Focus on Children’s Palliative Care at the Kenyan National Palliative Care Conference 2018

Categories: Care, Education, and Policy.

Photo: ICPCN’s Chief Executive Prof Julia Downing leading a workshop on Paediatric Palliative Care

The 5th National Kenyan conference on palliative care, themed Investing in Palliative Care for Universal Health Coverage was held in Nairobi from the 7th-9th November. Commencing on Wednesday 7th November, the stage was set with a choice of workshops for delegates. The three workshops held in the morning included: children’s palliative care; Research and innovation; and Strengthening facility based pain management through a low cost training initiative. In the afternoon the choice included: Strategic advocacy for palliative care and access to controlled medicines; Spirituality in palliative care; and advanced care planning.

Co-ordinated by ICPCN, the morning workshop on paediatric palliative care aimed to explore the use of the Public Health Approach in the development of children’s palliative care in Kenya. Over 60 participants attended and it was hoped that by the end of the workshop they would be able to:

  1. Discuss the Public Health Approach for the development of children’s palliative care including the roadmap for PC development
  2. Discuss the different components of the public health approach and why they are important for the ongoing development of CPC in Kenya.
  3. Apply the different components of the public health approach in their own context.
Kenyan Palliative Care (PC) Policy

Facilitators for the workshop included Prof Julia Downing, Prof Jessie Githang’a, Dr Liru Meshack and Dr Esther Nafulu. The four components of the Public Health model for palliative care were explored alongside the additional fifth pillar on research. Prof Julia started the workshop by exploring the importance and utilisation of policies, guidelines and frameworks. We all need to be aware of the variety of policies, frameworks, guidelines that influence CPC in Kenya – both those that help and those that hinder service provision. The Kenyan PC policy is currently being formulated so a great opportunity to ensure that CPC is catered for. Likewise the new UHC strategy is soon to be launched and it is not known whether there I anything included on CPC, if not then advocacy for PC within UHC is essential. The importance of having data to inform policy was stressed, along with the fact that we all have a responsibility to be aware of what shapes our service provision.

Access to medicines in CPC

Dr Liru then explored access to medicines for children’s palliative care, looking at a wide range of medicines, including oxygen, morphine and laxatives. The importance of having paediatric formulations was stressed along with the need for ongoing advocacy to ensure access. It was also noted that it is important to use medicines once they become available and it was noted that some paediatric morphine had been available but not used.

Education

Education is essential for CPC development in Kenya, and Dr Esther explored the need for education at different levels, including continuing education, inclusion in academic curriculum and specialist education. Examples of training were discussed including the ICPCN’s elearning programmes. The need to change attitudes and not just knowledge and skills was stressed, not just for health professionals but for all involved in CPC, policy makers, the media, the public etc. However resources are needed to strengthen and develop CPC education in Kenya.

Models and research

Dr Liru discussed different models of CPC implementation, the importance of integrating CPC into the different levels of care e.g. hospitals, health centres and the community. Universal Health Coverage is an important tool for advocacy for implementation and the use of child/parent advocates is key. Finally Prof Jessie explored the need to develop CPC research in Kenya and participants identified a wide range of topics for research. Challenges to undertaking CPC research were discussed along with ways of overcoming challenges such as mentorship and supervision.

Opening plenary

The opening plenary session on the Thursday focused on Palliative Care and Universal Health Coverage. Following a documentary of palliative care in East Africa, Dr Emmanuel Luyirika from APCA presented the main findings of the Lancet Commission report on pain and palliative care. The keynote address, given by Robert Yates from Chatham House in the UK focused on ensuring palliative care is a top priority in UHC reforms. Throughout his presentation he stressed the importance of ensuring palliative care for all, including children, is a core component of UHC and that we need to ensure that this is honoured and recognised by governments. Responding to his address, the Minister of Health officially opened the conference and reassured participants that when the governments UHC strategy is launched on the 1st December palliative care will be included. The theme of UHC was continued after coffee with a panel discussion addressing a range of pertinent issues of UHC and palliative care.

Rethinking advocacy

The afternoon saw participants breaking into 4 tracks: UHC; research and innovation; psychosocial support and spirituality; and clinical care across all settings. CPC was spread throughout the tracks, with the main focus being in the session on clinical care, covering topics such as the impact of PC on adolescents with HIV/AIDS at Bomu Hospital, children with cancer and the role of a child life specialist in CPC. Friday morning saw the plenary sessions focusing on different PC for different conditions and the importance of advocacy. The MoH National Cancer Control Programme presented on the Kenyan Cancer Control Programme and the ongoing development of the national PC policy. Then in her presentation on strategic advocacy, Dr Faith Mwangi-Powell urged us to rethink our advocacy and how we do it. Each of these presentations stressed the importance of CPC and its inclusion throughout the health system. Elizabeth Mutanga then shared her experience of having a father with dementia and the importance of palliative care for individuals with dementia, followed by a presentation on a compassionate care team and one a study looking at doctors attitudes towards PC on ICU in Rwanda.

Be bold and innovative

Further break out sessions were then followed by the final plenary. At the final plenary ICPCN’s Chief Executive Prof Julia Downing spoke about paediatric palliative care. Outlining its importance, global, regional and national development, and shared some of the outcomes from the CPC workshop held on the first day. She recognised the passion and commitment to CPC in Kenya and encouraged participants to be bold and innovative as they expand CPC coverage throughout Kenya. Finally the Kenyan PC research network was launched prior to Dr Zipporah Ali, Executive Director of KEHPCA, giving the vote of thanks.

The conference was a great success and we are already looking forward to the next one in two years time!