Background The THET (Tropical Health & Education Trust) partnership project on Strengthening and integrating Palliative Care into national health systems commenced in 2012. The project aims at enhancing the provision of palliative care in Kenya, Rwanda, Uganda and Zambia through the integration of palliative care into existing services within 12 hospitals and their associated community hubs.

Aims An important component of the programme was to capture the evolution of the models of integrated palliative care developed in each of the 12 hospitals.

Methods We conducted a baseline assessment, ongoing review and dialogue with regards to the vision for palliative care service provision to help map the process. For each hospital a matrix was developed which built on the core internationally accepted components of a model of care e.g. staffing, setting, services provided, types of patients seen, referral process, management of patients, integration within the health systems etc.

Results The process of defining and developing a model of care was unique for each setting, and was fluid and constantly changing. Different hospitals were able to articulate different components of the model at different stages, for example, some hospitals have clear visions for palliative care but are uncertain about options and best methods of implementing their visions. An important component of the model was mapping of the referral networks, which was challenging.

Conclusion The process of defining and developing a model of integrated palliative care go hand in hand, changing over time. Defining a model is challenging, but integral to the development of that service. Support is needed to services to do this, and the model will evolve over time. Strengthening this process and providing evidenced based frameworks from similar settings showing health systems integration is an important means of support. Many lessons from Africa are relevant to more economically developed countries.