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Ten Years after the WHA Resolution on Palliative Care: Are we closing the access abyss?

Paralysed patient Md. Khokon exercises by himself at home.

“If you want to go fast, go alone if you want to go far, go together.” African proverb. World Hospice and Palliative Care Day (WHPCD) will be celebrated on 12 October 2024. Every year we mark this day on the second Saturday of October. This year the theme is Ten years since the resolution: How are we doing? This question begs us to reflect on the journey and milestones achieved so far. We also need to identify the bottlenecks that continue to hinder progress in achieving Universal Health Coverage (UHC) which is inclusive of palliative care and come up with effective strategies to achieve this goal. British doctor Dame Cicely Saunders founded St Christopher’s Hospice and the modern hospice movement in 1967, which gave rise to palliative care. In 1974, Dr. Balfour Mount, a surgical oncologist at The Royal Victoria Hospital of McGill University in Montreal, Canada, coined the term palliative care to avoid the negative connotations of the word hospice in French culture. The difference palliative care makes to the lives of patients and their families and carers is radical, so it’s easy to see why palliative care took off and is now an accepted integral part of health care policies globally. Pioneers of palliative care have worked tirelessly to promote and develop Saunders’s approach. Driven by common goals, they have built collaborative networks on national, regional, and international levels, and won committed backing from key bodies such as the World Health Organisation (WHO). It’s now widely accepted that medical specialisation, the integration of palliative care into mainstream health systems, and the development of evidence-based practices are crucial to the ongoing reduction of suffering in people living with palliative care needs (PLWPCNs). Over the years, a lot of milestones have been achieved. There are a few regions where palliative care services have been fully integrated into healthcare systems, especially in the global North, but the gap remains wide between those who have achieved this and the countries and regions who are yet to achieve this goal. WHPCA estimates that 50% of the need for palliative care is being met in high income countries while only 4% of the need is being met in low and middle-income countries where over 80% of the need exists. 2024 marks 10 years since the World Health Assembly (WHO’s Governing Body) passed the only stand-alone resolution on palliative care, calling for all countries to “strengthen palliative care as a component of comprehensive care throughout the life course.” So, how are we doing? A lot has been said and published about statistics and it is evident that most of the need is in the global South. One of the strategic moves to make would be inclusivity and decolonising global health convenings. These conferences offer opportunities and platforms for the exchange of knowledge, decision-making processes, and fostering personal and professional growth among participants. This also creates opportunities for candid discussions, evidence presentations, research analyses, major commitments, and opportunities to enhance global knowledge exchange. There is an increased effort to ensure diversity and conference equity but this will entail more intention. Discussions at the conferences revolve around low and middle-income countries (LMICs) but these conversations occur without meaningful representation from the very communities under discussion. This may be caused by systemic barriers such as exorbitant travel costs and visa restrictions. The restrictions are not just geographical, but few speaking opportunities are given to community members from LMICs. Funding and sponsorship opportunities should be available for the global South participants especially young and emerging leaders to attend the global health conferences held in the global North and facilitate their visa and travel processes. Enhancing the diversity and representation of the global south participants in the planning, organising, and delivery of the global health conferences. Promoting dialogue and collaboration between the global and local health stakeholders and aligning the global health agenda with local health needs and priorities and that the local health stakeholders and actors are involved in the implementation and evaluation of the global health interventions and recommendations. By doing so, I believe that global health discussions can become more effective and impactful in advancing the global health agenda for achieving UHC for all including palliative care.

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