Featured Article

2016; Volume 17, No 8, August

Featured Article

Dr. Natalie Greaves

Palliative care advancing the cause through evidence-based advocacy

Dr. Natalie Greaves is our guest writer this month, together with colleagues, Dr. Natasha Sobers-Grannum and Dr. Heather Harewood.

Dr. Greaves is a founding director of the Barbados Association of Palliative Care and the Chairperson of the National Advisory Committee on Chronic Pain Management, Barbados.

Dr. Natalie Greaves, Dr. Natasha Sobers-Grannum and Dr. Heather Harewood, Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, Barbados.

As health professionals and carers involved in providing palliative care we stand daily on a battlefront that many others around us are hard-pressed to understand. Time and time again, we see levels of suffering, in combination with grace and peace, which inspire and motivate us to give more of ourselves. However, sometimes in spite of our best efforts our ability to care is terribly hampered by lack of resources; resources ranging from lack of trained personnel to assist in the work of palliative care delivery, to struggles with access to essential drugs in the quantities and formulations that our patients and loved ones need. 1 These frustrations often motivate us to advocate and to give voice to the voiceless. As we seek to effectively advocate, year after year, our arguments must continually draw strength from the research evidence base that supports the provision of palliative care if they are to remain effective. Evidence that shows that although palliative care is recognized to improve the quality of life of patients with cancer and non-cancer illnesses, only 14 percent of the estimated 40 million persons who need palliative care annually receive it. 2

In addition to the above evidence, we can also remind health decision-makers in our respective countries that by definition palliative care is part of Universal Health Coverage (UHC).

Universal Health Coverage is defined as ensuring that;

“. . . all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.”

Health Financing for Universal Health Coverage, World Health Organization. (Accessed 29 July 2016).

When deciding on services to include in an essential basket of health services policymakers must consider palliative care services. As they do this, they will need to discuss:

Who is eligible for care?
What kinds of services will they be provided with?
How much of these services is to be covered? 3

As palliative care providers, we should be involved in this process and have an important role to play in generating the additional research evidence needed to inform such UHC planning.

Let us rise to the occasion within our respective regions to build a strong palliative care evidence base – optional inclusion of palliative care in UHC services to populations is no longer tenable.


1 Connor Stephen R, Sepulveda Bermedo Maria Cecilia. (eds.) 2014. Global atlas of palliative care at the end of life. (London): Worldwide Palliative Care Alliance. (Accessed July 28, 2016)
2 World Health Organization Palliative Care Fact Sheet. (Accessed July 28, 2016).
3 Bruse, R., 2013. Defining the Basket of Services for Ireland’s Universal Health Insurance System: Insurance System: Content and composition of health basket. (Accessed 29 July 2016).


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