CAN EDUCATION CLOSE AFRICA’S PALLIATIVE CARE WORKFORCE GAP?

Sharon Kagimu is a paediatric palliative care nurse, currently pursuing a Higher Diploma in Palliative Care at Mildmay Institute of Health Sciences.

“As a palliative care specialist, I often feel that the public views my role as being somewhere between a nurse and a housemaid, which shows just how poorly palliative care is understood. However, I am deeply grateful that this scholarship is not only building my own capacity, but also contributing to the development of a skilled national workforce that can help address the critical gaps in palliative care service delivery.”

During her practice, she had walked into countless homes, schools, and hospital rooms, but it was the children who reshaped her understanding of vulnerability and strength. At Hospice Africa Uganda, she recalls a vivid experience caring for a child living with hypoxic-ischemic encephalopathy (HIE), a brain injury caused by oxygen deprivation at birth.

The child’s life was medically complex: delayed developmental milestones, abnormal muscle tone, persistent feeding difficulties, and recurrent infections. Every basic function required assistance. Care was continuous, not occasional. Yet what unsettled her most was not only the clinical picture, but the system around it.

In hospital corridors, she observed a troubling knowledge gap. Many clinicians were highly competent in diagnosis and pharmacological management, they could prescribe anticonvulsants, muscle relaxants, and feeding regimens. But training in holistic palliative care, including psychosocial support, family counselling, and emotional care, was often missing. Families’ spiritual distress, the psychological strain on siblings, and the emotional exhaustion of mothers who had not slept through the night in years were rarely addressed. The family unit, fractured under the weight of chronic illness, was not considered part of the treatment plan.

Palliative care demanded that she look wider. She had to ask: Who comforts the mothers? Who counsels the fathers blaming themselves? Who explains to siblings why their brother or sister cannot play like other children? Who manages pain while preserving integrity?

The shortage of trained staff amplified the burden. Often, she found herself providing care, training colleagues, and educating families and communities simultaneously. The weight of this responsibility, combined with limited human resources, created the risk of fatigue and professional burnout.

A further barrier was cultural perception. In some communities, neurological conditions or childhood cancers were interpreted as witchcraft or curses. Families were pressured to seek counter-witchcraft remedies instead of medical care, diverting precious time and resources while children suffered in silence.

She realized her role extended far beyond bedside nursing. She carried the burden of explaining to communities that these conditions were medical, not mystical; that seeking care was not defiance of culture but protection of life. At the same time, she worked to show fellow health workers that healing is not limited to tablets and injections, and that symptom control without emotional support is incomplete care.

But what choice did she have? Having a few trained colleagues to rely on, the human resource shortages, knowledge gaps, and relentless emotional demands left her no option but to stretch every ounce of her energy to care for children and their families, striving to fill the gaps that the national health system itself should have addressed.

Sharon’s experience mirrors a broader continental pattern.

Across Africa, discussions about palliative care frequently focus on medicine shortages, weak health systems, and inadequate funding. Much as these challenges are real, beneath them lies a structural deficit in human capacity. Palliative care depends on skilled people. Nurses trained in pain management, clinicians competent in communication and ethical decision-making, social workers equipped to support families through grief. But these competencies remain limited and unevenly distributed.

In many facilities, palliative care is an add-on to already overwhelming workloads. Like Sharon, a nurse may rotate between maternity, emergency, and general wards, then be expected to provide end-of-life support without formal training or institutional backing. Care is delivered out of personal commitment rather than system design.

Meanwhile, the need is expanding. Africa bears a significant share of global serious health-related suffering. A large proportion of children requiring palliative care live in low- and middle-income countries across the continent. Non-communicable diseases are rising alongside persistent infectious burdens. Longevity is increasing, but so is prolonged illness requiring long-term support.

The human cost is visible: unmanaged pain, untreated anxiety, families impoverished in pursuit of cure while comfort is neglected, and health workers experiencing burnout.

In contrast, if Universal Health Coverage is to be meaningful, it must include relief of suffering not only access to diagnosis and treatment. Sharon’s story raises urgent questions for policymakers, training institutions, and funders: How many more nurses need specialized training? How many curricula must integrate palliative care competencies? For how long can systems rely on overstretched individuals to fill structural gaps?

