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Millions in developing countries still denied access to palliative care

A helping hand

Ulrich Joho under a Creative Commons Licence

An estimated 40 million people across the world need palliative care each year. They include 20 million people approaching the end of life and those who need vital support to live with chronic, life-limiting conditions such as cancer and cardiovascular diseases. Yet only about three million people – less than 10 per cent of those who need it – can access it.

The figures are published today in a joint report by the Worldwide Palliative Care Alliance (WPCA) and the World Health Organization (WHO). ‘The Global Atlas of Palliative Care at the End of Life’ reveals startling global gaps in palliative care provision.

For example, around 80 per cent of the world’s population lacks adequate access to opioids for pain control. Yet richer countries such as Australia, Canada, New Zealand/Aotearoa, the US and several European countries account for more than 90 per cent of the global consumption of strong analgesics.

The ‘Global Atlas’ is the first document to map the need for and availability of palliative care globally. It shows that while 80 per cent of palliative care is provided in high-income countries, 80 per cent of the global need is in fact in low- and middle-income countries.

Despite these divisions, the report also highlights examples of growth in palliative care services and successful models of care embedded in community-based healthcare systems that bode well for the future.

While Africa has the majority of children who need palliative care at the end of life, it is also the continent which has seen the most significant increase in palliative care services in recent years.

In addition, the community-based model of palliative care – which centres on training and empowering volunteers to provide such care in their communities – has proved very successful in several developing regions, including in Africa and India.

In Kerala, in southwest India, for example, the Neighbourhood Network in Palliative Care trains local volunteers to support chronically ill people in their community and intervenes when needed with support from a network of trained staff.

Within 10 years, it has grown into a vast network of more than 500 community-owned palliative care programmes looking after more than 15,000 patients at any one time. It now has a workforce of over 15,000 trained community volunteers, 50 palliative care physicians, and 100 palliative care nurses.

There have also been successful projects to develop new approaches to improve home-based palliative care. The Continuum of Care for People Living with HIV/ Aids was a project set up in Tanzania to expand palliative care services by linking them with existing Lutheran hospitals and church congregations throughout the country.

This multi-agency project was implemented by the Evangelical Lutheran Church of Tanzania and has grown to become one of the major health-service providers in the country: nearly 15 per cent of the population benefits from its services.

The report recommends a series of measures to expand access to palliative care. They include: a major scale-up of palliative care services and integration of these within healthcare systems; tackling barriers preventing access to essential palliative medicines (especially oral opioid analgesics); and addressing education and training issues by integrating palliative care in professional training in nursing and other branches of medicine.

The report is published amidst some encouraging signs of change for the palliative care sector. Last week, the WHO’s Executive Board adopted a ground-breaking resolution that will bolster palliative care services across the world and sends a strong signal that this area of healthcare is finally moving up the international health agenda.

Given the world’s ageing population and the increasing numbers of people living with chronic non-communicable diseases, there is more demand for this type of care than ever.  Yet despite significant advances in palliative care over the last 40 years in developed countries and increasing calls for it to be recognized as a human right, there remains more to be done to make universal access for all a reality.

David Praill is Co-Chair of the World Palliative Care Alliance (WPCA) and also Chief Executive of Britain’s leading hospice charity Help the Hospices.

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