As Uganda marked the World Hospice and Palliative Care Day 2020, organizations that provide palliative care seized the occasion to call for and demand increased funding allocation from government to the critical services which are offered to patients with life threatening illnesses. This will not only support home-based care at all levels, but also go a long way to decongest the Uganda Cancer Institute.
Providers of palliative care made the appeal at a high-level meeting hosted by the Palliative Care Association of Uganda (PCAU) at Sheraton Kampala Hotel on 10th October 2020. The meeting brought together key stakeholders that included Ministry of Health officials, policy makers, health workers, people with palliative care needs and the general public to deliberate on successes and shortcomings in the delivery of palliative care in Uganda. Mr. Mark Mwesiga, the PCAU Country Director also recognized other stakeholders who joined the event online who included PCAU board members, life members, partners, and representatives of member organizations.
Panelists revealed that while Uganda led the way in palliative care in the early 1990s, with progressive programs like home care, day care, and community volunteers, progress has now been dragging especially due to inadequate financing and lack of a standalone policy on palliative care.
In Uganda only 11% of those who need pain control within the wider context of palliative care access it. The COVID-19 lockdown restrictions have also contributed to the setback with 50% of the patients failing to access palliative care services mainly between April and May.
Dr Henry Ddungu, the Board President of the Palliative Care Association of Uganda noted that it hurts to see that member organizations are no longer able to implement what they love most and have had to reduce the numbers of patients to be helped due to lack of finances.
He called on government to allocate some funding to hospices annually to enable them to purchase new vehicles and pay salaries to allow many patients to receive care at home with their loved ones, because they are never comfortable in hospitals.
He also requested government to support the Institute on Palliative Care Medicine, which trains Diploma, Degree and PhD courses, so as to build Uganda’s human resource capacity in the field of palliative care.
According to Dr. Emmanuel Luyirika, Executive Director of the African Palliative Care Association, the lack of a stand-alone policy on palliative care has left Uganda lagging behind countries like Rwanda, Swaziland, Mozambique, Botswana and Tanzania which have already passed policies.
He noted that Uganda and other UN member states committed to achieve Universal Health Coverage by 2030, and this also involves enactment of a supporting policy. There is need to establish an all-encompassing palliative care policy, and providing resources for patients to access services, and hiring more health workers to provide palliative care emphasizing that the policy should be well funded from the patient to the service provider.
Apart from underperforming on the Abuja declaration by African countries to allocate at least 15% of their national budget to the health sector, Uganda’s funding to health has also been declining over the years.
Dr. Luyirika noted that the question of funding is beyond Ministry of Health, it involves Ministry of Finance, Parliament and the President, and therefore there is need to push more for funding especially at parliamentary level. Being the election season, he said that as people campaign for elective positions, palliative care stakeholders need to ask them what they are going to do for the health sector to ensure palliative care is available at the lowest level of community.
In response, Dr. Jackson Amone, the Commissioner Clinical Services at the Ministry of Health gave assurance that the policy is at an advanced stage and awaits presentation to cabinet. He added that the Ministry has trained palliative care specialists and administrators from Ministry to the lowest level, and that the budgeting process has prioritized medicines since the highest budget goes to oral morphine.
Dr. Amone also noted that the Ministry is in the process of restructuring the staffing in the health sector, at all levels, in order to create functional positions for palliative care personnel. The consultants, nurses and everybody and in doing that, they also intend to put a wage bill, so that a nurse does not do palliative care as an add-on.
The Minister of Health who was the Chief Guest was represented by Dr. Charles Olaro, the Director, Curative Services at the Ministry of Health. He said government acknowledges that Universal Health Coverage can only be achieved by ensuring that preventive, curative rehabilitative and palliative services of sufficient quality are effective and available for all those who need it.
He noted that at the 73rd World Health Assembly held in May 2020, delegates declared palliative care as an essential in universal health coverage, lack of which causes serious suffering.
He further highlighted the challenges that the COVID-19 pandemic has brought and noted that those with life limiting conditions are likely to be severely affected and so should be protected. He acknowledged PCAU for developing the SOPs to that are being used to ensure continuity of care during this time.
Recognizing access to palliative care as a human right, Dr. Olaro said government is looking to strengthen human resource both for palliative care nurses and specialists who are at Masters Degree level.