The content of this section is under the coordination of Dr. Katherine Pettus, PhD, the IAHPC Advocacy Officer. If you wish to suggest any additional resources to add to this page, please contact Dr. Pettus via our website.
Agenda Item 3.1 on Draft General Program of Work
IAHPC welcomes the new standalone paragraph 38 in the Draft GPW13, which recognises the need to increase palliative care provision around the world for children, adults, and older persons. We also welcome the explicit inclusion of palliative care in the spectrum of UHC essential services. We draw member states’ attention to the recently released Lancet Commission Report “Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage”. The Lancet Commission Report resulted from a three year project involving 61 co-authors from 25 countries. It presents an Essential Package of palliative care services, including medicines, equipment and staffing models that health systems worldwide must provide. It also calls for more balanced global policies to facilitate access to opioid analgesics such as oral morphine to meet legitimate medical need, and limiting non-medical use. The Commission estimates global need for palliative care and pain relief using a new measure of Serious Health- related Suffering. An estimated 25.5 million people died with serious health related suffering – nearly half of all deaths worldwide, in 2015. This includes 2.5 million children aged under 15 (representing more than 1/3 of child deaths). More than 80% of the children, adults and older persons needing palliative care live in the LMICs. The IAHPC and Lancet Working Group is standing by to assist member states in developing policies and budgets to implement the Essential Package.
Palliative care cannot be a substitute for improved access to public health interventions and treatments that could have prevented much suffering and premature death in the first place. But, equally, no health system can expect to meet the needs of its people without providing access to basic pain relief and palliative care.
For more information and advocacy messages see hospicecare.com
Agenda Item 3.6 Access to Medicines
IAHPC notes that availability of internationally controlled essential medicines for legitimate medical purposes has improved in some WHO member states. However, much work remains to make these medicines accessible and affordable to meet palliative care needs of patients and families in countries reporting low to no consumption, according to the International Narcotics Control Board. IAHPC works closely with the INCB, the Commission on Narcotic Drugs and with CICAD at the Organisation of American States, to ensure the rational improved availability of controlled medicines while preventing non- medical use. We are committed to assisting WHO member states to implementing WHA 69/25 on access to medicines. These include internationally controlled essential medicines for the relief of pain and palliative care. We commend the WHO Secretariat for including an indicator for palliative care development in the GPW13, and an attainable target for member states. The WHO Guidance states clearly that palliative care provision requires access to essential medicines (including for example, oral morphine), training, education of health care professionals, public policy, and a small share of the health budget. Our global membership is a resource of expert providers from diverse cultures and contexts. We offer technical assistance to assess the proposed WHO palliative care indicator and target, and can assist with professional education and training programs upon request. Basic training and education of providers is the most safe and ethical way to relieve patient suffering. It supports a resilient culture that prevents diversion and non- medical use of controlled medicines. IAHPC recently collaborated with UNODC to prepare the recent “Technical Guidance on Increasing Access to and Availability of Controlled Drugs for Medical Purposes: Key Areas of Focus” to be discussed with WHO at the next regular meeting of the Commission on Narcotic Drugs. See http://bit.ly/2mVZxB6, hospicecare.com
The World Health Organisation (WHO) has just issued its revised Draft Program of Work (GPW13), which will be discussed later this month at the EB Meeting. Palliative care advocates worked hard to ensure that the GPW includes good language on the need for palliative care in sections pertaining to Universal Health Coverage (UHC), communicable and non-communicable diseases (NCDs) and ageing. The new daft has much improved language and a stand-alone paragraph on palliative care. The WHO Technical Team will soon release an indicator on internationally controlled medicines, to be included in the Impact Framework.
The text of the Draft GPW, to be discussed during the upcoming WHO Executive Board meeting, can be found here. There are several references to palliative care outside the stand-alone paragraph, which reads as follows.
38. "There is limited availability of palliative care services in much of the world, which contributes to much avoidable suffering for millions of patients and their families. WHO will emphasize the need to create or strengthen health systems that include palliative care as an integral component of treatment within the continuum of care. The Organization will promote the adequate availability of internationally controlled essential medicines in palliative care, including for the management of pain, while preventing their diversion and abuse.”
