In Panama, the government had in 2003 approved the Patient Right’s Law mandating that each healthcare unit should provide palliative care.
Following this, in 2010, a decree was passed creating ‘The National Program of Palliative Care’. Subsequently the operating guidelines that are currently in used in each healthcare unit were developed.
Caja de Seguro Social (CSS), the social security institution, which covers 82% of Panamanian population, in August 2014 included the Palliative Care Programme in their Organisational Chart.
In March 2016, a new law for controlled substances was approved to replace the previous one which had endured for the last 50 years. The new law is currently awaiting final regulation.
The National Palliative Care Programme jointly with the University of Panama, Ministry of Health, CSS, and several non-governmental organisations (NGOs), (such as FUNDACANCER, ANCEC, HOSPES, ELNEC, have offered healthcare providers in different cities at national level, several continuous education activities such as workshops and short training courses.
Formal Education: Specialised and graduate trainings with Government sponsorship
The option to specialise in palliative care is available for physicians (20 fellowships) and for nurses (22 fellowships). There are also options for training in Psycho-Oncology, and a Masters programme in Pharmaceutical Oncology and Palliative Care (year 2016-2018).
Currently, the Clinical Pharmacy Masters Programme offers clinical practice in palliative care (480 hrs). Several universities also include palliative care training at undergraduate level based on the National Palliative Care Programme guidelines for academic curricula of Health Schools based on competence.
Availability of controlled medications
Morphine, oxycodone, tramadol, fentanyl and codeine are now included in the National Essential Medicines List.
The Ministry of Health and CSS have allocated resources in their annual budget for their yearly purchase. Similarly, an improved system for estimate calculation was put in place recently and a system facilitating electronic prescription has also started.
There is a tendency to increase the morphine mg equivalent according to the records from the WHO Collaborating Center for Pain Policy and Palliative Care at the University of Wisconsin.
The number of healthcare providers duly trained nationwide in palliative care has increased.
From one palliative care unit (at the National Oncology Institute) in 2010 to date, there are several Coordinations of Palliative Care at national level and 15 multidisciplinary palliative care teams in 11 cities.
Since 2015, MINSA-CSS palliative care coordination has improved significantly and all CSS clinics have now palliative care units.
The number of people receiving palliative care has increased from 1000 (year 2010) to 2500 (year 2014). One third of this population lives in outside of cities.
Recently, a National Association of Palliative Care was created.
Civil society have produced a report detailing progress on implementing the WHA Palliative Care resolution including case studies from Romania and other countries. You can access the report on the Worldwide Hospice Palliative Care Alliance website.