Build palliative care capacity: report findings
Two meetings were recently held in Kenya and Uganda to share the Phase 1 findings from the PEPFAR-funded public health evaluation of palliative care that included the demand for improved palliative care capacity.
This phase of the two-year prospective study – aimed at describing the nature and scope of PEPFAR HIV palliative care provision in both settings – was comprised of a cross-sectional survey of 10 percent of the 600 facilities in each country funded by PEPFAR, and was conducted between April-August 2007.
Attended by team members from the African Palliative Care Association, the UK-based Department of Palliative Care, Policy and Rehabilitation at King’s College London, representatives from the overwhelming majority of the participating sites (51/60 in Kenya; 56/60 in Uganda), as well as the Kenya Hospices and Palliative Care Association, the Centres for Disease Control and Prevention, and the respective Ministries of Health, the MEASURE Evaluation-funded results-sharing meetings were held the Silver Springs Hotel, in Nairobi, Kenya, and in the Hotel Africana, in Kampala, Uganda.
Following presentations that described palliative care, reviewed the key findings from the evaluation, and profiled the nature of the Phase 2 part of the study, and a brief interactive question-and-answer session, participants in each country broke into small working groups to review critically and comment upon the results under themed areas : i.e. (i) antiretroviral therapy, the Basic Care Package (BCP), pain management, malaria, tuberculosis, and other opportunistic infections; (ii) nutrition, social care and psychological care; (iii) infrastructure and medication stocks, supply and use, and laboratory services; (iv) staffing, and; (v) cross-cutting facility issues. Below is a very brief summary of some of key recommendations at each site provided by the groups:
Kenya meeting
- Build capacity of palliative care providers;
- Increase referral for spiritual and home care services;
- Review the Dangerous Drugs Act;
- Provide transport to track patient defaulters;
- Expand existing laboratory services;
- Attach spiritual leaders to the health facilities;
- Improve the quality and quantity of staff training;
- Reimburse volunteers, and link them to a community mobilisation strategy;
- Provide electricity and safe water;
- Provision of funds to lower level facilities to purchase ambulances.
Uganda meeting
- Provide training at health centre level to increase coverage and accessibility;
- Link lower level health facilities to referral centres for better management and monitoring of ART;
- Prioritise the distribution of the BCP to the lower level units and ensure it is comprehensive in nature, not just comprised of components;
- Opioids should be available at all referral centres, with a need for clinicians to appreciate pain in HIV care;
- Encourage health care workers in home-based care institutions to refer patients for psychiatric care;
- Introduce training in logistics management;
- Advocate for, and roll out, spiritual care training;
- Train community volunteers in counselling and home help;
- Increase referrals for spiritual and home care services;
- Government-owned facilities need more sensitisation to palliative care.
In general terms, the meetings were viewed as very productive and worthwhile, with participants not only learning about the evaluation’s findings but also informing its recommendations. As Geoffrey Banga Nkurunziza, an APCA research assistant who attended the Kampala meeting, remarked: ‘This has proved a very useful means of disseminating our findings. As such, I think it is an approach that we should aim to replicate in our future studies.’
Full results arising from the Phase 1 report will be disseminated when available.