This is the culmination of 14 months’ work, led by the Nepalese Association for Palliative Care (NAPCare) with representation from the Ministry of Health and Population, WHO and several health-related NGOs. It was made possible by the generous support of Two Worlds Cancer Collaboration, Canada.
Over the next few weeks the Strategy will complete the final stages of its development in the Ministry of Health, before it is adopted as the framework setting out the vision for the growth of palliative care in Nepal for the next ten years.
Palliative care was first established in Nepal in 1998. Whilst NAPCare and other providers have offered training to clinicians countrywide, service provision has been restricted to the Kathmandu Valley and two other urban centres.
Services have focused mainly on people with cancer, whilst increasing numbers of people suffering from chronic cardiac, respiratory and other illnesses have not had access to palliative care.
The national strategy which takes a public health approach and builds on ongoing needs assessment work, aims to make palliative care available to all who need it, whatever their age and illness and wherever they live.
It includes provision of palliative care from village health posts, staffed by mid-level health workers, through district hospitals led by GPs who have completed Nepal’s unique MDGP qualification, to secondary and tertiary hospitals in major cities.
Nepal’s sparsely populated mountainous terrain, with lack of roads and infrastructure, means that people often have to often walk for several hours or even longer to reach healthcare facilities.
Appropriate models of palliative care will need to take this into account and the strategy highlights the need for ongoing research to develop and monitor the effectiveness of emerging models.
Although medicinal morphine is manufactured in Nepal in all of the common palliative care formulations, it is not available in remote areas.
The strategy addresses this by stressing the need for morphine and other essential palliative care medicines to be made available, free or at an affordable cost, to those who need them, wherever they live.
The Government of Nepal remains committed to palliative care development. For the last four years it has been providing training via the National Health Training Centre in partnership with NAPCare.
Officials in the Ministry of Health are enthusiastic about the strategy and have committed to accelerate the process of adoption by the government.
Professor Bishnu Paudel, President of NAPCare, said: “I am very happy to hand over the draft National Palliative Care Strategy to the Ministry of Health. Once it is officially endorsed by the Government of Nepal, it will enable us to plan and implement high quality, appropriate palliative care to minimise the suffering of the Nepalese people.”
In a recorded message, Professor Max Watson from Northern Ireland, who himself worked for many years in Nepal and who facilitated the initial strategy workshop in 2016, said on behalf of the international delegates: “We congratulate NAPCare and the government on the development of the palliative care strategy, which shows Nepal as a leader in Asian palliative care.
“Two Worlds and your other friends across the world will continue to provide support in whatever way we can, as you implement this great strategy.”
Read more about the development of the strategy on ehospice.