Palliative care development in Africa: how can we provide enough quality care?
- R A Powell1,
- F N Mwangi-Powell2,
- F Kiyange3,
- L Radbruch4 and
- R Harding5,6
- 1Department of Learning and Research, African Palliative Care Association, Kampala, Uganda
- 2African Palliative Care Association, Kampala, Uganda
- 3Department of Programmes, African Palliative Care Association, Kampala, Uganda
- 4Department of Palliative Medicine, University of Bonn, Bonn, Germany
- 5Department of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
- 6Professor of Palliative Care, Department of Family Medicine, University of Cape Town, South Africa
- Correspondence to RA Powell, Department of Learning and Research, African Palliative Care Association, P.O. Box 72518, Kampala, Uganda; tony.powell{at}africanpalliativecare.org
Based on the WHO's estimates for 2005, 1% of Africa's total population,1 approximately 9.67 million people need palliative care for life-limiting illnesses throughout the continent.
In sub-Saharan Africa, where infectious diseases constitute the major disease burden, AIDS is the primary determinant of this need, with HIV infections accounting for 68% (22.5 million cases) of global infections in 2009.2 In addition, non-communicable diseases (NCDs) (eg, cardiovascular diseases, trauma, cancers, cardiovascular and respiratory diseases, and diabetes) are also significant sources of morbidity and mortality. According to a recent WHO report, of the 57 million global deaths in 2008, 36 million (63%) were due to NCDs, with nearly 80% of these deaths occurring in low- and middle-income countries.3 Moreover, NCDs are projected to exceed infectious diseases by 2030.4
Despite this need, palliative care coverage on the continent is poor. For the vast majority of Africans who currently endure progressive, life-limiting illnesses, access to culturally appropriate, holistic palliative care (that includes effective pain and symptom management) is at best limited, and at worst non-existent.
However, despite being a low funding priority in Africa compared with HIV and cancer treatment and prevention programmes, several milestones in palliative care have been attained since the establishment of the first hospice in Zimbabwe in 1979. These include: legislation on prescribing by nurses and clinical officers in Uganda; the adoption in 2002 of the ‘Cape Town Declaration’, which advanced that palliative care is the right of every adult and child with a life-limiting illness; the development of palliative care standards for the region; the launch of national palliative care policies in Rwanda and Swaziland; the integration of palliative care into the curricula of …
