Through continued advocacy we were pleased to see palliative care strongly included within the Political Declaration and as a core indicator in the monitoring framework. However, the current draft of the Global Action Plan does not indicate or lay out actions in relation to how progress will be achieved on access to palliative care, including pain treatment, by member states from 2013-2020. The Global Action Plan is currently largely focussed on preventative initiatives to tackle key risk factors. Actions related to palliative care are not currently included within the country priority actions or the extended set of possible actions at the country level.
At the consultation meeting, the WPCA, after liaison with partners working on palliative care advocacy, made the following intervention:
“I would firstly like to take us back to the impact of NCDs on patients and provide a little context for my intervention through the story of Enrique Hernandez, a forty two year old man from Mexico. In May 2011, Enrique, noticed blood in his urine. A large tumor was discovered in his kidney. In January 2012, Hernandez’s tumor was surgically removed. Although doctors told him that other organs had not been affected by the cancer, Hernandez’ pain did not subside. In an interview, Hernandez said: “When I arrived home I started to get these pains. I couldn’t sleep. The pain was too severe… I was crying.” While he was put on chemotherapy, his pain treatment remained inadequate. When he was interviewed six weeks after his surgery, he was receiving a weak opioid pain killer that only provided him partial relief. During the interview, Hernandez was visibly in pain. He said: “There are days when it is too strong. It’s especially severe at night, when the temperature drops. [When I have severe pain]…I make a claim to God… that he relieve me of it because I can’t [stand it]. My nerves give in. I cannot tolerate [being around] my children [of 10 and 12] because of the noise.” Hernandez had no access to strong opioid analgesics despite suffering severe pain requiring, as advised by WHO, the use of these medications. The closest palliative care services are an hour a way in a private vehicle and no one had referred him.
Despite the inclusion of access to palliative care as an indicator within the monitoring and evaluation framework, the current Global Action Plan (GAP) does not lay out how access to palliative care and pain treatment will be made available by 2020 in relation to actions by government or UN partners. With the current plan, we are unlikely to see significant progress in relation to the palliative care indicator over the coming 7 years. We therefore recommend that, in line with the political declaration:
- The GAP needs to address the pain and suffering of people living with and dying from NCDs.
- The GAP should recognise that NCDs will continue to be a major cause of morbidity and suffering in years to come and many people will require palliative care.
- The GAP should provide additional information on the palliative care indicator including its purpose, context and limitations and specific actions required for developing palliative care services by WHO, UN partners and governments. Palliative care is not just for people with cancer but for all conditions and it is not just about access to pain treatment.
- We would like to see palliation included wherever prevention and control is mentioned within the Global Action Plan.
- Most importantly, improving access to palliative care, including pain treatment, should be included within the list of prioritised minimum actions at the country level in appendix 3 under objective 4. This is in order to:
- move towards universal health coverage of which palliative care is recognised as a needed and essential health service
- strengthen health systems by ensuring a cost effective intervention such as palliative care which both improves quality of life of people with NCDs and prevents unnecessary hospitalisation and futile treatment expenditure in the last days, months and years of life”.
The need for the inclusion of palliative care within the priority country actions was supported by Julie Torode, Deputy Director of the Union for International Cancer Control (UICC) and Cary Adams, CEO of UICC and co-chair of the NCD Alliance. Dr Oleg Chestnov, Assistant Director General of WHO assured participants that there was no need to persuade WHO that palliative care should be included, that it should be in the Global Action Plan and that this would be raised with member states at that consultation next week.
Palliative care advocates are currently finalising a revised statement on the rationale and evidence, particularly in relation to cost effectiveness and patient outcomes, to include palliative care as a prioritised country action and to address some of the challenges with the current selection criteria.Suggested actions will be in line with the WHO triangle relating to the need for policy, drug availability and education on palliative care and WHO’s own guidance documentation on ensuring balance in relation to national policies on controlled medications and the development of cancer control programmes.
If palliative care is not included more strongly within the Global Action Plan on NCDs, we are concerned that we will not see expect significant progress in relation to access to palliative care for people with NCDs over the coming 7 years. Parallel consultations are ongoing at the regional and national level which pan-national and national palliative care organisations are encouraged to engage with their governments and WHO offices on this issue. Member states will begin their consultation process with WHO on 11 March 2013.
Read the latest Global Action Plan on NCDs and details of the consultation process. Thanks to Human Rights Watch for providing the case study of Enrique Hernandez.
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