Palliative care project in Rwanda having a lasting impact

Categories: Policy.

In just one year, the number of health workers in Gasabo District trained in palliative care has increased. This is at least in part to do with the National Palliative Care Policy which was adopted by the Rwanda Ministry of Health in 2011.

Following up on the implementation of the national policy, the Foundation for Hospices in Sub- Saharan Africa (FHSSA), in collaboration with the African Palliative Care Association (APCA), offered a grant to the Palliative Care Association of Rwanda (PCAR) to continue integrating palliative care at Kibagabaga hospital. 

One year on, it is important to look back at what has been achieved at Kibagabaga Hospital.

According to the World Health Organization, NCDs account for about 28.2% of the national deaths from disease in Rwanda (World Health Organization – NCD Country Profiles, 2011). The challenge for a country like Rwanda is to prevent and treat NCDs in a holistic manner. This is important as infectious diseases, chronic diseases and NCDs often affect the same people. It also means that health services can be delivered by the same health professionals in the same health centers across all illnesses – integration.

For this reason, treatment of infectious disease, NCDs and chronic care has to be integrated. This will promote efficiency and a continuum of care.

Now however, the country has committed to provide all Rwandans living with incurable illnesses, as well as their families and caregivers, with high-quality affordable palliative care services to meet their physical, psychological, social and spiritual needs by 2020 — one of the first such policies in sub-Saharan Africa and the developing world. (CMAJ October 4, 2011 vol. 183 no. 14 first published September 12, 2011: 10.1503/cmaj.109-3963 Vogel, L.).

Kibagabaga hospital is the first hospital which is integrating holistic palliative care in Rwanda. The first pediatric palliative care center was launched in 2009 and the integration of it in all inpatient services began in 2010.

Whilst Rwanda has made some big strides in laying the basis for introducing palliative care, serious challenges remain. A qualitative study consisted of 68 patients was undertaken during the period of June 2012 to May 2013. Semi-structured interviews were also undertaken with services providers.

Increasing of number of palliative care service providers in the hospital

The survey indicated that the number of health workers increased considerably (24 in 2008 to 100 in 2012) and the quantity of morphine used by the hospital increased (5% per year in 2008 to 26% in 2012).  

In addition the study found that:

-The FHSSA fund was able to train another 20 health providers from the hospital who work as focal points in each ward.

-A clinical placement at Hospice Uganda and Mulago Hospital was established for 3 health professionals from Kibagabaga Hospital.

-Staff learned from the experiences of other countries about the use of oral morphine. This gave a confidence to Kibagabaga Hospital staff to start using Oral/IV morphine. This directly improved the quality of life for many patients and their families. Relief from pain is crucial for improving the quality of life for patients with life-threatening illnesses and their families in Rwanda.

Rwanda made an effort to integrate palliative care into health system with a particular focus on infectious diseases. Rwanda is now focusing on preventing non-communicable diseases and palliative care. An important step forward.

The FHSSA project in Kibagabaga Hospital has made a significant contribution to the change the minds of health providers in the district. Kibagabaga hospital has benefited from this high level of expertise and so has Rwanda as a whole.