Policy and Advocacy

2018; Volume 19, No 12, December

Policy and Advocacy

This month, Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, shares a pair of reports from IAHPC delegates who attended international meetings in October and November.

The Global Conference on Primary Health Care:
25-26 October 2018, Astana, Kazakhstan

Report by IAHPC delegate Ms. Gulnara Kunirova, Kazakhstan Association of Palliative Care

I wore two delegate hats at the Astana meeting: one for IAHPC, and the other for the Public Council of the Ministry of Health of Kazakhstan.

This experience was very both exciting and rewarding. Fellow delegates were Drs. Katherine Pettus, Sébastian Moine, and Santiago Correa. We made up a small, but very effective palliative care community in the conference, and each of us used every opportunity to network and spread awareness and knowledge.

I was glad to be a witness of this historical moment when Heads of State and Government ministers clearly committed to making palliative care — along with promotive, preventive, curative, and rehabilitative care — accessible to all. [The Astana Declaration text is here.]

PC part of Kazakhstan health care budgeting speech

I was proud to hear the Minister of Finance of Kazakhstan mention ‘palliative care’ in his speech devoted to health care budgeting. In Kazakhstan, palliative care is included in the so-called ‘guaranteed package of free medical care,’ which covers socially sensitive diseases like ischemic heart disease, diabetes, cancer, tuberculosis, and others.

PC advances noted, death superstitions discussed

The special event on Primary Health and Palliative Care was one of the most interesting. The Russian Minister of Health, Veroníka Skvortsóva, talked about the recent significant advancement of palliative care in Russia, while the Uzbekistan Minister of Health, Alisher Shadmanov, shared realistic concerns and optimistic plans for future development of palliative care in his country. Dr. Benjamin Koh, the Singapore Health Ministry representative, spoke about death superstitions in a country where the history of palliative care dates back to the early 1960s.

PC: An ethical responsibility beneficial to all

I made my modest contribution to the session with a reminder that aссessible and affordable palliative care integrated into the health care system is not only an ethical responsibility of any government, it is also beneficial to all from the point of view of economic efficiency, social justice, patient satisfaction, improvement of clinical practice, and prevention of professional burnout among medical workers. My unedited report is here.

Notes from Katherine: See Dr. Sébastien Moine’s EAPC Blog on the meeting.

I encourage colleagues to learn more about advocacy and apply to participate with us at meetings WHO and Commission on Narcotic Drugs meetings.


41st Expert Committee on Drug Dependence:
12-16 November, Geneva, Switzerland

Report by IAHPC delegate Dr. Ebtesam Ahmed, D.Pharm

On November 12, I attended the 41st Expert Committee on Drug Dependence (ECDD) open session representing IAHPC, a ‘non-state actor’ in official relations with the World Health Organization (WHO). The committee discussed, among other topics, whether or not to recommend that tramadol, an opioid pain medication used to treat moderate to severe pain in many countries, should be listed in one of the schedules of the international drug control conventions. Currently, tramadol is not scheduled or subject to international control as morphine or fentanyl are, although it is regulated at the national level in many countries worldwide. I attended to present the IAHPC case against scheduling. Read my unedited report here.

Dr. Mariângela Simão, WHO Assistant Director-General for Drug Access, Vaccines, and Pharmaceuticals, opened the meeting and welcomed participants. Dr. Gilles Forte, Secretary, WHO Expert Committee on Drug Dependence, provided an overview of the ECCD committee, an independent group of experts in the field of medicines and substance use disorder.

Christa Cepuch, Pharmacist Coordinator of Médicins San Frontières (Doctors Without Borders), presented on the consequences of scheduling tramadol on an international level and the impact it would have on the palliative care community.

I then had the opportunity to present the data from a survey conducted in October 2018 by IAHPC among our physician members. I reported that it was evident from my personal experiences in Guatemala that tramadol plays an extremely important role in palliative care and pain relief, as it is one of the very few treatment options available for the management of pain. From a public health and a human rights perspective, the consequences of scheduling tramadol would be devastating for patients and medical providers in countries and regions where morphine is inadequate.

Dr. Mahmoud Elhabiby, representing the Egypt Ministry of Health, gave a presentation about the current situation in Egypt and the public health crisis that it is facing with nonmedical use of trafficked tramadol. It is important to emphasize that the problem in Egypt is with illicit substances arriving through illegal channels, and not the officially registered tramadol preparation for medical purposes.

Christopher Hallam,with the International Drug Policy Consortium, stated that ‘tramadol is often the only analgesic medication available for pain treatment, especially in low- and low-middle-income countries.’

A group of experts representing Grünenthal, a pharmaceutical company based in Germany, gave the final presentation. These included: Dr. Silvia Allende-Pérez, Instituto Nacional de Cancerología, Mexico; Dr. Ernest Yorke, Korle-Bu Teaching Hospital, Ghana; Dr. Ramani Vijayan Sannasi, University of Malaya, Malaysia; Dr. Kelly Dunn, Johns Hopkins School of Medicine, USA; and Dr. Axel Klein, A.C.K. Consultants LLP, England.

Note from Katherine: I encourage colleagues to apply to IAHPC to participate in its delegations at meetings of the WHO and Commission on Narcotic Drugs. Clinician advocacy is an essential service for our patients and families.

Call for Delegates and Advocates:
144th meeting, WHO Executive Board

IAHPC will send a delegation to the 144th meeting of the WHO Executive Board in January 2019 (documents for the meeting are listed here). Our members can advocate with staff at their government Ministry of Health to prepare for the meeting, and can apply to attend in person with the delegation. All participation must be self-funded, as we have no budget at the present time to support more than staff representation.

Please check this list to see if your country is a member of the Executive Board. If you would like to participate in our advocacy strategy, which will emphasize improving access to controlled medicines and integrating palliative care into primary health care, please contact me (kpettus@iahpc.com) at your earliest convenience. I will guide you through the process if you are unfamiliar with it.


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