Policy and Advocacy

2020; Volume 21, No 6, June

Policy and Advocacy

Dr. Katherine I. Pettus, PhD, IAHPC Advocacy Officer for Palliative Care Medicines, brings the latest roundup of advocacy news.

It Takes A Pandemic: 73rd World Health Assembly report

By Katherine Pettus, IAHPC Advocacy Officer

More than two dozen speakers participated in the WHA online meeting.
A Virtual Assembly

The 73rd World Health Assembly was like none I have ever attended. For one thing, I attended virtually, as a registered IAHPC delegate, rather than traveling to Geneva as I usually do. I joined heads of state, health ministers, civil society representatives, and reporters around the world from my home office, watching the livestream and listening to national statements interpreted into all six UN languages. The entire spectacle was masterfully orchestrated by WHO staff at headquarters in Geneva.

Resolution adopted
on COVID response

The dignitaries who appeared on one another’s screens throughout the Assembly managed to unanimously adopt a key resolution titled “COVID-19 response.” Along with all the other non-state actors, we were sad at not being allowed, for the first time ever, to present our oral submissions to the Assembly. However, we did upload our written statement to the WHO website.

Zambia & Bangladesh successfully
pressed to include palliative care

Thanks to the insistence of the permanent missions of Zambia and Bangladesh, negotiators agreed to include “palliative care” in one operative paragraph (OP) of the resolution — along with safe testing and treatment since it had been left out of the original (Zero Draft) proposed by the European Union.

OP 7.7, agreed by consensus, now instructs all WHO members to:

Provide access to safe testing, treatment, and palliative care for COVID-19, paying particular attention to the protection of those with pre-existing health conditions, older persons, and other people at risk, in particular health professionals, health workers and other relevant frontline workers

This “agreed language,” now endorsed by 146 WHO member states (an unprecedented number for a resolution), gives national, regional, and international palliative care associations more leverage when advocating with their governments for ramped-up palliative care service development, both now and for preparedness planning. Dr. Frances Bwalya, representative of the Permanent Mission of Zambia, stated, “We are duty bound to protect the interests of silent voices, those that cannot speak for themselves.” A more eloquent statement in defense of palliative care would be hard to find.

Next Steps: Education, Relationship Building, & Advocacy

IAHPC can facilitate the necessary collaborations between national palliative care associations and WHO to implement the resolution’s palliative care mandate. Non-state actor status gives us the privilege to consult with the Secretariat and participate in meetings of member states (unless specifically restricted) as an officially registered delegation.

Our 2020 delegation represented the palliative care associations of our six target countries and Panama. It included nurse practitioner Kate Reed Cox of Australia; Drs. Farzana Khan and Rumana Dowla from Bangladesh; Dr. Marvin Colorado from El Salvador; Dr. Zipporah Ali from Kenya, Dr. Abidan Chansa from Zambia, and Dr. Nisla Camano from Panama, for the Latin American Palliative Care Association. One of their delegation “duties” was to forward our WHA submission to their health ministries and permanent missions in Geneva. They will follow up with those contacts and report back to us.

Concrete actions are possible

Advocates can leverage the resolution’s palliative care language by offering to help their health ministries train health workers to build the palliative care services they need alongside the services for prevention and treatment of COVID-19. Advocates could suggest that their governments request the WHO Secretariat to provide a monitoring and evaluation framework with milestones. One milestone could require integration of the Lancet Commission on Palliative Care’s Essential Package of medicines and equipment (see below, or Appendix 3 of the recently published WHO Clinical Management of COVID-19 - interim guidance), which can be adapted to the income classification of the country (high, upper- or lower-middle, low).

The Essential Package would cost low-income countries about US$2.16 per capita per year at lowest reported international medicine prices, or just over 1% of total low- and middle-income countries’ per capita health expenditure. In other words, pennies on the dollar! The fact that those prices may have gone up slightly owing to pandemic pressures on manufacturing and supply chains cannot be an excuse for failing to implement the package.

Access to essential medicines like morphine is a core human rights obligation that all states must ensure regardless of income level.

Advocacy education
for our members

The IAHPC is developing an advanced advocacy webinar series, following publication of our Basic Course. This is intended as a tool for palliative care associations wishing to help their governments implement the language of the various WHA and UN resolutions committing member states to provide palliative care. The Basic Course is free to IAHPC members and can be accessed here. If you're not yet a member, please join today, or ask your institution to join so that you and your colleagues can take these courses, free to members. Stay tuned for my monthly Policy and Advocacy reports in the IAHPC Newsletter; sign up for a free subscription to have the newsletter delivered to your preferred email.

Read my full report on WHA73, as well as the eHospice article.


Essential Package for Palliative Care

Aligned with sustainable development goals: should be made universally accessible by 2030.

Medicines

Amitriptyline
Bisacodyl (Senna)
Dexamethasone
Diazepam
Diphenhydramine (chlorpheniramine, cyclizine, dimenhydrinate)
Fluconazole
Fluoxetine or other SSRI (sertraline and citalopram)
Furosamide
Hyoscine butylbromide
HaloperidolIbuprofen (naproxen, diclofenac, meloxicam)
Lactulose (sorbitol or polyethylene glycol)
Loperamide
Metoclopramide
Metronidazole
Morphine (oral immediate-release and injectable)
Naloxone
Parenteral
Omeprazole oral
Ondasetron
Paracetamol oral
Petroleum jelly

Medical equipment

Pressure-reducing mattress
Nasogastric drainage or feeding tube
Urinary catheters
Opioid lock box
Flashlight with rechargeable battery
Adult diapers/cotton and plastic
Oxygen

Human resources

Doctors (specialty and general
Nurses (specialty and general)
Social workers and counselors
Psychiatrist, psychologist, or counselor
Physical therapist
Pharmacist
Community health workers
Clinical support staff
Non clinical support staff



Do you have any comments or questions about this piece or our advocacy program?

Contact Dr. Katherine Pettus



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