Photo: Home care workers meeting courtesy of True Colours Trust staff

Photo: Mother and child holding hands. Copyright Nadia Bettega

Integrating palliative care into the public health system in Kenya and Malawi

The True Colours Trust is supporting the Kenya Hospice and Palliative Care Association (KEHPCA) and the Palliative Care Association of Malawi (PACAM) to integrate palliative care into the public health system in Kenya and Malawi respectively.  The programme in Kenya has a national remit and is working through 11 of the country’s county referral hospitals (former provincial/level 5 hospitals) while the programme in Malawi is district based, operating through the 13 district hospitals of the country’s Southern Region.  Work in both countries includes palliative care for both adults and children.

The approaches used in each country are distinct as the programme design is based upon the structure of the national public health system and specifically identified needs in each location.  However, there are a number of similarities including the following:

  • a focus on working with hospital management;
  • the provision of training and mentorship in palliative care and pain management to all cadres of health professionals as well as community volunteers;
  • establishing designated palliative care clinics within hospitals and improving systemic access to pain relief and other essential palliative care drugs.

The programmes grew out of the Waterloo Coalition: a time limited initiative to improve significantly access to palliative care in Malawi and Kenya between April 2011 and December 2012 (more information on the Waterloo Coalition can be found below).  The Trustees were impressed by the scale of impact both projects had during the life of the Waterloo Coalition and by the significant increase in the number of patients able to access palliative care services as a result.  The Trustees therefore decided to continue funding the programmes once the Waterloo Coalition came to an end.

The Evidence Centre, a UK based specialist in monitoring and evaluation, has provided KEHPCA and PACAM with training, mentorship and support in M & E throughout the programmes, helping them ensure that the programmes’ successes and challenges are accurately recorded to inform practice and communication with government and other key stakeholders.

The work in Kenya and Malawi has continued to go from strength to strength.  Figures from the latest reports indicate that in Kenya 10 out of the 11 county referral hospitals now have consistent access to morphine and in Malawi 11 of the 13 district hospitals also have consistent access to morphine (classed as 75% of the time in Malawi).  When the projects began in September 2011 none of the hospitals had consistent access to morphine which is essential for effective pain relief.  The statutory authorities should be commended for their respective support to KEHPCA and PACAM, their recognition of the needs of people with life-limiting and life-threatening illnesses and the steps they have taken to ensure that these gains are sustainable.  In Kenya the government released National Palliative Care Guidelines and an accompanying training curriculum, Cabinet Secretary of Health has pledged to include palliative care in the national budget and the government has increased significantly its orders of morphine powder to ensure supply matches demand.

The programmes are ongoing and Trustees have every expectation that further gains will continue to be made.

Additional information on the Waterloo Coalition can be found here.