2020; Volume 21, No 9, September
Celebrating IAHPC Engagement with UN Agencies
By Katherine Pettus, PhD
IAHPC Advocacy Officer for Palliative Care Medicines
This month we celebrate the 75th birthday of the United Nations by reporting on the many ways IAHPC engages with UN Agencies through evidence-based advocacy. In today’s global health emergency, the UN is more important than ever, including for palliative care! The IAHPC is a nongovernmental organization (NGO) “in consultative status” with the United Nations Economic and Social Council (ECOSOC) and a non-state actor (NSA) “in official relations” with the World Health Organization (WHO). We are proud to celebrate our UN family birthday!
UN Agencies’ statement on access
to PC medicines during COVID-19
On August 14, the International Narcotics Control Board (INCB), the World Health Organization (WHO), and the United Nations Office on Drugs and Crime (UNODC) issued an unprecedented Joint Statement calling on all governments to ensure adequate access to essential palliative care medicines (EPCMs) during the pandemic.
More than 80% of the world had no access to essential palliative care medicines before the pandemic, and the situation has deteriorated even further as treatment of COVID-19 patients drains medicine stocks even in high-income countries. Clinician advocates can contribute to sustainable solutions through informed advocacy, an activity that seems like a black box to many clinicians since the vast majority of medical, pharmacy, and nursing schools around the world still fail to teach students either how to prescribe and use EPCMs, or how to engage in policy and advocacy for improved access.
The current legal framework governing access commits member states to a human rights-based approach, which guarantees adequate supplies and provides appropriate professional training. Readers of our briefing note on Global Availability of Internationally Controlled Essential Medicines, one of the Global Palliative Care and COVID-19 Series, may remember that this was one of our eight recommendations. IAHPC is deeply grateful to the UN agencies involved for flagging this critical element of public health palliative care.
We would also like to take this opportunity to congratulate Dr. Cornelius de Joncheere for being re-elected President of the International Narcotics Control Board. I first met Dr. de Joncheere when he directed the Essential Medicines and Health Products division at the World Health Organization. He has been a tireless advocate at the INCB for improved access to internationally controlled substances for medical and scientific purposes, which of course include essential palliative care medicines. We look forward to continuing our collaboration.
Expanding IAHPC presence
at WHO regional meetings
Every year, the World Health Organization’s six regional offices conduct meetings with all their respective member states to discuss how the resolutions and priorities of the World Health Assembly and Executive Board can be actualized and implemented in their geographic area. IAHPC is invited to some of those regional meetings — namely Europe (EURO) and the Western Pacific (WPRO) region — but rarely to the AFRO (Africa), SEARO (South East Asia), and AMRO (the Americas).
One advocacy objective for 2020-2021 is to receive invitations for all WHO regions and field a delegation of members from each to comment on the agenda. Our goal is to develop a strong regional corps of advocates who can influence policy through their relationships with representatives of their national governments.
Currently, palliative care is largely absent from most of the working documents of these regional meetings, even when it is present in the working documents of the World Health Assembly and Geneva Secretariat. This is because we have engaged in consistent advocacy in Geneva, at the international level, but not yet at the regional level. It is time for that to change.
I encourage aspiring advocates to review the agenda of your regional session, read one or two of the documents that interest you, and watch some of the live or recorded sessions. [Access documents and resolutions: AFRO, EURO, SEARO, WPRO.]
Listen for what is not said, as much as to what is. What your country representative probably did not say is that palliative care is an essential service in the COVID-19 response, as stipulated in a resolution of the 73rd World Health Assembly, which governments are charged with implementing as soon as possible. Then start thinking about how you can change this situation so that next year your country statement will include a reference to palliative care. Read the IAHPC statement to the 70th meeting of the EURO region here, watch Board Chair Dr. Lukas Radbruch’s video here and read our statement for the 71st meeting of WPRO here. These statements have been sent to the Secretariats of the Regional meetings for review by member states.
Decisions by the WHA under discussion
The regional committees will discuss some decisions of the 73rd World Health Assembly following the “silence procedure” (i.e., no member state objected to the proposed text).
- WHA73 approved the WHO policy brief on managing COVID-19 across long-term care services, which begins by declaring that health systems have a responsibility to offer safe, accessible, affordable, and quality health care, including assistive and palliative care, for all people, without discrimination. [Read the Spanish translation.]
- The policy brief addresses difficulties adapting to increased health care needs in long-term care facilities. “While some long-term care facilities employ nurses and other health care staff…there are reports of the difficulties faced by non-medically trained staff in long-term care facilities needing to provide care to people with COVID-19 infections or to those who need palliative care, without health care staff support or oversight by qualified health professionals such as physicians and nurses.”
- Key actions for long-term care facilities include “Facilitate flexible arrangements whereby palliative care teams and other relevant health and care professionals work with staff...to ensure access to palliative care as needed.” Another directive urged member states to “Ensure that national and regional policies, programmes and guidelines are in place to support the provision of palliative care in long-term care facilities and long-term care services (including physical, psychological, social, and spiritual support).” The facilities are instructed to “establish rapid response teams, preferably with geriatric and palliative care training…to reduce avoidable hospitalizations and ensure optimal person-centered communication and decision-making.” There are another 10 references to palliative care in the document. National palliative care associations can partner with organizations of older persons and professional organizations of geriatricians to leverage this policy brief to develop and deliver appropriate services for older persons in their countries.
Our statement to the INCB on
access to controlled medicines
IAHPC submitted a statement for the October session of the International Narcotics Control Board, which will hear evidence on “Older Persons and Drug Use.” We reframed this topic as “Access to Controlled Medicines for Relief of Health-Related Suffering of Older Persons.”
The statement takes a rights-based perspective and discusses the authorizing framework of international standards requiring member states to provide adequate access to palliative care and internationally controlled essential medicines for the relief of pain, symptom control, and treatment of substance use disorder. Please download the IAHPC statement and use it in your advocacy for improving palliative care for older persons.
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