2017_09_04_ICS_atlas_paliativos

A quarter of African countries have increased their palliative services issue since 2006. This is the result of a research led by the ATLANTES Program of the University of Navarra and published in Lancet Oncologyone of the three most important scientific journals in the world in Oncology.

The study points to uneven growth in the region, with just over 80% of the services detected on the continent located in South Africa, Kenya and Uganda. These three countries have experienced substantial growth in the last 12 years: from 120 to 210, from eight to 44 and from eight to 34, respectively. On the other hand, services have been created in countries where they did not exist: Namibia, Sudan, Ethiopia, Lesotho, Rwanda, Ivory Coast and Libya.

In addition to the implementation of services, the team of researchers has analyzed through the scientific literature other indicators of the development of palliative care in Africa: health policies, the status of the Education in this discipline, the availability of drugs to combat pain and the vitality of the professional activity.

Separate palliative care policies exist in Malawi, Mozambique, Rwanda, Swaziland, Tanzania and Zimbabwe. Côte d'Ivoire, Kenya, Rwanda, South Africa and Tanzania have integrated palliative care into their health policies.

data reveals that palliative care in Africa is largely dependent on foundations and external donors, as is the case in South Africa and Nigeria. On the other hand, the financial aspect is one of the main barriers to access to palliative care, as is the case in Côte d'Ivoire and Morocco. The Ugandan government earmarks part of its national budget specifically for this area health care.

Access to drugs to combat pain

Regarding the training of professionals, it should be noted that there are postgraduate program diplomas in palliative care in Kenya, South Africa, Uganda and Tanzania. This medical discipline is included in the training of Degree for physicians in Botswana, Côte d'Ivoire, Egypt, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda and Zambia. It is also offered at curriculum for nurses in Botswana, Kenya, Malawi, South Africa, Uganda and Zambia.

With regard to pain medication, the lack of opioids is widespread in Africa. Countries such as Côte d'Ivoire, Egypt, Nigeria and Rwanda have strict limitations on their use and prescription. Others, such as Tanzania and Ethiopia, require special permits to prescribe or administer morphine. South Africa has the highest consumption of this drug on the continent and Tunisia has the highest per capita consumption in non-English-speaking nations.

Finally, in the section vitality of the profession, it should be noted that national palliative care organizations are fundamental to the development of palliative care in the various countries. Of particular note is the work of the African Palliative Care association (APCA), the umbrella organization that provides training, support and advocacy for this discipline on the continent.

The main authors of article are Carlos Centeno, researcher lead author of the ATLANTES Program of the Institute for Culture and Society (ICS) of the University of Navarra; John Rhee, of the School Icahn School of Medicine at Mount Sinai, New York; Eduardo Garralda, of the ATLANTES program of the ICS and of the Institute of research Sanitaria de Navarra (IdiSNA); Carlos Torrado, Santiago Blanco and Ibone Ayala, from the School of Medicine at the University of Navarra; Eve Namisango, from the association African Palliative Care and King's College London; Liliana de Lima, from the association International Care Centers and Palliative Care; and Richard A. Powell, from group of development of MWAPO Health.

The work has been developed with the financial support of Banco Santander and is part of a larger body of programs of study led by the ICS ATLANTES Program to analyze the status of palliative care in Africa. Its central axis is the Atlas of Palliative Care in Africa, which collects data from 48 countries. 

Changes in the issue total palliative care services from 2006 to 2017:

Country	2006	2017
South Africa	120	210
Kenya	8	44
Uganda	8	34
Tanzania	4	20
Zimbabwe	13	13
Malawi	5	9
Nigeria	2	7
Botswana	3	4
Egypt	3	3
Namibia	0	3
Sudan	0	2
Morocco	1	1
Ethiopia	0	1
Gambia	1	1
Lesotho	0	1
Sierra Leone	1	1
Rwanda	0	1
Ivory Coast	0	1
Libya	0	1