New report to facilitate the integration of palliative care into the public health system in Africa
We asked The Evidence Centre to undertake a qualitative evaluation of the two flagship programmes we funded through the Waterloo Coalition to integrate palliative care into public hospitals in Kenya and Malawi. The programmes were led by the Kenya Hospice and Palliative Care Association and the Palliative Care Support Trust in Malawi.
The Evidence Centre found that the programmes suggest the following ten top tips for regional programmes wanting to set up similar services:
❶ Approach the senior decision makers in local areas and at government level to help them understand what palliative care is and that patients can be helped.
❷ Ask managers to set aside resources for palliative care, including enough money to purchase pain relief medications regularly and maybe a motorbike or bicycle for outreach visits. This can improve staff morale, as well as reducing patient suffering.
❸ Approach traditional leaders and other community stakeholders so they are aware of the programme and can pledge support publicly. Local leaders can refer others and can encourage healthcare professionals and managers to prioritise palliative care.
❹ Include a pharmacist on the team helping to set up palliative care. The pharmacist can work with central medicines supply organisations to improve access to pain relief medications because professionals may become disillusioned if medicines are not available. The pharmacist can also run training about prescribing opioids.
❺ Allocate a hospital room that is large enough to be used as a palliative care clinic so palliative care is visible and so a specific palliative care team can be formed.
❻ Make sure that at least one or two people have palliative care as their whole job role, so they do not have to juggle doing other things.
❼ Train as many people as possible, from all cadres of health professionals. Training could be run once each year to provide a refresher and to account for staff turnover. It is important to select people carefully to take part in training. These people need empathy and compassion and have to be able to use what they learn in practice.
❽ Offer clinical placements as an integral part of training, rather than an add on, so professionals can see how palliative care works in practice – and include follow up support to keep professionals and managers motivated, such as regular telephone calls or mentoring visits.
❾ Run short awareness-raising orientation sessions so staff on hospital wards learn about the palliative care clinic and know how to make referrals.
❿ Set up simple ways to monitor progress. Keep evaluation easy and quick, and share successes regularly.
More detailed recommendations for those wishing to develop palliative care in individual hospitals or on a regional or national scale are listed on pages 29 and 30 of the full report, Developing Palliative Care: key lessons from programmes in Kenya and Malawi. The Evidence Centre also produced a standalone checklist for those wishing to integrate palliative care into individual hospitals or into the public health system through a broader programme entitled, Developing Palliative Care- checklist.
The reports are available to download below or in the report section of our website.