Index:

The meeting brought together the growing number of palliative care practitioners across Africa to discuss the challenges and share experiences of delivering palliative care in resource poor countries. The event’s aim was to consolidate APCA as the organisation charged with promoting palliative care across the continent by coordinating efforts to provide training, support and standards of care for professionals and others involved in palliative care delivery. The meeting started with the first ever AGM for APCA and a selection of its board of directors.

The AGM was followed by a two day conference to share experiences of palliative care provision in sub-Saharan Africa. On the last day there was a consultative meeting with representatives of President Bush’s Emergency Plan for AIDS Relief (PEPFAR). More than $2.2 billion of the $15 billion pledged by the US government against HIV/AIDS in Africa has been earmarked for palliative care. This is the first global commitment of this magnitude and, APCA members hope, provides a major opportunity for the scaling up of palliative care provision across the continent.

Why Palliative Care?

Despite the huge numbers of people needing treatment and care as a result of the HIV/AIDS pandemic, the provision of palliative care remains extremely limited in sub-Saharan Africa. Few governments have mobilized the policies and resources to ensure that doctors, nurses and other professionals are equipped to provide appropriate and affordable care to the millions of people who need it. The availability of drugs for controlling pain and treating opportunistic infections remains a lottery. In some countries, restrictive laws which prevent or limit the use of oral morphine, for example, mean that patients and their families are suffering unacceptable levels of pain and distress unnecessarily.

Representatives from hospices and other programmes which provide home-based palliative care in different communities across 22 African countries came together for the event. The gathering also included donors to these programmes, including The Diana, Princess of Wales Memorial Fund, The Open Society Institute (SOROS) and representatives of President Bush’s Emergency Plan for AIDS Relief (PEPFAR), Help the Hospices, The Catholic Relief Society, The National Hospice and Palliative Care Association (NHPCO), The Federation of Hospices in Sub-Saharan Africa (FHSSA) and a representative from the Global Fund’s Technical Review Panel.

The highlights

The first edition of the APCA journal of palliative care was launched. Julia Downing, the Journal’s co-editor noted, "In the palliative care training declaration signed in Cape Town—three things stood out for me and there were the need for:
1) A regional palliative care association
2) A palliative care journal for the region
3) A palliative care text book for the region".

In Uganda, nurses and clinical officers have been permitted to prescribe morphine after undertaking nine months of palliative care training, which is a major step in ensuring the accessibility of palliative care drugs
In Tanzania, the Muheza palliative care project has been integrated into existing heath services through the district hospital, ensuring sustainability of palliative care provision.
The Palliative Care Association for Tanzania was launched during the conference.
In Kenya, a doctor-on-rotation programme ensures that trained doctors receive exposure to palliative care through Nairobi hospice before they are posted to the various health facilities in Kenya.
In South Africa, a mentorship programme involving 28 hospices is being used to
promote Integrated Community-based Home Care, with established organizations
providing guidance and support to those still developing.
In Zimbabwe, palliative care training is being offered to communities who are
providing the care. Although there is moderate government support for palliative care, champions mainly Island Hospice and The Hospice Association of Zimbabwe have also undertaken extensive training among health professionals.

APCA’s Role

Participants embraced APCA’s new board and agreed that APCA will be catalyst for
palliative care expansion across sub-Saharan Africa. They endorsed APCA’s various
objectives which are to:

• Promote the availability of palliative care for all in need.
  • Encourage governments in sub-Saharan Africa to support affordable and appropriate palliative care which is incorporated into the whole spectrum of health care services.
• Promote the availability of palliative care drugs for all in need.
  • Encourage the establishment of national palliative care associations in all African countries.
• Promote palliative care training programmes suitable for sub-Saharan African countries.
• Develop standard guidelines for training and care at different levels of health professional and care providers.