Background A worldwide mapping of palliative care services for children identified only 16% of countries have established paediatric palliative care (PPC) services. Most of these countries are in the developing world. In sub Saharan Africa, where the need is great due to HIV, Tuberculosis and Malaria, only South Africa and Malawi had any PPC services Two projects were initiated to expand access to palliative care services for children, based on education and advocacy, reaching five countries and impacting on development in two others.

Method A Textbook for Africa was written by PPC practitioners experienced in working with children in developing countries including a UK GP who had worked in Uganda. Using lessons learned in South Africa a Toolkit for development of PPC programmes was compiled. A Multi-professional curriculum was developed and piloted in Tanzania, Uganda and South Africa. This curriculum has also been presented in Malawi, India, Kenya and Zambia. Existing model programmes were identified and strengthened, for clinical placement of students. Further sites have been identified and strengthened for placements. An e-learning module on pain assessment and management, has been developed for further expanding education of professionals. A Virtual PPC training centre, the Baobab website was established. Communication has been initiated with university departments for integration of PPC in undergraduate training.

Results 240 professionals have received PPC training in five countries New programmes have been initiated PPC has been initiated in hospitals Training has expanded to three further countries.

Conclusion Expansion of PPC services can be achieved through education, advocacy and collaboration even in developing countries