Proposed target: Increase the availability of oral morphine in facilities at all levels from 25% to 50%
38. "Hay una disponibilidad limitada de servicios de cuidados paliativos en gran parte del mundo, lo que contribuye a un sufrimiento evitable para millones de pacientes y sus familias. La OMS enfatizará la necesidad de crear o fortalecer sistemas de salud que incluyan los cuidados paliativos como un componente integral del tratamiento en el continuo de la atención. La Organización promoverá la disponibilidad adecuada en cuidados paliativos de medicamentos esenciales controlados internacionalmente, incluyendo aquellos para el tratamiento del dolor, al tiempo que se prevendrá su desviación y abuso".
Meta propuesta: Aumentar la disponibilidad de morfina oral del 25% al 50% en las instituciones de todos los niveles de atención
What you can do. IAHPC is urging national and regional associations, members, and friends, to advocate with their governments to support the GPW, the palliative care language, and proposed palliative care indicator. Provider advocates should identify the officials in their their government responsible for relations with WHO, and get the contact information for their country’s representative at the WHOEB in Geneva. These may be the same or different people. They should introduce themselves to that person, and should prepare a paragraph for them on how their government is working to include palliative care and controlled medicines in their public health programs. This can include successes and challenges, and invite them to get in touch with your National Association — give them the name and contact info of a specific person who can respond to them.
You can send this specific paragraph to your government officials with, or separately from, the more general Advocacy Note we will send out shortly. This will allow your government delegations to make an oral intervention from the floor of the WHO EB meeting concerning the state of palliative care and progress towards Agenda 2030 (SDG Target 3.8) in your countries. Without your giving them this information, the delegation might not know what is happening, and therefore will be unable to address the topic. Government interventions are usually prepared a week or more before the event, so the sooner you can prepare this information and get it to your government officials, the better.
We are in the process of developing an Advocacy Concept Note and will post it as soon as it is approved.
Please do not hesitate to contact me if you have any questions.
Thanks in advance for your work, Katherine Pettus, Advocacy Officer.
Regional and national palliative care organisations should read and reflect on these questions, and answer them to the best of your ability. Then send them to IAHPC so that we can compile one submission for the OEWGA9. Deadline to send to IAHPC is April 1.
For any questions, please write to me at firstname.lastname@example.org
Advocacy is defined as "the act of pleading for, supporting, or recommending.”
IAHPC pleads for, supports, and recommends policies that
The IAHPC Advocacy Program engages with policymakers and non-governmental organisations at multiple levels (international, regional, national, and municipal) to raise awareness about the need for palliative care and to advance the IAHPC Mission.
As an organisation in official relations with the World Health Organisation, IAHPC advocates for palliative care policies that align with the World Health Organisation definition and WHA Resolution 67/19.
We partner with other global, regional, and national palliative care organisations, as well as with other global health organisations, and non-governmental organizations that support the rights of vulnerable populations, including older persons. Our global advocacy partners include, but are not limited to: the Worldwide Hospice and Palliative Care Alliance, the International Children’s Palliative Care Network, the Pain and Policy Studies Group, Union for International Cancer Control, NCD Alliance. Our regional partners include, but are not limited to, The African Palliative Care Association, the European Palliative Care Association, the Asia Pacific Palliative Care Hospice Palliative Care Network.
Below is a list of future and ongoing advocacy opportunities and relevant documents for each, including IAHPC statements and interventions
Non-Communicable Diseases Meeting Uruguay 2017, UNGASS 2018
Agenda 2030 and High Level Political Forum
Open Ended Working Group on Ageing #9 2018
World Health Organisation Executive Board Meeting and Assembly 2019
Commission on Narcotic Drugs UNGASS2016 and 2019
Advocacy and Opioid Availability Workshops (Montevideo, Bogota, Guatemala City, San Salvador)
In this section you will find a list of resources and tools that we hope you will find useful in your effort to advance palliative care policies in your country/setting.