The resource gap in palliative care is, fundamentally, an education gap. Expanding training pathways, professional recognition, and institutional support is foundational. Without deliberate investment in education and workforce development, the promise of compassionate, comprehensive care across Africa will remain a faint illusion.

Nonetheless, Sharon’s journey is not an isolated story of individual determination. It is evidence that education works when it is intentional, accessible, and sustained.

Since 2011, the African Palliative Care Education Scholarship Fund, established by the African Palliative Care Association in partnership with Global Partners in Care, has invested directly in building the continent’s human capacity. Nurses, social workers, and clinicians from across Africa are competitively selected and supported to receive formal, accredited training in palliative care. Crucially, they return home to serve — carrying with them not just certificates, but competencies.

The geographic distribution of these scholars tells a strategic story. Training is not concentrated in a few metropolitan centres. It is dispersed. When recipients return to rural districts, regional hospitals, and community programs, palliative care ceases to be an urban privilege. Children in remote villages, elderly patients in under-resourced facilities, and families navigating serious illness outside capital cities gain access to trained professionals who understand symptom control, communication, ethical decision-making, and psychosocial support.

Education, in this context, multiplies impact. One trained nurse does not serve patients alone; she mentors colleagues, trains volunteer, influences institutional practice, and contributes to local policy discussions. Knowledge migrates horizontally across regions and vertically within systems. The effect is catalytic rather than linear.

Like Sharon, the experience of other scholarship recipients illustrates this clearly.  Johannes Kadhila for example returned to Namibia to work at Hardap National Correctional Facility After completing a postgraduate diploma in palliative care medicine at the University of Cape Town in South Africa.

“In correctional facilities, serious illness is often overlooked,” he explains. “The training helped me adopt palliative care for people in custody, including those with disabilities and special needs. Pain relief, dignity, and emotional support are now part of how I deliver care, even in a place not designed for healing.”

Correctional settings are rarely designed around holistic care. Yet through formal training, Johannes integrated pain management, disability support, and emotional care into a system historically focused on custody rather than compassionate care.

Similarly, in Uganda, Tumusiime Emmanuel, a clinical nutritionist and officer in the Uganda People’s Defense Forces, is pursuing a master’s degree in palliative care at Makerere University through the Institute of Hospice and Palliative Care. In his dual role, he integrates nutrition into palliative care, ensuring that military personnel and their families receive supportive care during serious illness.

Tumusiime Emmanuel, Uganda People’s Defense Forces

“Working within the UPDF health system, the scholarship has changed how I see serious illness among serving officers and their families. It has given me the skills to introduce proper pain management and supportive care where it had not existed before.”

The effects of these scholarships extend far beyond individual careers. Graduates strengthen clinical services, guide colleagues, and influence policy, helping ensure palliative care reaches communities that have long been left out. Atuhaire Auleria, a palliative care specialist nurse at Kawempe Home Care in Uganda, now manages a caseload of around 35 patients daily, while also training colleagues and volunteers in basic palliative care. “Home-based care allows us to support patients and their families in a space where they feel safe and understood. The palliative care scholarship has strengthened my ability to manage symptoms and guide families through this journey. I also train volunteers and younger staff so that this knowledge continues to reach patients, even when I am not there.”

Across Kenya and the Democratic Republic of Congo, scholarship graduates are mentoring colleagues, advocating for inclusion of palliative care in health plans, and improving patient care in communities with limited access to trained providers.

Catherine Wakaba, who holds a higher diploma in palliative care and works at Gertrude’s Children’s Hospital in Kenya, exemplifies this impact.

 “I educate my peers on palliative care, listen to patients’ needs, and support the entire family,” she says, as she works to integrate palliative care into routine services and ensure holistic support for children and their families.

Arguably, this is the measurable difference education makes. It reframes care delivery. It shifts institutional culture. It expands who is seen as deserving of comfort.

If the resource gap in Africa’s palliative care landscape is fundamentally a workforce gap, then education is the most direct structural intervention available. Medicines are essential, but without trained professionals, they remain underutilized or improperly applied. Funding is important, but without human capacity, it cannot translate into sustained service delivery.

The question for stakeholders is no longer whether education matters. The evidence demonstrates that it does. The strategic question is scale: How many more Sharons, how many more Johannes, can be trained? How many underserved regions can transition from absence of care to informed, compassionate service?