Background The provision of palliative and end-of-life care for patients with progressive disease is inadequate worldwide. The WHO strategy to develop a public health system of palliative care at the national level proposes a quadripartite approach: policy, education, drug availability and implementation. This is particularly necessary in low income countries facing a high disease burden with low resources. To date there have been no published evaluations of advocacy strategies aiming to use the WHO approach to enhance access to palliative care.

Objective To evaluate the Palliative Care Initiative which implements the WHO approach to strategically improve palliative care throughout Zambia, using a multiple methods rapid field evaluation.

Methods and results Eight hospices and palliative care organisations in Zambia were part-funded over 2 years (2009–11) and were thus able to expand their services, offer a reliable supply of drugs, secure fuel for transport, and support home carers. Simultaneously, an extensive programme of rural and urban training resulted in staff being more confident in caring for the dying with improved attitudes to the concerns of very ill patients and their families. A multi-agency morphine pilot project led by the Palliative Care Association of Zambia and the Ministry of Health resolved some of the obstacles and increased morphine availability although its use remains low. Palliative care is now being considered by the technical working group at the Ministry of Health.

Conclusions For palliative care to thrive in any resource-poor country it must be integrated into the public health system and secure long-term funding.