By Martin Lankoandé, Marie N. Ouédroago, Augustin T. Bambara, Carine Bague/Atiou, and Christian W.W. Sapo
Ougadougou, Burkina Faso
This article was first published in the IAHPC newsletter and has been reproduced by kind permission
Hospice Burkina is proud to share our mid-term experience in palliative care advocacy. Hospice Burkina is the national palliative care association of Burkina Faso, founded in 2017 by aneshesiologist Dr. Martin Lankoandé. Our mission is to implement palliative care. The association brings together palliative care health professionals, both trained and untrained, with volunteers. The Hospice Burkina strategy is anchored to WHO framework building blocks like service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance. We also used the Recommendations from the White Paper for Global Palliative Care Advocacy from PAL-LIFE as a strategic framework.
Online course led to a national conference
In 2018, the International Association of Hospice and Palliative Care, with the World Health Organization (WHO), organized an online course on “How to Write a Policy Brief.” Our chosen topic was: public and political awareness of palliative and elderly care in Burkina Faso. The course guided us to complete the table below.
Table: Evidence-based, data-related palliative care barriers in Burkina Faso
|Pillars of palliative care||Aspect||Yes||No|
|Policies||Is there a policy on palliative care?||x|
|Is there a pain management policy?||x|
|Is there a geriatric care policy?||x|
|Is there a policy to facilitate access to opioids?||x|
|Laws||Does the Constitution guarantee the right to health care?||x|
|Does the Constitution explicitly provide for the right to palliative care?||x|
|Has the Public Health Code included palliative care in the basket of care?||x|
|Does the Code of Medical Ethics explicitly mention the right to palliative care?||x|
|Is there a law or regulation on palliative care?||x|
|Is there a law against pain?||x|
|Training||Are there any continuing education courses on pain and palliative care?||x|
|Is there initial training on pain and palliative care?||x|
|Are there staff trained in pain and palliative care?||x|
|Palliative care services||Is there suspension oral morphine?||x|
|Is there enough morphine for patients?||x|
|Are there studies assessing palliative care needs?||x|
|Nationwide, are there facilities where palliative care is provided?||x|
Global civil society to the rescue!
One of the recommendations of our policy brief was to organize a national conference, assembling all stakeholders in palliative care delivery. Our request for financial support from the Ministry of Health was unsuccessful. However, by collaborating with the Organization for the Prevention of Intense Suffering (OPIS) (whose vision is to eliminate the preventable suffering of all sentient beings in the world), an online fundraising drive raised €10,000 to help finance a conference, including travel, accommodation, food for participants, security, rental of a venue, and equipment for the meeting. Dr. Marie-Charlotte Bouësseau, of WHO Geneva, and staff of the WHO-Burkina Country Office lent managerial support.
Experts in the field of palliative care and pain came from Uganda, Belgium, France, Cameroon, Benin, Germany, and Switzerland to attend the conference, held in December 2019. National guests included directors of university hospitals, directors of medical faculties and schools of public health, professional organizations, caregivers, and patients. Hospice Burkina organized a home visit during the conference.
Recommendations from the conference included:
- develop palliative care policies
- establish introductory and ongoing workforce training
- establish access to liquid morphine
Accomplishments to date
The COVID-19 pandemic has delayed implementation of the recommendations; however, there have been many accomplishments to date:
- The National Assembly of Burkina Faso is considering legislation on the right to palliative care.
- The Ministry of Health has ordered 5 kg of morphine powder for the preparation of oral morphine syrup in the pharmacology laboratory of the Burkina Faso Center of Excellence in Drug Sciences with the approval the National Competent Authority.
- The Faculty of Medicine at Saint Thomas Aquinas Catholic University in Burkina Faso is preparing a 60-hour palliative care module.
- A 12-hour teaching module is being added to the training curriculum of the Master of Anesthesiology at the School of Public Health.
- Palliative care services are beginning in the capital city of Ouagadougou.
Challenges that remain
Remaining challenges are the lack of:
- a national palliative care strategy
- a palliative care education in health science training centers
- a palliative care focal point at the Ministry of Health
- integration of palliative care services at all levels of the health care system
Another key challenge is the frequent change of Ministry of Health leadership that entails repetitive efforts at advocacy.
Hospice Burkina’s goal is to encourage the government to assume its share of responsibility by making a lasting commitment to the fight against health-related suffering. Advocacy support from international organizations such as the WHO, and global civil society organizations, such as IAHPC and OPIS, are strengthening our advocacy to promote palliative care integration in Burkina Faso.