Palliative care remains a vital yet under-resourced aspect of health delivery in many low- and middle-income countries. In Zimbabwe, the drive to embed palliative care into all levels of the health system has gained traction through a nationwide integration training programme.
Funded by the True Colours Trust, the initiative has equipped multidisciplinary teams with the skills, confidence, and cultural sensitivity needed to provide holistic care to patients facing life-limiting illnesses.
Background and Rationale
Zimbabwe faces a growing burden of non-communicable diseases, HIV, and cancer-related illnesses. Yet, many healthcare workers—particularly those at district and primary care levels—have had limited exposure to palliative care principles. The integration training initiative sought to address this gap through an in-service approach that brought learning directly to the workplace.
Development of Training Materials
An in-service training manual and curriculum was developed using resources from the African Palliative Care Association (APCA) and tailored to the Zimbabwean context. The content was aligned with national health priorities and designed to be practical and accessible to a range of healthcare workers.
Training Approach
Trainings were conducted on-site at District and Provincial Hospitals to ensure relevance and reduce logistical barriers. The 5-day sessions used interactive methodologies, including case studies, group discussions, role plays on communication and ethics, symptom management demonstrations, and integration of spiritual and psychosocial care.
Key Content Areas
– Palliative care
– Ethical and legal issues in palliative care
– Pain and symptom control
– Communication skills
– Cultural and spiritual care
– Paediatric and geriatric palliative care
– Teamwork and referrals
– Working with families
-End of life care
-Bereavement awareness
– Psychosocial issues in palliative care
– Self-care
Mentorship and Supervision
To enhance skill retention and provide real-time support, the training programme incorporated a structured mentorship and supervision component.
Trained facilitators conducted follow-up visits and remote support sessions, providing case-based mentorship, on-site coaching, assistance in developing palliative care plans, and strengthening of referral systems and documentation. This approach reinforced theoretical knowledge, built confidence, and helped trainees address practical challenges within their own settings.
Island Palliative Care Nurse conducting training of community home-based carers
Outcomes: Establishing Functional Palliative Care Teams
Participants provided positive feedback on the training programmes , highlighting their relevance and effectiveness, they demonstrated increased knowledge and skills after training. The training enhanced teamwork among health professionals leading to more comprehensive care, increased confidence in providing palliative care, leading to improved job satisfaction.
A key outcome of the training programme was the establishment of Palliative Care Committees in each participating hospital. These committees were designed to serve as functional, hospital-based palliative care teams, ensuring that palliative care is actively practiced and integrated into daily clinical routines.
Their responsibilities include:
– Coordinating palliative care referrals within the facility and to community services
– Ensuring proper documentation of palliative care plans and patient follow-up
– Advocating for availability of essential medicines and inclusion of palliative care in institutional planning
– Conducting regular case reviews and ward rounds.
Each committee developed Terms of Reference (TORs) tailored to their facility’s needs, outlining their structure, roles, and activities to sustain palliative care delivery beyond the initial training.
Reach and Impact
The programme successfully trained health professionals in more than 25 districts, including nurses, doctors, social workers, and community health volunteers.
Participants reported increased confidence in handling terminal illness cases and better interdisciplinary collaboration. Some hospitals began offering regular palliative care rounds, while others set up patient support groups and improved documentation of end-of-life care plans. Pre-service training for nurses and medical students is in place and one university in Zimbabwe is offering a degree in Palliative care.
Lessons Learned
The importance of conducting a thorough needs assessment to identify knowledge gaps and training needs among health professionals was one of the key lessons learnt from this exercise. This helped to develop training programmes that are tailored to the specific need and context of the healthcare system enhances learning. It is important to continually monitor and evaluate the effectiveness of training programmes as it helps to identify areas that need improvement. Integration of an interdisciplinary approach to training, involving multiple healthcare professionals enhances acceptance and understanding of the multidisciplinary team approach in palliative care.
Challenges and Next Steps
While enthusiasm was high, facilities also faced challenges such as staff shortages, heavy workloads, and limited access to opioids. There were challenges in reaching health professionals in rural areas, limiting access to training and support
To sustain the momentum:
– The curriculum will be digitized to support self-paced learning
Provincial monitoring teams will continue to mentor and support local committees
Conclusion
Zimbabwe’s integration training programme demonstrates that palliative care can be effectively mainstreamed into the public health system with the right tools, training, and local leadership.
With continued support from partners like the True Colours Trust, the country is building a more compassionate, patient-centred healthcare system—one hospital at a time.
Author Bio
Franciscah Tsikai is a Palliative Care Nurse Consultant at Island Hospice and Healthcare in Zimbabwe, where she has led palliative care training and capacity-building initiatives since 2006.
She holds an MPhil in Palliative Medicine from the University of Cape Town and has over 34 years of experience in clinical palliative care. She developed Zimbabwe’s in-service palliative care training manual and has played a key role in integrating palliative care into public health systems. Her work continues to impact healthcare professionals across the country through mentorship, curriculum development, and advocacy.
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Lead photo caption: Health professionals at St Theresa’s Hospital, who underwent palliative care training during the integration process.
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Franciscah Tsikai
Palliative Care Consultant |
Island Hospice & Healthcare |
This is great work being conducted to improves people’s care through this palliative care approach. Keep up the good work
Thank you so much for introducing palliative care at our hospital and for training quite a number of staff. This has instilled confidence in us on how to take care of people with life threatening conditions and to build an improved relationship among health care providers, clients and clients’ relative.