Palliative Care in Southern Africa - Country Reports

With the huge burden of cancer, HIV, and other life-limiting illnesses across Africa, a clear public health argument exists for the availability of pain- and symptom-relieving drugs to improve the quality of life of millions of people, to maximise clinical benefit from available treatments, and to ensure freedom from unnecessary suffering. Despite this, many barriers exist that prevent access to palliative care on the continent. In particular, effective pain medication is not adequately available to people who need it.

Author

October 10th, 2012

With the huge burden of cancer, HIV, and other life-limiting illnesses across Africa, a clear public health argument exists for the availability of pain- and symptom-relieving drugs to improve the quality of life of millions of people, to maximise clinical benefit from available treatments, and to ensure freedom from unnecessary suffering. Despite this, many barriers exist that prevent access to palliative care on the continent. In particular, effective pain medication is not adequately available to people who need it.

In 1995 the International Narcotics Control Board surveyed government drug control authorities. It identified multiple barriers, similar to the barriers being identified today, including:

  • „„excessively strict national laws and regulations;
  • „„fear of addiction, tolerance, and side-effects;
  • poorly developed health care systems and supply; and,
  • lack of knowledge on the part of health-care professionals, the public, and policy-makers.

While these barriers pose a great challenge not only to accessing pain medication, the absence of national policies and the lack of government understanding about the importance of pain medication exacerbates them. The Open Society Foundations (OSF), based in New York, and the Open Society Initiative for Southern Africa (OSISA) funded the African Palliative Care Association (APCA) to undertake a review of national policies and national implementation documents across ten African countries, to assess the extent to which palliative care pain medication and associated gender issues are addressed. The review looked at opportunities to increase access to palliative care for all those who need it.

This report - Palliative Care in Southern Africa: Review of legislation, policy documentation and implementation guidelines in ten Southern African countries - provides useful insights into how the issues reviewed have been addressed in Angola, Botswana, the Democratic Republic of Congo (DRC), Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia, and Zimbabwe, and offers suggestions on how governments can address these challenges at the policy level. While this report does not provide a review of all the possible national policies in each country, it offers some useful findings from key documents that could be relevant in palliative care development in the region.

The report was produced by the African Palliative Care Association and funded by the Open Society Foundations and the Open Society Initiative for Southern Africa. APCA, OSF and OSISA strongly recommend the inclusion of palliative care in national policies so as to ensure:

  • identification and setting of priorities for palliative care development in each country;
  • identification and allocation of resources needed to support these priorities and to provide a basis for resource mobilisation;
  • „„collaboration between relevant stakeholders, including governments, civil society, institutions of higher learning, and private agencies; and,
  • „„a framework for standards that can underpin access to effective palliative care, and appropriate planning.

All three organisations hope that this report will encourage southern African governments, other national stakeholders, and palliative care providers to work together to establish policies that will meet the palliative care needs of patients with life-threatening illnesses, reducing unnecessary pain and suffering in the region. 

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