Optimizing Quality of Life through Palliative Care for Adults and Children affected by Cancer The Public Health need for Palliative Care for Adults and Children with Cancer Dr Emmanuel Luyirika 105M-T3 Track Disclosure of interest: None
Outline of presentation WHO Public Health Strategy for Palliative care Key statistics Burden of disease Progress in palliative care Key challenges Way forward
The WHO Public Health Strategy for PC Policy Education Medicines availability Implementation
African statistics Africa has: 55 countries a population of 1.2 billion 40% of the population below 15 years 26% of the world refugee population (Uganda alone has over 1 million) 16 million people are displaced or refugees Only 27 countries in Africa have access to Radiotherapy major language groups are Francophone, Anglophone, Lusophone and Arabic speaking areas
Burden of disease Africa has 800,000 new cancer patients per year >80% of patients present late Cancers linked to infectious agents such as Hep B, HPV, HCV, etc. common in Africa Very poor coverage of palliative care in all aspects except in South Africa and very few other countries Less than 10% palliative care coverage of those in need Almost half of Africa has no access to radiotherapy Very low survival rates about 13% in Uganda
Palliative care progress in Africa National palliative care policy development Seven countries namely Rwanda, Swaziland, Zimbabwe, Mozambique, Tanzania, Malawi and Botswana have national palliative care policies which also include children Uganda has a draft awaiting final approval Botswana has a policy which entrenches govt support for hospices and CSOs, & Palliative care in medical aid National PC strategies/pc in other health guidelines/ cancer control plans: Botswana, Malawi, Kenya and Zimbabwe. South Africa has several national palliative care frameworks in the making
Palliative Care policy development in Uganda
Palliative Care Policy development in Botswana
Palliative care progress in Africa Essential Palliative Care Medicines and technologies Over 10 countries Uganda, Kenya, Swaziland, Malawi, Tanzania, Rwanda, Zimbabwe, South Africa, Botswana, Nigeria, Zambia have access to oral morphine Outside South Africa national coverage is still poor Oral morphine reconstitution is now happening in Uganda, Swaziland, Malawi, Tanzania, Kenya, Nigeria, Rwanda Pain management guidelines developed for 3 countries; Botswana, Malawi and Uganda.
Palliative care progress in Africa Essential Palliative Care Medicines and technologies Countries using liquid oral morphine have adopted national centralised or regionalised low cost morphine reconstitution technologies Use of mobile phone technology to track opioid stocks piloted in Africa, Uganda (APCA with Honexus and also PCAU and MoH) etc. The South Africa Medicines availability task team is reviewing Essential Medicines List and lobbying for nurse prescribing scheduled medicines Nurse opioid prescription in Uganda with other African countries considering task shifting opioid prescription
Palliative care progress in Africa Essential Palliative Care Medicines and technologies Several experiential visits for South-to-South peer learning for access to PC medications were supported by APCA and these include countries; Kenya, Malawi, Botswana, Mozambique and Swaziland etc. Several African countries have palliative care medicines in the Essential Medicines list: Uganda, Kenya, Tanzania, Swaziland, South Africa, Namibia, Rwanda, Mozambique etc. Essential cancer diagnostic technologies are inadequate.
A case for oral liquid morphine (Hospice Africa Uganda)
Oral Morphine reconstitution- HAU
Palliative care progress in Africa Human Resources for palliative care Specialist Palliative Care education in Uganda, South Africa, Tanzania, (Malawi) at certificate, diploma and degree levels and integration into curricula in Uganda, Kenya, 21 different awareness and educational tools have been developed and shared in 19 African countries; Uganda, Rwanda, Kenya, Tanzania, Zambia, Ghana, Malawi, The Gambia, Botswana, DRC, Zimbabwe, Swaziland, Mozambique, Namibia, Togo, Ethiopia, Cameroon, South Africa and Nigeria PC awareness activities have benefited 10000 stakeholders in 22 countries: Uganda, Burundi, Rwanda, Kenya, Zambia, Malawi, The Gambia, Botswana, DRC, Zimbabwe, Swaziland, Mozambique, Namibia, Togo, Tanzania, Ethiopia, Sudan, Cameroon, South Africa, Cote d' Ivoire, Ghana and Nigeria.
Palliative care progress in Africa Human Resources for palliative care Nine countries have PC training packages; Zimbabwe, Tanzania, Malawi, Uganda, Kenya, Mozambique, Swaziland, Botswana and Namibia. APCA has supported PC training for over 3975 pre and in-service health care workers in 14 countries over the past 5 years in; Uganda, Kenya, Tanzania, Zambia, Namibia, Zimbabwe, Mozambique, Botswana, Nigeria, Malawi, The Gambia, Swaziland, DRC, Sudan. The only paediatric palliative care diploma is running at Mildmay Uganda
Palliative care progress in Africa Palliative Care Service Delivery With American Cancer Society support several hospitals and Cancer Institutes are improving access to pain management in Uganda, Nigeria, Ghana, Swaziland, Botswana, Ethiopia, Mozambique, etc. With funding from True Colours Trust and THET UoE, Diana Fund, Global Partners in Care, AIHA etc., over 100 hospices and health facilities across Africa are offering palliative care Quality improvement programmes through the APCA standards audit have been done in Uganda, TZ, Malawi, Zambia, Zimbabwe, Kenya covering over 10 sites
Palliative care progress in Africa Financing for palliative care Some national health budgets covered different aspects of palliative care: Kenya, Uganda, Botswana, Swaziland, Malawi, South Africa and Rwanda. Botswana in its new palliative care policy commits to give financial resources to designated non-state hospices and palliative care organisations Most Palliative care initiatives in Africa funded from non-government sector Only Ghana and Rwanda health insurance covering some aspects of palliative care
Palliative care progress in Africa Strategic information Some countries have included palliative care indicators in HMIS; Uganda Utilising of M health Palliative care research in some of the countries African Palliative Care Research Network with North-to South collaborations
Palliative care challenges in Africa Policy: Over 40 countries have not developed palliative care policies Medicines: Many countries have no access to pain medicines in the public and private heath system, Service delivery coverage is still below 15% of the need Palliative care Financing is still lacking with majority of palliative care funded out of pocket, NGO funded Lack of comprehensive national health insurance covering palliative care Palliative care integration into cancer institutes is also not funded Recognition of palliative care and oncology specialists
Inequity in Access to Cancer Care (Example of radiotherapy) 23 African countries without RT
Way forward Need to work with countries to integrate palliative care into all cancer care initiatives by: Developing palliative care policies that cover children and adults Increasing cancer and palliative care human resources including paediatrics Availing palliative care medicines for both adults and children esp. opioids Inclusion of palliative care indicators into national health management information systems Improving national domestic budgetary allocations for palliative care Increasing points of palliative care delivery including cancer sites, hospitals, community and homebased initiatives and programmes Increasing evidence-based models of paed and adult palliative care delivery Addressing the RADIOTHERAPY gap in Africa
Thank you to our palliative care donors and partners in Africa