Palliative Care Association of Rwanda (PCAR) implemented a one-year project involving Palliative Care Link Nurses (PCLNs) to leverage PC service delivery. Through trained PCLNs the project attempted to i) promote best practices through education, clinical procedures ii) follow up patients by health center staff, CHW cell coordinators and CHWs at village level to improve on continuum of care.

Justification Rwanda government has put into integration of PC in both public Hospital system and availability of strong pain management drugs (Opioid) the need for essential PC package still unmet, still huge gaps in patient care outside hospital ward (home based)

Key Results Twenty-seven (30) link nurses (20 female and 10 male Nurses) from different hospital wards were trained with one Doctor. Follow-up meetings at the hospital and health center levels were organized. Patient follow up meetings with 73 CHW cell coordinators were conducted. In 3 months after the training, nine (11) patients with cancer were discharged to be followed at home. Two (2) patients who had been abandoned at the hospital for 3 years were reunited with their families. Hospital staff were enlightened on the importance of working as a team to provide holistic care to patients.

Main lessons PC is not yet on hospital structure which makes the staff consider it as additional responsibility. Follow up meetings at the hospital have many disruptions because the nurses are on duty and patients are waiting. Some nurses work during the night shift and therefore difficult to meet during the day.

Key recommendations Ministry of Health should include PC in job description of the staff trained. PC advocacy is needed in top government policy makers as well as in all stakeholders involved in universal health coverage as it a new concept to many.