10 years after the WHA Palliative Care Resolution – how has Malaysia fared ?

In May, 2014 at the 67^th World Health Assembly, agenda item 15.5 was a proposed resolution: Strengthening of palliative care as a component of comprehensive care throughout the life course.

The resolution affirmed that palliative care, when indicated, is fundamental to improving quality of life, well-being, comfort and human dignity for individuals, being an effective person-centred health service, that values patients’ need to receive adequate, personally and culturally sensitive information on their health status, and their central role in making decisions about the treatment received.

It also acknowledges that palliative care is an ethical responsibility of health systems and is the ethical duty of healthcare professionals to alleviate pain and suffering. It addresses the need for access to essential medicine, education and the inclusion of palliative care as part of universal health coverage.

The adoption of the resolution urges member countries to:

1. Develop, strengthen and implement palliative care policies to support the comprehensive strengthening of health systems to integrate evidence based, cost effective and equitable palliative care services in the continuum of care, across all levels, with emphasis on primary care, community and home-based care, and universal coverage schemes.
2. Ensure adequate domestic funding and allocation of human resources for palliative care initiatives, including development and implementation of palliative care policies, education and training, and quality improvement initiatives, and supporting the availability and appropriate use of essential medicines, including controlled medicines for symptom management.
3. Provide basic support, including through multisectoral partnerships, to families, community volunteers and other individuals acting as caregivers, under the supervision of trained professional
4. Aim to include palliative care as an integral component of the ongoing education and training offered to care providers, in accordance with their roles and responsibilities
5. Assess domestic palliative care needs, including pain management medication requirements, and promote collaborative action to ensure adequate supply of essential medicines
6. Review and revise national and local legislation and policies for controlled medicines, with reference to WHO policy guidance, on improving access to and rational use of pain management medicines in line with United Nations international drug control conventions
7. Update national essential medicine lists in the light of recent additions of sections on pain and palliative care medicines to the WHO Model List of Essential Medicines and the WHO Model List of Essential Medicines for Children
8. Foster partnerships between government and civil society, including patients’ organisations, to support the provision of services for patients requiring palliative care
9. Implement and monitor palliative care actions included in WHO’s global action plan for the prevention and control of non-communicable diseases 2013 – 2020.

Palliative care was introduced in Malaysia in the 1990s through the efforts of mainly non-government organisations such as Hospis Malaysia and the National Cancer Society of Malaysia. The first Ministry of Health service started in Kota Kinabalu in 1995. In 2019, the Ministry of Health published their National Strategy for Palliative Care 2019 – 2030.

Indirectly, the various iterations of the quality of death and dying index (2010, 2014 and 2021) has seen a decline in the ranking of Malaysia compared to other countries.

The recent update by the Department of Statistics Malaysia suggest that Malaysia will be an ageing nation by 2030 where 15% of the population will be 60 years and over.

Ageing communities as well as the rise of non-communicable diseases will create a major need for social and healthcare services with palliative care a major need.

The notion of a healthy ageing community is a fallacy without a recognition of the need of healthy dying. This normally translates to people wanting pain and symptom relief and a desire to spend their final days at home.

Conforming to many of the recommendations of the WHA 67.19 resolution is not just about health finances but also reforming health systems, multi-sectoral engagement and collaboration, with an integrative system approach rather than one that exists side by side and are separate, as is currently the case in Malaysia.

Changes in how we work to deliver the services required, will improve both health outcomes and can result in cost savings. There are worthwhile examples in our neighbouring and some low middle income countries.

Malaysia has increased its palliative care services since 2014 but this has mainly been focussed on the introduction of specialist services in hospitals.

Thousands of Malaysians need access to palliative care daily. Much of these could be done in the community if there is access to education, training, essential medicines and occasionally emergency services. Patients needs assistance when it is necessary, not if it is provided according to a schedule and where it is convenient for the provider.

At a palliative care conference held in Africa a few years ago, a patient advocate spoke out to policy makers: “your policies are useless unless the benefit is felt by patients”.

Thus, perhaps when we reflect on whether Malaysia has conformed to the 9 recommendations of the palliative care resolution, think of the lived experiences of members of our community.

Did they know they had palliative care needs? Were they able to access medication to relieve their suffering? Were their caregivers supported, such as caregiver training, psycho-social and grief and bereavement support? Were they able to participate in making decisions that involve themselves? If the answer is no, will policy makers care enough to improve it?

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Lead Photo:

Meeting of the WHO Technical Working Group for Palliative Care, Oct 2023, Madrid. As a member of the committee, Dr Ednin has been involved in international palliative care advocacy for over 20 years. The global palliative care community is also evaluating the global progress of palliative care on the 10^thanniversary of the WHA 67.19 resolution.