Zimbabwe faces many challenges in the provision of Children’s Palliative Care

Hospice and Palliative Care in Zimbabwe began in the late 1970’s and was spearheaded by Island Hospice Zimbabwe. In Africa Zimbabwe was one of the first countries to practice palliative care. At present  palliative care in Zimbabwe is provided in institutions like Island Hospice, Mashambanzou, Government hospitals and Mission Hospitals as well as the clinics belonging to local authorities.

Most hospice and palliative care services in Zimbabwe focus on adults. Although each hospital in Zimbabwe has a paediatric unit, due to lack of qualified personnel not much is done to help the children with life limiting conditions in these institutions. There is no palliative care unit in Zimbabwe where children can be admitted and be looked after.

Many Zimbabwe children  would benefit from palliative care. This is due to various chronic conditions such as cancer, HIV infection, brain tumours, hydrocephalus and many more. The majority of these children present late, particularly those with cancer or brain tumours. This makes their management even more complicated. According to KidzCan Zimbabwe, a private voluntary organisation that helps children living with cancer, in 2011 alone 485 children with either cancer or a brain tumours were seen. Of these 485 children, a quarter of whom presented late so the prognosis was not good, were given end-of-life care and the rest were either treated or referred for palliative care.

What are the challenges?
There are many challenges that affect children’s palliative care in Zimbabwe. Some of these include:

• No dedicated palliative care unit for in-patients. Often children are discharged with a prescription, for their carers to buy the medication and they are then looked after at home with little support. This normally results in poor pain management of the child.
• Lack of properly trained personnel to handle cases of this complexity. Many children or care givers will never come to know their real situation when diagnosed with a life-threatening illness.
• A shortage of essential drugs to manage these children. As much as we want the children to have quality care, sometimes it is hampered by lack of drugs used for treating the child. Recently KidzCan began assisting in this programme by providing essential drugs, with a particular focus on cancer.
• No funds are allocated by responsible authorities to bankroll this programme. The Ministry of Health has no specific funds allocated for this programme yet so many children die in pain.
• Insufficient awareness programmes to educate people about the need for palliative care for children.
• There is no defined policy on children’s palliative care in Zimbabwe. A new palliative care document being produced by the Hospice and Palliative Care Association of Zimbabwe (HOSPAZ) in conjunction with the Ministry of Health does not cover children’s palliative care.

Overcoming the challenges
The way forward in solving these issues that beset the children’s palliative care programmes in Zimbabwe:

• Train more personnel in children’s palliative care
• Strong advocacy is needed to represent children’s hospice and palliative care issues
• Address the myths in terms of drugs or terminology used in palliative care.
• Allocate more resources for the care of children with life limiting illnesses, so that it can succeed.
• Create partnerships with other relevant stakeholders. 
• Revisit the new palliative document being drafted to accommodate issues that have to do with the care of children.
• Have at least one unit dedicated to children’s palliative care in the two major government referral hospitals in Harare and Bulawayo.

The importance of collaboration
There is much room for improvement when we look at the situation of children’s palliative care in Zimbabwe. All stakeholders need to come together and contribute towards this objective so that our children will have quality care. It is not possible for government alone or for KidzCan to provide the solutions.