The Waterloo Coalition: a collaboration to dramatically improve access to palliative care in Kenya and Malawi
The Waterloo Coalition was a time-limited initiative to improve significantly access to palliative care in Malawi and Kenya between April 2011 and December 2012.
It comprised The True Colours Trust and The Palliative Care Initiative of The Diana, Princess of Wales Memorial Fund, each of whom provided £300,000 towards the initiative, and four other international palliative care organisations: the African Palliative Care Association (APCA), the Global Access to Pain Relief Initiative (GAPRI), the International Children’s Palliative Care Network (ICPCN) and the Worldwide Palliative Care Alliance (WPCA). The Open Society Institute’s International Palliative Care Initiative, the Foundation for Hospices in sub-Saharan Africa (FHSSA) and EMMS International have observer status. Alongside funding, the Coalition members were also able to provide technical support.
The two countries were selected from the Diana, Princess of Wales Memorial Fund’s seven focus countries following a comprehensive assessment of current opportunities and capacity in each country. The time-line was set to coincide with the closure of the Diana, Princess of Wales Memorial Fund in December 2012. The Coalition first met in November 2010 in Waterloo, London and took its name from the location of its first meeting.
The Coalition worked pro-actively to identify and support in-country partners who could work alongside government providers to increase the number of patients accessing palliative care. This was done by replicating successful projects, training staff and ensuring access to essential drugs.
Because the Coalition was a time-limited initiative it was outcome focussed. Successful applicant organisations had to report against quarterly targets, have clear achievable objectives and be sure that they could accomplish all that was laid out in their application by the end of December 2012.
The Coalition approved grants to:
- The Palliative Care Support Trust in Malawi towards an 18-month project (STEP UP) to establish palliative care services in six district hospitals and communities in Malawi’s southern region.
- The Kenya Hospice and Palliative Care Association (KEHPCA) towards a 12-month project to establish palliative care services in 11 provincial and level 5 (referral) hospitals.
- The Kenya Hospice and Palliative Care Association (KEHPCA) towards a joint initiative with the Kenya Medical Training College to develop a higher diploma in palliative care nursing.
- The International Children’s Palliative Care Network towards two supervision visits to support the roll-out of children’s palliative care to three regional hospitals in Malawi.
- Partners in Health – Abwenzi Pa Za Umoyo in Malawi to integrate palliative care into Neno District Hospital.
- EMMS International to integrate palliative care services into Ekwendeni Hospital in northern Malawi.
- The African Palliative Care Association and The Evidence Centre to evaluate the two largest programmes.
The final reports were received in 2012 and further grants made to KEHPCA and to STEP UP which is now a project within The Palliative Care Association of Malawi (PACAM).
In both Malawi and Kenya, there has been a significant increase in the number of people who have been able to access palliative care and appropriate pain relief as a result of funding from the Waterloo Coalition. Health professionals have been trained and undertaken clinical placements, new palliative care units have been established in a number of hospitals and systems for ordering and supplying morphine have been strengthened.