Policy and Advocacy

2015; Volume 16, No 10, October

Implementation of opioid analgesics in Senegal: An important step in the management of pain and palliative care

Dr. Oumar Ba

Dr. Oumar Ba Medical Oncologist and Coordinator of National Tumors Registry, Ministry of Health, explains how a recent workshop in Dakar aims to bring big changes to healthcare policy in Senegal.

The resolution adopted in 2014 by the World Health Assembly states that palliative care needs will continue to grow, and calls on all countries to integrate palliative care into their health systems to end preventable suffering through the use of appropriate medicines. This short article explains how we, in Senegal, responded to the challenge.

On 18-20 August 2015, the Ministry of Health and Social Welfare, in association with the National Supply Pharmacy (PNA), and with the support of the World Health Organization (WHO), organized a major workshop for health professionals in Dakar. The aim of the workshop was to evaluate Senegal's need for opioid analgesics and anti-cancer medicines and a distribution network for morphine products.

The Dakar workshop: Willhem Scholten, Consultant – Medicines and Controlled Substances (left), with Dr Cheikh Dia, President of the Order of Private Pharmacies

The workshop enabled us to create an inventory of palliative care in Senegal. In 2015, the National Pharmacy Supply will receive its first delivery of immediate-release oral morphine (10 and 20mg) and sustained release (30mg). Oral morphine, added to the list of essential drugs in 2012, is in short supply and is frequently out of stock. In 2014, despite the forecast of past national morphine needs of 1.2 kg to 12 kg, supplies were far from covering the estimated annual needs of 700,000 Senegalese under palliative care.

The main challenges confronting us in Senegal that require urgent solutions are:

Palliative care is not integrated into our health system, apart from a few public health institutions.
A lack of palliative care training for health professionals.
Inadequate provision of anti-cancer drugs and analgesics, both in terms of quality and quantity.

Participants at Dakar workshop: On the left is Dr. Laity Gning, of PNA

The workshop programme has enabled us to:

Share the WHO guidelines on palliative care.
Reassess morphine needs and immediately cover the current demand of 14.292 kg. To achieve our long-term goal of 212 kg of morphine per year, we need to increase the number of prescribers and increase our annual target for consumption statistics by 10 %.
Revise table II of the regulations in order to end the limit of seven days for morphine prescriptions and increase it to 28 days to allow greater access to opioids.
Establish a secure distribution channel for opioids through the PNA distribution network.
Identify the training needs of healthcare professionals with regard to palliative care and good prescribing practices of morphine derivatives. (A survey of the skills and practical knowledge of palliative care health professionals will be made shortly with the support of Human Rights Watch).
Strengthen the PNA-Wholesale Pharmacists partnership to secure improved availability and quality of opioid analgesics and anti-cancer medicines controlled by the National Drug Control Laboratory.

This workshop is an important step forward in the new health policy for Senegal to enable access to palliative care and support for patients.

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Dr. Oumar Ba.

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