An insufficient commitment: specialized palliative care services increase by 38% in Africa, but are still far from meeting the continent's needs

The mapping of palliative care development in Africa reveals that the continent is making significant efforts, but the result remains insufficient. Specialized services have increased by 38%, but still average only 0.06 services per 100,000 inhabitants. This figure is insufficient to meet the needs of the continent, where it would be desirable to reach at least 2 services per 100,000 people. This is the scenario sample in the new Atlas of Palliative Care in AfricaThe study offers the most complete and rigorous information to date on the status of palliative care on the continent.

The research has been led by the ATLANTES Global Observatory of Palliative Care of the Institute for Culture and Society. Institute for Culture and Society (ICS) of the University of Navarra, in partnership with the African Palliative Care Association (APCA). This Wednesday, it was presented at the 8th African Palliative Care congress , held in Gaborone (Botswana).

The atlas data , which updates, expands and improves the previous edition, published in 2017, has been collected and analyzed following a rigorous methodology and applying the new conceptual framework of the World Health Organization (WHO), of which ATLANTES is a partner center. It has also benefited from the participation and support of 121 expert consultants from 50 African countries, trained by ATLANTES, who have worked in the field to collect and verify the information.

Urgent needs

It is estimated that more than 17 million people face severe health-related suffering in Africa. Despite a strong commitment to scaling up health policies in palliative care, the map sample urgent needs. Only Uganda reaches the Advanced level and only five countries - South Africa, Malawi, Kenya, Morocco and Rwanda - have well-established systems. On the other side of the scale, Angola, Burundi, Central African Republic, Chad, Equatorial Guinea, Eritrea, Guinea-Bissau, Sao Tome and Principe and Somalia have no specialized services. Overall, more than half of the continent is still in an emerging state in the development palliative care.

Another issue of concern is the limited access to pain relief medicines: in 76% of the countries, oral morphine is available in less than 10% of urban primary care centers; this shortage extends to 85% in rural areas. Only in countries such as Mauritius, Morocco, Namibia and Rwanda does urban availability exceed 70%. For children, there are only 102 specialized pediatric palliative care services on the entire continent - and more than half are concentrated in just three countries: South Africa, Zambia and Uganda.

The study reveals marked inequalities between English-speaking and non-English-speaking African countries. The former consistently achieved better results in access to essential pain medications, such as oral morphine, in the training of professionals and in the availability specialized services, including pediatric services. Likewise, English-speaking countries published up to fifteen times more research than non-English-speaking countries, leaving the latter with less evidence of their own to guide their policies and greater dependence on external models.

Advances

However, there is reason for hope, as 10 countries now have stand-alone national palliative care strategies; 25 have integrated palliative care into broader plans; and six are working on policies. These include Chad, Djibouti, Guinea-Bissau, Lesotho and Niger, where they had never been considered before.

Similarly, there are now 26 African countries that now have a national palliative care authority under their Ministries of Health (eight more than in 2017), of which Benin, Malawi, Rwanda and Uganda have fully structured coordinating bodies. On the other hand, Equatorial Guinea, Lesotho, Gambia and Zambia have lost national authority status, reflecting the fragility of these developments.

The case of Uganda should be highlighted as a reference for palliative care in Africa. This low-income country of 51 million inhabitants was one of the first to guarantee free and decentralized access to oral morphine and to allow nurses to prescribe it. It also stands out in such areas as the establishment of indicators to evaluate status and its work to integrate palliative care into universal healthcare coverage. The country has also demonstrated its innovative nature by including palliative care in the mandatory university training of health professionals. In this field, it is also integrated in Malawi, Namibia, Zimbabwe, Kenya, Morocco and Ghana.

Aninternship tool

The Atlas of Palliative Care in Africa aims to be aninternship tool for advocacy and awareness raising in all countries, and to contribute to the development of public policies, thanks to its visualdesign , including maps and infographics, the Atlas. It can be consulted online, free of charge, on the ICS website.

This atlas is the third submission in a series of five publications that will bring together, for the first time, a global map of palliative care. The atlas for the Asia-Pacific region was presented in Malaysia last April, and the one for Europe was unveiled in Helsinki in May. The Americas and the Eastern Mediterranean will follow this autumn.