Here in Uganda, this week we celebrated 50 years of Independence as many other African countries have also celebrated. As we look at palliative care in 50 years time, from an epidemiological perspective, we see many challenges as far as palliative care on the continent is concerned.
First, we are faced with a growing population. By 2050, the population in Africa is estimated to amount to 1/8th of the world population. Further, the median population age is currently 15 years of age, which in 50 years will mean a burgeoning population over the age of 65.
As we commemorate the theme of this year’s World Hospice and Palliative Care Day – “Living to the end: palliative care for an ageing population” – it’s more important than ever to consider Africa’s future aging population in consideration of their care in light of these challenges.
Second, there has been a steady rise of Non Communicable Diseases (NCDs) in Africa, including cancer of the cervix, cancer with infections related to the HIV epidemic, cancer of the liver, and other types of cancer which will result in a big challenge over the next 50 years.
In Africa, we also face a lack in palliative care professionals. Over the next 50 years, we need to develop a cadre of specialists who can provide palliative care within African health systems. We also need palliative care policy and legislation to become widespread – many governments in Africa need to commit themselves to the availability of pain relief medication.
In Uganda, we have a model of palliative care that other countries can glean from – free morphine for patients in need, passed legislation which allows nurses and clinical officers below doctors to prescribe morphine to increase the number of patients who can benefit from access to pain relief. The actual expense of morphine is also fully funded by the Ugandan government.
In terms of the focus of development partners, right now the focus is on treatment, but there is a neglect of emphasis around palliative care. With the aforementioned rise in the incidence rate of NCDs and with the advance of ARVs and increasing HIV population, palliative care will become of increasing importance in health care delivery systems in developing countries.
On a personal appeal, what I would like to see happen on a national level and on regional levels across Africa, would be for African countries to come together to include palliative care into political agendas. I’m looking forward to a time when palliative care can be discussed by ministries of health and policy makers across Africa to have the same consideration as HIV, malaria, maternal health, and other health services. So that’s my vision for palliative care in Uganda, and across Africa until the next Jubilee celebration.
Dr Amandua Jacinto
Commissioner Clinical Services
Ministry of Health, Uganda
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