As the need for palliative care increases, the demand for opioid analgesics and other strong medications for the management of pain will go up. These substances are tightly controlled by the International Narcotics Control Board, and also by national governments. As countries, particularly low- and middle-income countries deal with an increased burden of disease, it is necessary to advocate for changes in national policy to improve access to these medications.
The IPPF, an initiative of the International Pain and Policy Studies Group at the University of Wisconsin, has been running since 2006. The aim of the IPPF is to support fellows as they “develop and implement a project to evaluate national policy and systems and improve the availability of pain medications for pain relief and palliative care in their respective countries” (IPPSG) by providing them with the knowledge and skills to do this, as well as with mentorship by international experts.
The IPPF fellows commit to spending at least eight hours of their working week on improving access to opioid medications in their country.
Each group of fellows participate in a training course in Madison, Wisconsin during which time they develop an action plan to make these essential drugs available in their country. Over the two years following their appointment, the fellows implement the project supported by mentors from the IPPSG.
The fellows attend country and regional ‘Update and Review’ meetings to network, build links and learn from each other to overcome challenges and share good practice.
Dr Priyadarshini Kulkarni, Honourable Secretary-elect of the Indian Association of Palliative Care, and IPPF fellow said: “The exchange of thoughts and ideas has been very helpful for those of us working in India. When we see people from other countries with similar problems, but who approach these in a different way, we can learn from them and, not copy them exactly, but adapt them to our own situation.”
Speaking at the reception, Dr Shalini Valabhan of Pallium India acknowledged the sustained advocacy efforts of Indian palliative care pioneers such as Dr M.R, Rajagopal, noting that the advances in access to pain medications in India that have taken place of the past year, has only been possible due to these sustained efforts. She also commented on the value of IPPF mentorship, saying: “If you need any support or guidance, IPPF is there.”
This guidance and mentorship has been invaluable in Sri Lanka, says Dr Suraj Perera: “Because of the Fellowship, we were able to welcome international experts in palliative care to help us with planning and capacity building. And Dr (Jim) Cleary was able to leverage a meeting with the Director General of Medical Services to convince the government of the importance of palliative care.”
For Dr Taalaigul Sabyrbekova, head of ‘Ergene’, a public foundation in the Kyrgyz Republic for women with breast cancer, being an IPPF fellow gave her a much louder voice in the political sphere in her country. She said: “It gives you credibility, being an ‘International Fellow’ with a university in the United States, people sit up and take notice.”
Having the reputation of the University of Wisconsin behind them, sharing learning with other fellows, and receiving the years of palliative care experience brought by the programme’s mentors, the IPPF fellows are making steady progress in improving access to pain control in their countries. Look out for further articles about the work of individual fellows on future editions of ehospice.
Learn more about the International Pain and Policy Studies Group online.