Article of the Month
Reviewed by: Gian Domenico Borasio, MD,
University of Munich, Germany and IAHPC Board Member
Hospice and Palliative Care Development in Africa:
A Multi-Method Review of Services and Experiences
Author(s): David Clark, Michael Wright, Jennifer Hunt, and Thomas Lynch
International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Lancaster, United Kingdom
Journal: Journal of Pain and Symptom Management 2007; 33(6): 698-710.
Summary
There is a paucity of information on hospice and palliative care provision in Africa and only a weak evidence base upon which to build policy and practice development. This article set out to assess the current state of provision across the continent, mapping the existence of services country by country and exploring the perspectives and experiences of those involved.
Methods
The data were collected between September 2003 and July 2005. A multi-method review was conducted involving a synthesis of evidence from published and gray literature, ethnographic field visits to seven countries, qualitative interviews with 94 individuals from 14 countries, and the collation of existing public health data. Forty-seven African countries were reviewed, involving the assistance of numerous hospice and palliative care activists, including clinicians, managers, volunteers, policy makers, and staff of donor organizations.
Results
The 47 countries of Africa could be grouped into four categories:
- no identified hospice or palliative care activity (21 countries, comprising 160 million people, mostly in the Sub-Saharan zone);
- capacity building activity is underway to promote hospice and palliative care delivery (11 countries, comprising 260 million people);
- localized provision of hospice and palliative care is in place, often heavily supported by external donors (11 countries, comprising 293 million people);
- hospice and palliative care services are approaching some measure of integration with mainstream service providers and gaining wider policy recognition (four countries - Kenya, South Africa, Uganda, and Zimbabwe - comprising 114 million people).
Overall, services remain scattered and piecemeal in most African countries, and coverage is poor. Nongovernmental organizations are the predominant source of provision. Major difficulties relate to opioid availability, workforce development, and achieving sustainable critical mass.
Conclusions
Models exist in Kenya, South Africa, Uganda, and Zimbabwe for the development of affordable, sustainable community-based hospice and palliative care services, but sensitivity is required in adopting Western models of hospice and palliative care for implementation in the African cultural context.
Why I chose this article.
- It is a timely look at the complex reality of hospice services in Africa. As the authors state, interest in the development of hospice and palliative care in Africa has never been greater.
- It employs a variety of methods to address the difficulty in gathering reliable data from a complex and poorly researched environment, and succeeds in delivering a comprehensive view of African hospice reality.
- It highlights the danger of imposing a Western model of hospice and palliative care on a different and varied cultural context such as Africa. The need for developing culture-sensitive interventions and service delivery systems is underscored.
This article should prove invaluable not only to professional with a direct interest in African hospice development, but also to everyone involved with the development of hospice and palliative care services in resource-poor countries.
Reviewer:
Gian Domenico Borasio, MD,
University of Munich, Germany and IAHPC Board Member
Biographical detail at: http://www.hospicecare.com/Bio/domenico.htm
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http://www.hospicecare.com/AOM/
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