliative and comprehensive chronic care service delivery. We run national capacity projects for controlled medicines including technical assistance to countries on oral liquid morphine reconstitution, supporting clinical guidelines development, study tours, scholarships for multidisciplinary health worker teams and small grants for hospices and hospitals involved in palliative and comprehensive chronic care.
Introduction
The general lack of palliative care in national health policies, education programmes and health services leads to health systems that are too weak to achieve quality and comprehensive services for their populations. Yet palliative care interventions, based on WHO's public health model and health systems agenda have great potential for strengthening health systems to deliver quality services. APCA is implementing strategies that target all these components and pillars of the health system, as well as the stakeholders within these, including: policy makers, legislators, service providers and educationalists.
Several factors exert an adverse influence on the provision of palliative care and comprehensive chronic care services for the majority of people in Africa. Firstly, palliative care is a relatively new discipline on the continent and its development is hampered by the fact that it is not integrated into national health systems. Consider the following status samples of palliative care in 53 African countries:
- Twelve countries – Guinea, Libya, Ethiopia, Uganda, Rwanda, Tamzania, Malawi, Mozambique, Zimbabwe, Botswana, South Africa and Swaziland -- have stand alone palliative care plans or programmes alongside their health strategic plans.
- Twenty two countries also have palliative care in either their cancer or HIV plans or both. These include Tunisia, Kenya, Namibia,Zambia,Nigeria, Ghana, Burkina Faso, Cote D’Ivore among others. Eight countries – Rwanda, Swaziland, Zimbabwe, Swaziland, Tanzania, Malawi, Mozambique, Botswana, -- have developed stand-alone national palliative care policies and/or guidelines. Malawi has also developed national palliative care guidelines and Rwanda has also adopted national palliative care standards.
- Five countries –Kenya, Malawi, South Africa, Egypt, Ghana, Botswana and Uganda -- have palliative care integrated in the curricula of health professionals. These countries have recognised palliative care as an examinable subject. The status of palliative care integration signifies a significant deficit in skills training.
- Three countries – Malawi, Kenya, and Botswana -- have developed and are implementing a palliative care national training package, while Namibia, Tanzania and Uganda are in the process of developing a national training package.
Most palliative care is provided by non-governmental, faith-based or community-based organisations with no inbuilt sustainability mechanisms. These challenges it is hoped will be overcome as more countries integrate palliative care in both national health systems and educational institutions. APCA encourages governments throughout Africa to make use of the four-pillar enhanced public health model of palliative care provision to support a population- based approach to palliative care development. This approach focuses on palliative care integration into national health systems to increase service accessibility for patients in need. In addition APCA is encouraging countries to implement the WHA Palliative Care Resolution of 2014 as well as the WHA cancer Resolution of 2017 which put emphasis on palliative care as a national response with both state and non-state actors.