Regional Report: Africa
The African Association for Palliative Care (APCA) Special Article
Addressing the African palliative care agenda
Despite commendable advances, the palliative care agenda facing the resource-constrained countries of Africa remains considerable. By December 2007, an estimated 22.5 million people in Sub-Saharan Africa were living with HIV/AIDS. This is more than 60 per cent of the global disease burden, with over 2 million HIV-related deaths and 2.5 million new infections reported in the year alone from the region (UNAIDS / WHO, 2007). Additionally, of the approximately 12 million new cancer cases recorded in 2007, 662,300 (5.6 per cent) originated in Sub-Saharan Africa (American Cancer Society / WHO). This figure probably underestimates the true extent of the problem given the absence of accurate cancer registries, and the fact that patients’ expectations of disease-modifying oncological treatment are low, diminishing the number of clinical presentations (Anon, 2007a; Murray et al, 2005). Moreover, cancer rates in Africa are expected to grow by 400 percent over the next 50 years (Morris, 2003).
This formidable disease burden is compounded by inadequate palliative care service provision. For the overwhelming majority of Africans who currently endure these illnesses, access to culturally appropriate, holistic palliative care (that includes effective pain management) is at best limited, and at worst non-existent (Harding and Higginson, 2004). Sub-Saharan Africa has twice as many deaths per 1,000 head of population annually compared to that of North America, yet has only 1.5% of global palliative care resources compared to 55% in the latter (Anon, 2007b). Moreover, a recent survey found not only that 44.7% (21/47) of African countries had no identified hospice or palliative care activity, and that only 8.5% (n=4) could be classified as having services approaching some measure of integration with mainstream service providers (Clark et al., 2007).
Operational since early 2005, the African Palliative Care Association (APCA) recently released its three-year strategic work plan (APCA Strategic Plan 2007-10) to start addressing these challenges and fulfill its vision: everyone living in Africa with a life-limiting illness having access to quality palliative care that is delivered in an affordable and culturally appropriate manner. In order to realise this vision, APCA developed a strategic plan centred upon seven key objectives: advocacy; partnerships; education and training; standards of care; research, monitoring and evaluation (M&E), and information dissemination; financial sustainability; and capacity development.
Advocacy: Governments across the continent are encouraged to support affordable and appropriate palliative care, to be incorporated into the whole spectrum of health care services, and promote the availability of palliative care drugs for all in need…
Partnerships: To raise the profile, and coordinate the development, of palliative care in Africa, APCA has encouraged the development of operational partnerships, especially through the formation, and ongoing support, of new national palliative care associations (12 associations have to date been formed)…
Education and training: APCA is playing a leading role in creating a strong palliative care competence in Africa by facilitating the delivery of training programmes suitable for the continent…
Standards of care: APCA is developing and promoting quality standards for palliative care service provision and training…
Research, M&E, and information dissemination: Developing evidence-based services is a cornerstone of reflective palliative care development in Africa…
Financial sustainability: APCA has generated its own resources through establishing workable partnerships with international palliative care organisations, and fundraising strategies, and is engaged in developing staff and partners’ capacity in fundraising and grants management, undertaking organisational assessment and development within APCA and partners.
Capacity development: APCA continually strives to strengthen its organisational competency and potencyto support its activities.
APCA’s strategic plan is grounded in the existing deficiencies of palliative care across Africa. It is not anticipated that these shortcomings can, and will, be addressed imminently. However, there is now an impetus for change that will hopefully start to deliver the quality and quantity of palliative care services that people with progressive, life-limiting illnesses across the continent desperately need.
- In its relatively brief existence, APCA has harnessed that impetus, raising the profile of African palliative care. Indeed, in a number of African countries, there now exist palliative care country teams where previously knowledge of palliative care as a concept was negligible.
Because of space limitations the key objectives were shortened. To access the full copy of the APCA Strategic Plan, 2007-10, visit: www.apca.co.ug.
American Cancer Society / WHO) (2007) Global Cancer Facts and Figures. Atlanta, USA: American Cancer Society
Anon (2007a) London Declaration on Cancer Control in Africa. www.afrox.org/declaration.html
Anon (2007b) Global Health Council newsletter. May 14 2007
Clark D, Wright M, Hunt J & Lynch T (2007) Hospice and palliative care development in Africa: A multi-method review of services and experiences. Journal of Pain and Symptom Management, 33, 698-710
Harding R & Higginson IJ (2004) Palliative Care in Sub-Saharan Africa: An Appraisal. London: The Diana, Princess of Wales Memorial Fund
Morris K. (2003) Cancer? In Africa? Lancet Oncology, 4: 5
Murray SA, Grant E, Mwangi-Powell F (2005) Time to wake up to cancer’s toll. British Medical Journal, 331: 904
UNAIDS / WHO (2007) AIDS Epidemic Update. Geneva: UNAIDS
Richard K. Mugula, M&E Officer
Richard A. Powell, Monitoring & Evaluation & Research Manager
Dr Faith Mwangi-Powell, Executive Director
African Palliative Care Association, P.O. Box 72518, Kampala, Uganda
Contact: Richard K. Mugula
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