Improving palliative care in Africa through education

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Published: 8 Dec 2015
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Dr Emmanuel Luyirika - African Palliative Care Association, Kampala, Uganda

Dr Luyirika talks to ecancertv at AORTIC 2015 about the measures that need to be taken to improve cancer patients' access to palliative care.

He says that palliative care needs to be part of the medical curriculum and that more resources need to be committed to education, noting the importance of the African Union and regional bodies in Africa in working together towards this goal.

Click here for the ecancer e-learning course on palliative care in Africa.

Palliative care is such an essential part of any healthcare system to meet the needs of patients with life-limiting illnesses, especially cancer, HIV, multi-resistant drug TB and many other conditions for which palliative care is needed. The challenge that palliative care has faced is that on the African continent we’ve had minimal policy development for palliative care, we’ve had minimal funding by the governments for palliative care, we’ve had minimal human resource development for the discipline as well as having proper systems for its delivery on the continent. That poses a challenge for patients who need the service and it means that African countries have a lot to do to ensure that the discipline is developed, that patients do not face unnecessary suffering, especially when faced with serious conditions such as cancer and especially at the end of their lives.

What issues need tackling?

The first step is to ensure that governments respond to the World Health Assembly resolution that was passed in 2014 to integrate palliative care into their health systems. That resolution has nine roles for member states and among those is policy development for countries to ensure that they have policies that encourage the provision of palliative care in their countries. There is also the issue of legislation that is an impediment to access opioid or narcotic medications, those need to be revised. There is also the need to ensure that palliative care is integrated in the curricula for the training of health workers and allied health workers on the continent as well as funding that must be put aside by governments to fund the medications, fund health workers and the education and integration of palliative care into health services. There’s also the need to put resources into palliative care research so that better models of palliative care delivery are developed on the continent as well as ensuring that better and modern ways of delivering palliative care education are strengthened on the continent.

Is it difficult to get all these different countries to do the same amount?

It’s very difficult to get countries to develop at the same level, one, because of diversity on the continent. We have four major areas on the continent: we have the English-speaking, we have Francophone, we have Portuguese-speaking and then we have Arabic countries. Now, the development is at different stages in those different language zones. Palliative care on the continent seems to be more developed on the Anglophone side and therefore sharing best practices from the Anglophone side to the other language zones is not yet fully developed. Secondly, countries have different levels of resources so the poorer countries will struggle to develop and dedicate resources for palliative care because they have several competing needs for their economies. Then, thirdly, you also have the issues around the knowledge, the knowledge about palliative care is not as widely spread among the countries as it should be so that’s another area that we are working on and looking at.

What are the conclusions of your talk?

In my conclusion I think we need to engage regional bodies on the continent. We have to continually engage the African Union to ensure that member countries get to the same level and aspire to the same ideals as far as palliative care is concerned. We need to engage the other bodies like the ECOWAS in West Africa, like the East African Community in East Africa and SADC in Southern Africa so that they work towards better development of palliative care on the continent, but also engaging health work education and training institutions to ensure that palliative care is integrated within their curricula as well as developing mechanisms of passing on palliative care information and advocacy to the general population on the continent.