By Dr. Hibah Osman, IAHPC Board Member
The task of starting palliative care programs in countries where the specialty is in early stages of development can be extremely challenging. Mistakes and missteps often accompany each step forward. Early palliative care advocates and pioneers may find themselves working alone among colleagues who have a limited understanding of the specialty and policy makers who have yet to appreciate the added value that palliative care brings to the health care system. While international meetings may offer opportunities to share data, ideas, and experiences, regular attendance can be hampered by travel and visa restrictions or limitations of time and resources.
In September 2019, the WHO Eastern Mediterranean Regional Office (EMRO) invited regional and international experts to a meeting whose aim was to encourage collaborations and conceive a regional plan for the development of palliative care. The meeting led to the establishment of the EMR Palliative Care Expert Network, a community of peers with one goal: support governments as they implement national palliative care priorities, structures, and activities in line with regional and global commitments.
Since September, the team’s work has been conducted exclusively using email and web-based meetings, which foster swift action while requiring minimal financial resources.
The Eastern Mediterranean region ranges from high-income, petroleum-rich countries in the Gulf to low-income countries that have suffered the consequences of political instability, conflict, extreme poverty, and forced migration, such as Yemen and Afghanistan. This variability is reflected in widely different national priorities, development and structure of health systems, and resources allocated to health care. Some countries provide services across health care levels while others have no palliative care services at all. Palliative care providers remain few in number and their efforts tend to be siloed — kept within a single institution or country. Although there have been regional educational initiatives, the EMR has historically lacked an organized effort to gather leaders in a formal collaboration aimed at integrating palliative care into health systems across the region.
The September meeting was organized in collaboration with WHO Geneva; the International Program for Palliative Care at Massachusetts General Hospital; and Balsam, the Lebanese Center for Palliative Care; and was hosted at the American University of Beirut Medical Center (AUBMC). Participants included representatives from nine of the 22 member states in the EMR to discuss priorities, exchange experiences, and draft a roadmap for the development of palliative care in the region. The member states represented were: Egypt, Iraq, Kuwait, Lebanon, Morocco, Pakistan, Saudi Arabia, Sudan, and Qatar.
The EMR Palliative Care Expert Network provides the WHO EMRO with input and technical guidance to support governments as they implement palliative care development. The current group of experts has been working on a two-year action plan in three working groups: policy, human resources, and clinical services. Activities include the development of policy briefs, training curricula, models of service delivery, and indicators to measure progress.
This initiative has been a forum for connection and collaboration for advocates in the region who had largely been working in isolation. The planned output is measurable, feasible, and has the potential to encourage the development of palliative care across countries, regardless of where they are in the process of introducing this new specialty into their health systems. And, best of all, the process is fueled by the shared vision of organizers and participants.