By Katherine Irene Pettus, PhD
IAHPC Advocacy Officer
The 67th World Health Assembly (WHA) generated a range of powerful discussions around palliative care and such related issues as Non Communicable Diseases (NCDs), hepatitis, access to essential medicines, traditional medicines, and universal health coverage, among other topics. Two packed side events focused specifically on palliative care, featuring speakers representing official delegations from all the World Health Organization (WHO) regions, as well as NGOs from a wide spectrum of member states. The week culminated in unanimous adoption of the first ever WHA resolution on palliative care, sponsored by Panama, co-sponsored by more than twelve member states, and endorsed by at least fifty others. During the debate which took place on Friday May 23, many delegates made detailed and positive interventions regarding their national palliative care programs and the need for the WHO to provide technical assistance and begin implementing the resolution throughout the world as soon as possible.
The fact that many of the interventions made in the discussion were made by countries where palliative care development is still limited, was particularly interesting and encouraging. The interventions revealed that there is more global surface area than advocates realized available to provide the sustainable funding, technical assistance, and transnational cooperation necessary to implement the resolution in coming years! Bahrain led the afternoon of speeches, followed closely by Lebanon and Jordan. Other Eastern Mediterranean region countries speaking strongly in favor of the resolution were Iraq, Oman, Egypt, Kuwait, and Libya.
Swaziland gave the statement for the 47 African region states (AFRO), emphasizing the need to develop pediatric palliative care, while both Uganda and Nigeria made stand-alone statements citing their history and progress in making palliative care available to their citizens. Uganda has made a unique and invaluable contribution to the AFRO region by developing the capacity to manufacture government sponsored oral morphine for home and inpatient care, education at all levels of the medical curriculum, and licensing program for nurse prescribers. Nigeria is developing the “Pain Free Hospitals” initiative, among many other innovative programs.
Delegates from Mexico, Guatemala, Costa Rica, Paraguay, Brazil, Colombia, Argentina, and of course Panama, the original sponsor, spoke in support of the resolution. Brazil emphasized palliative care as part of the right to the highest attainable standard of health, and Colombia promoted a comprehensive program and better access to opioid medicines within a framework of “pharmaceutical vigilance.”
European region interventions were made by representatives of Italy, Spain and Switzerland, Sweden on behalf of the Nordic countries, Germany and the Ukraine. Switzerland insisted on the fact that WHO must work productively with the Commission on Narcotic Drugs (CND) and the International Narcotics Control Board (INCB) in Vienna to improve access to controlled medicines around the world, where more than 80% of the population has low to no access to pain relief.
The Association of Southeast Asian (ASEAN) and Western Pacific WHO regions were represented by interventions from Japan, China, Chinese Taipei, Korea, Malaysia, Indonesia, Vietnam, the Maldives, Samoa, and the Philippines. Thailand was the only country to propose an amendment to the resolution, requesting that the title be changed from “Strengthening of palliative care as a component of integrated treatment within the continuum of care” to “Strengthening of palliative care as a component of comprehensive care throughout the life course.” In his own words, the Thai delegate wished the emphasis of the resolution to be on “care” as a continuum that includes psycho-spiritual attention within the home and the community, rather than on “treatment,” which implies only clinical facilities. This language resonates with another WHA 2014 resolution entitled “Multi-sectorial action for a life course approach to healthy aging.”
At a side event hosted by the ASEAN plus 3 countries on Universal Health Coverage, senior health officials from Malaysia, Thailand, and Indonesia responded in the affirmative to my question about which countries included palliative care in their universal coverage schemes. Either it is fully integrated, or the ASEAN countries are working towards integration. Whatever their place on the continuum, the idea that palliative care should be part of universal coverage, has been firmly introduced.
Canada and the US both made robust statements citing the need to integrate psychosocial as well as spiritual dimensions of palliative care into the healthcare system, as well as the imperative of improving access to pain medicine globally within the framework of the three drug control conventions. Australia called for the development of a palliative care indicator within the WHO framework to track how well countries were integrating the approach and how well citizens could access palliative care.
From l to r: Yvonne Luxford for Alzheimer’s Disease International, Cary Adams, for the UICC and partner organizations and Stephen Connor for the Worldwide Palliative Care Alliance and IAHPC, issued the final interventions by NGOs.
The International Federation of Medical Students Alliance also made a compelling statement on behalf of 108 National Member Organizations from more than 100 countries across six continents with over 1.2 million students.
All in all the afternoon ended in a celebratory mood, as the resolution, which was the fruit of more than a decade of dedicated advocacy, gave the WHO a clear mandate to reshape health policy by providing technical assistance to countries wishing to integrate palliative care into their healthcare systems. As Diederik Lohman, Senior Advisor to Human Rights Watch on palliative care issues, and a leader of the NGO delegation stated, “Now the real work of implementation begins.”
Links to the palliative care and other resolutions, and to related blogs on the WHA:
http://eapcnet.wordpress.com/2014/05/23/palliative-care-at-the-world-health-assembly/
http://eapcnet.wordpress.com/2014/06/01/a-deeply-respectful-programme-presentation-of-atome-outcomes-side-event-67th-world-health-assembly-in-geneva/
NGO statements at WHA:
https://apps.who.int/ngostatements/content/155-union-international-cancer-control-uicc
https://apps.who.int/ngostatements/content/155-worldwide-palliative-care-alliance
https://apps.who.int/ngostatements/content/155-alzheimer%E2%80%99s-disease-international
https://apps.who.int/ngostatements/content/131-international-federation-medical-students%E2%80%99-associations-ifmsa
If you have difficulty opening the above statements go to the following link and scroll through all statements:
https://apps.who.int/ngostatements/
NCDs, access to essential medicines, and Hepatitis Resolutions:
http://www.who.int/mediacentre/news/releases/2014/WHA-20140522/en/
http://apps.who.int/gb/ebwha/pdf_files/EB134/B134_R18-en.pdf
http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_BCONF6-en.pdf
http://www.ip-watch.org/2014/05/24/world-health-assembly-approves-plan-to-strengthen-access-to-essential-medicines/
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