Healthcare workers’ understanding of palliative care policy in Swaziland: A qualitative study

Categories: Featured, Policy, and Research.

We undertook a qualitative study to explore healthcare workers’ understanding of the content of the palliative care policy in Swaziland (eSwatini). Our research question was; what is the understanding of healthcare workers on the content of palliative care policy? A total of 17 health workers participated in this study, selected from one regional hospital (Hlatikulu), one health centre (Nhlangano) and three rural clinics which were purposefully selected by the researcher.

The national palliative care policy and strategy were developed in 2011 and since then, the policy has enjoyed the public support of influential policy actors including the health minister. The Ministry of Health has a dedicated budget line for palliative care in the health budget, a palliative care desk and dedicated palliative care officer. According to the results of this study, the policy did translate into increased levels of palliative care provision, although it did not produce greater geographic equity.

The study findings showed that policymakers had a clear understanding about the policy. However, palliative care was generally more understood by health workers from healthcare centres compared to rural healthcare workers in rural clinics. They were aware of their scope of work with respect to palliative care and of the available guidelines that were designed to assist with providing standards and norms for managing life limiting and threatening conditions. The health workers did, however, present a view that they were unclear about the kind of services they should render under palliative care.

Palliative Care Initiative

Where and by whom should palliative care be offered?

The study also showed that there was a lack of knowledge about palliative care, confusion as to where palliative care should be offered and by whom and the role of providing medication as a part of palliative care. Interestingly, the health workers mentioned the importance of different actors, the importance of teamwork and some perceived successes of palliative care implementation. Several challenges were reflected which included the availability of medicines, human resources, transport, infrastructure and a lack of coordination of Rural Health Motivators. Suggested strategies for improving palliative care which have been pointed out include training, improving medicine supply and organisational issues.

In addition, the study findings offer a concrete baseline on palliative care awareness among health workers; nevertheless, it neither reflects an increase nor decrease of palliative care services. On the other hand, it is worth noting that the findings provide a clear hint on how the policy could be effectively operationalised. In addition, certain outcomes can be measured quantitatively, thus giving clear direction on how palliative care services can be strengthened in the Shesilweni region. Palliative Care policies should be fully operationalised for efficiency; Involvement of key stakeholders should be an active process level ingredient

“The palliative care policy is a huge and essential achievement for the Kingdom of Swaziland. However, more efforts need to directed into implementing the policy and improving the provision of Palliative care services in Swaziland. Having a partially operationalised policy is insufficient.” Dr. T N Maseko

Read the full study report here

 The African Palliative Care Research Network paper of the month