Palliative care included in Bangladesh’s national plan for noncommunicable diseases

Categories: Policy.

Following a request from Liliana De Lima, I had the tremendous opportunity to represent the International Association for Palliative Care at the WHO 67th session of the Regional Committee for South East Asia in Dhaka, Bangladesh. 

I was given an initial guideline of activities in collaboration with the Bangladesh Government representative from the Ministry of Health and Family Welfare.

In Bangladesh, with its population of about 160 million people, the burden of NCDs has been rising at an alarming pace. In a review of 23 developing countries, Bangladesh had the ninth highest age-standardized mortality due to chronic diseases, such as primary cardiovascular diseases and diabetes.

Unplanned urbanization is a conduit for unhealthy lifestyles, for example smoking and fast food consumption, while common risk factors give rise to intermediate risk factors: raised blood pressure, raised blood glucose, unfavourable lipid profiles, obesity and impaired lung function.

Approximately 51% of deaths in Bangladesh are due to non communicable diseases and other chronic health conditions. In turn, the intermediate risk factors predispose individuals to the ‘fatal four’: cardiovascular disease, cancer, chronic respiratory disease and diabetes, as well as stroke. Pain is often manifested as one of the symptoms of these NCDs, e.g. acute myocardial infarction and cancer.

Palliative care is an integral part of care for life-limiting and life-threatening diseases. Strategically it is known to improve quality of life of patients with NCDs. Hence, while we were targeting indicators for NCDs at the WHO regional committee meeting, our major work was to incorporate an appropriate indicator for NCDs in Bangladesh.

With the help of the IAHPC, and with the encouragement of Dr Poonam Khetrapal, Director General of WHO South East-Asia Region, I was able to work with health ministry officials and succeeded in incorporating the following in the final draft that was adopted on 12 September:

“It was requested that WHO should review and, where appropriate, revise national and local legislation and policies for controlled medicines, with reference to WHO policy guidelines on improving access to, and rational use of, pain management medicine, in line with the United Nations International Drug Control Conventions. Palliative care is an appropriate response for all NCDs, including ischemic heart disease, which is the biggest killer in Bangladesh. Our preferred indicator is “morphine equivalent consumption of strong opioid analgesics (excluding methadone) per capita consumption” (SEA/RC67/31.p:42).

I am grateful to Liliana De Lima and Katherine Pettus for guiding me through Skype and emails to prepare the draft. I would also like to thank my mentors at the Leadership Development Initiative (LDI), Ohio Health, USA, and the fellowship programs of the International Pain Policy Studies Group, Wisconsin, USA, who helped us to realize our potential.

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