APCA: Steps in its ongoing success story

Categories: Care, Education, Leadership, and Policy.

The African Palliative Care Association’s (APCA’s) approach to improve health care throughout the continent would make an excellent how-to manual.

The celebration, this year, of APCA’s 20 years in operation is testament both to its longevity and its effectiveness. The association has developed programs and initiatives that span governments, laws, institutions, palliative care practices and education, health research, and the community at large. These interconnected actions are structured around four objectives (see box).

Along the way, it widened its reach to chip away at major social barriers to care, including lack of both universal health coverage and internet access.

Of all the strategies it employs, the single thing its 6,300 members and affiliates value the most, is its educational in-person and virtual education program, says APCA Executive Director Emmanuel Luyirika, MD. These gatherings are doubly meaningful: experts deliver important information about approaches to care and management, treatments and advances in palliative care, and members can form mutually beneficial relationships with peers.

Step 1: Policy support

“Our main achievement has been bringing in political players,” says Luyirika. “For the last decade, we’ve had palliative care sessions with African ministers of health every three years.” In 2013, 23 countries attended; by 2022, 34 of Africa’s 54 countries took part.

Each session—one day of meetings of ministers and their technical teams, then three days of scientific presentations—is built around a single focus: implementing the 2014 World Health Assembly’s resolution stating that “palliative care is a moral imperative of health systems and should be integrated into all levels of health care” (2016), creating a palliative care package for universal health coverage (2019), and how countries can implement palliative care systems (2022).

By the end of the session, ministers sign an official declaration that guides their focus of work for the coming few years.

“We have supported more than 11 countries to develop national palliative care policies, and then to formulate those policies,” notes Luyirika.

Dr. Emmanuel Luyirika. Photo used with permission.

Step 2: Care put into place

Access to medicines is a major issue. APCA has responded by disseminating and discussing the WHO Model List of essential medicines for palliative care and supporting local reconstitution of morphine powder into liquid form. “It’s a cheap formulation that is invaluable in pain and symptom control but cannot be misused or abused,” says Luyirika. “Once made, it is appropriate for use in hospital, hospice, the community and at home.”

Contrary to what some believe, morphine is not outlawed in most countries, he adds, though many are more focused on the control of the medicine than the necessity of making it available for medical and scientific use. The association also wrote a pocket book on handling pain, a clinical tool for the use of controlled medicines, available in both French and English.

Also on the front lines of care, it runs a scholarship program for nurses, social workers, home-care workers, and other allied health care workers to study in palliative care. Small grants are offered to hospices, hospitals and community-based organizations to run palliative care programs.

Uganda is a leading example of palliative care in Africa. This photo by Germans Natuhwera shows the delight of a patient after his facial tumor was removed at the Uganda Cancer Institute. His care was financially supported by Little Hospice Hoima's "comfort fund" for the very needy. Photo used with permission.

Uganda is a leading example of palliative care in Africa. This photo by Germanus Natuhwera shows the delight of a patient after his facial tumor was removed at the Uganda Cancer Institute. His care was financially supported by Little Hospice Hoima’s “comfort fund” for the very needy. Photo used with permission.

 

Step 3: Evidence-based practices

The APCA has partnered with academic institutions, such as King’s College London, the University of Leeds and others in Africa, Europe and North America, to implement research projects that generate peer-reviewed articles.

Step 4: Long-term sustainability

“This involves the organizational level and beyond,” says Luyirika. “We made sure that we have functional structures.” Each volunteer board member is selected for their specialized knowledge: the current board includes those skilled in metrics, finance, education, government relations, law, resource mobilization, and fundraising.

APCA has qualified external audits and is always on the lookout for future partners and partnerships for funding or to collaborate on research or other projects. It also fosters its relationship with member institutions by supporting sustainability capacity building, such as “doing strategic planning that responds to those they serve,” he says. “How to be accountable to members, to donors, and to the country where you operate, how to set up national palliative care funds,” are serious issues that the APCA takes to heart.

“One of the biggest challenges right now is funding,” says Luyirika.

 

APCA executive director credits IAHPC’s assistance

“There are key areas where IAHPC has been of great support to us… Katherine Pettus’s presence in Vienna is a very useful for our advocacy efforts, as we can’t afford to be there. And a number of our members have received IAHPC Scholarships to attend global conferences and events. It also contributes to the development of the African Palliative Care Atlas.”

This article was originally published by the International Association for Hospice & Palliative Care (IAHPC).


Comments

  1. Are ALL AWARE THAT LITTLE HOSPICE HOIMA IS BRANCH OF HOSPICE AFRICA UGANDA WHICH IS THE MODEL FOR AFRICAN PALLIATIVE CARE with a vision of “Palliative care for all in need in Africa.” THe idea and the start of African Hospice and Palliative Car Association similar to EAHPC was born in 2003 and after 2 years was off the ground. HAU has REACHED A FURTHER 34 COUNTRIES WITH ORAL AFFORDABLE MORPHINE AND PALLIATIVE CARE SINCE 1993 when there were only 3 countries with PC.This was achieved THROUGH INTERNATIONAL PROGRAMMES at HAU. AS I WRITE THE ANGLOPHONE countriesARE HERE FOR THIER EXPERIENCE OF AFRICAN PALLIATIVE CARE IN THE COMMUNITY AFTER SUCCESSFULLY COMPLETING 3 MONTHS ON LINE COURSE. THEY ARE TAUGHT TO ADAPT TO THEIR CULTURE AND NATIONAL, AS WELL AS PERSONAL ECONOMY. WE MUST KEEP IN MIND THAT THE LMI COUNTRIES HAVE 50% OR MORE WHO NEVER SEE A HEALTH WORKER FOR LACK OF MONEY. THUS HAU NEVER TURN ANYONE AWAY WHO NEEDS PALLIATIVE CARE.. But we are limited in many plans by lack of financial support. So we are boots on the ground and APCA is a coordinating organisation. PCAU has spread services through most Districts since they commenced using those trained at the Institute of Palliative Care in Africa, an essential section of HAU, in order to reach our vision. PCAU have been so successful in making Uganda a true model for other countries in Africa. They have done such good work since commenced at HAU in 1999 and becoming independent in 2007 with Rose Kiwanukas’ leadership. They have ,spread palliative care ,through those we have trained, they are now legally allowed to prescribe oral morphine because of the lack of doctors in Uganda. This is true in all LMLCs in Africa today. Our main gift from the Ugand Government since 2003 is that oral morphine is free to all prescribed by a recognsied and trained medic for those in pain. Sadly the cost in many African countries is prohibitive and pateitns are turned away with thier pain if they cannot pay. This is aainst our vision and should be addressed in other Africn countries ding this to their Government. The patient and family must be the centre of all decisions made from MOH to those on the ground.

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