Palliative Care in sub-Saharan Africa
Recent developments include the following:
PEPFAR Public Health Evaluation - Care and Support
The President's Emergency Plan for AIDS Relief (PEPFAR), funded by the U.S. government, is the biggest programme ever launched against a single disease. Its three objectives are:
- prevention of new infections
- treatment with antiretroviral therapy
- palliative care (now called care and support)
Dr Richard Harding and Vicky Simms, with former colleague Dr Suzanne Penfold, carried out a mixed-methods public health evaluation of PEPFAR care and support in 2007-2008, in collaboration with the African Palliative Care Association.
Phase 1: A survey of 120 care facilities in Kenya and Uganda, found that over 90% of facilities provided some level of clinical, psychological,and preventive care. Pain control was very limited with paracetamol often the only analgesic. In focus group discussions, patients appreciated free care and positive attitudes from staff, but said that services would be improved by more staff, shorter queues, and reliable drug supplies.
Phase 2: Phase 2 consisted of a longitudinal cohort study to measure patient-reported outcomes of care and support, a costing survey, and qualitative interviews to understand patient and carer experiences.
Report for Diana Foundation
In May 2004, Dr Richard Harding and Professor Irene Higginson launched their report "Palliative care in Sub-Saharan Africa: an appraisal". The report, commissioned by the Diana, Princess of Wales Memorial Fund, is a wide-ranging review and appraisal of current activity and evidence of palliative care activity.
Due to the impact of both the HIV epidemic and increasing cancer rates, palliative care is increasingly recognised by policy makers, funders and pratitioners as a crucial component of public health provision in Sub-Saharan Africa. Historically, pain and symptom management, particularly the provision of opioids for chronic pain, have been largely absent. However, significant developments have been achieved, and it is timely to consider the evidence base for current and future resource allocation. The report reviews the context, practice, challenges and needs by appraising the available scientific and grey literature. Recommendations are presented for practitioners, funders, researchers and policy makers.
Paediatric palliative care in sub-Saharan Africa
In 2010 Diana Princess of Wales Memorial Fund and King's College London published a report on paediatric palliative care in sub-Saharan Africa.
In addition, our study of sub-Saharan African end of life HIV care providers is available here.