Investigating a Sustainable Public Health Approach to the Provision of Palliative Care: A Regional Case-Study in Ethiopia

Categories: Featured, Policy, and Research.

Despite access to palliative care being an international human right, it is estimated that only a small percentage in need have access, particularly in low-and middle-income countries.

Across Africa, only 5% of those in need of palliative care are able to receive care (1). No less in Ethiopia, where despite palliative care being included in national health policies and guidelines, millions of people have limited access.

A study undertaken to understand and investigate the provision of palliative care in rural and regional Ethiopia made recommendations for a sustainable public health approach to be implemented. The World Health Organization Public Health Strategy was used as a theoretical framework for the data analysis and discussion of the findings (2). The recommended model includes community and professional education, essential drug availability, strengthened health policy, and implementation of aspects like strategic plans, standards and guidelines.

The study was situated in the Tigray region of Ethiopia, with almost 200 participants participating in a survey, interviews and focus groups. Participants included policy, education and health care leaders, health professionals working in three different settings (tertiary hospital, community hospital and primary healthcare units), as well as community members.

The qualitative findings indicated that despite palliative care being included in national health policies and guidelines, only a few leaders were aware of them. Additionally, those working at the bedside had no access to these documents and/or were unaware of their existence.

Some palliative care was evident in settings caring for those people with HIV/AIDS, even in their homes. This was thought to be mainly because these services received NGO support.

A modified version of the Palliative Care Quiz for Nursing (3) revealed that pain and symptom was the most poorly understood; and psychological care most understood. Additionally, the results indicated that despite participants having a positive attitude towards providing palliative care, they had insufficient knowledge and poor self-reported practice in all three types of health care settings.

Perhaps one reason for this is that palliative care is not integrated into undergraduate health care curricula. And with healthcare professionals lacking education in palliative care, the consequence was little community awareness.

Difficulties in production, inconsistent availability, and prescription of Morphine were evident across all healthcare settings, meaning there was reliance on alternative and less satisfactory analgesics.

Recommendations arising from the study were in line with the WHO Public Health Strategy. These included the use of Health Extension Workers to promote palliative care in the community through education and home visits. Strategies for sustainable palliative care were described, especially networking between the various healthcare settings; and improved communication between health professionals through better use of mobile phone technology. Additionally, practical training in palliative care needs to be facilitated for health professionals and include awareness of national health policies and guidelines. Further, strategies to enhance the supply and accessibility of morphine need to be considered especially in this rural and regional area of Ethiopia.

This article is a summary of a PhD project recently completed by Atsede Aregay at Monash University, Australia.

1. Downing, J., Grant, L., Leng, M., & Namukwaya, E. (2015). Understanding Models of Palliative Care Delivery in Sub-Saharan Africa: Learning From Programs in Kenya and Malawi. J Pain Symptom Manage, 50(3), 362-370.
2. Callaway, M. V., Connor, S. R., & Foley, K. M. (2018). World Health Organization public health model: a roadmap for palliative care development. Journal of pain and symptom management, 55(2), S6-S13.
3. Ross, M. M., McDonald, B., & McGuinness, J. (1996). The palliative care quiz for nursing (PCQN): the development of an instrument to measure nurses’ knowledge of palliative care. J Adv Nurs, 23(1), 126-137.


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