Palliative care in Africa: an appraisal

Abstract

The paper in today's Lancet by Richard Harding and Irene Higginson is timely and useful. They are reporting on palliative care in sub-Saharan Africa. We on the ground have little time for reviewing current literature, and they report on strengths and weaknesses of palliative care. Palliative care services in Africa mainly sprang from the identification of suffering and an urgent need to meet the needs of, initially, cancer patients and in more recent years those with HIV/AIDS (Garanganga E, HARARE, Zimbabwe, and Gwyther L, Capetown, South Africa, personal communications; and our experiences at Nairobi Hospice and Hospice Uganda 1 Merriman A Living while dying. J Christian Med Commission. 1991; Google Scholar , 2 African Palliative Care AssociationHospice Africa. http://www.hospiceafrica.or.ug/apca/apca_index.htm Google Scholar , 3 Sepulveda C Habiyambere V Amandua J et al. Quality care at end of life in Africa. BMJ. 2003; 327: 209-13 Crossref PubMed Scopus (97) Google Scholar , 4 Kikule E A good death in Uganda: survey of the needs for palliative care for terminally ill people in urban areas. BMJ. 2003; 327: 192-94 Crossref PubMed Scopus (94) Google Scholar , 5 Murray SA Grant E Grant A Kendall M Dying from cancer in developed and developing countries: lessons from 2 qualitative interview studies of patients and their carers. BMJ. 2003; 326: 368-72 Crossref PubMed Google Scholar ). Harding and Higginson's main thrust is the need for monitoring and evaluation of services. Indeed, this ongoing activity is essential if palliative care is to go forward. Palliative care in sub-Saharan AfricaControl of pain and symptoms and terminal care are necessary for quality HIV and cancer care in sub-Saharan Africa. However, what constitutes feasible, accessible, and effective palliative care, and how to develop such services, remains to be resolved. Africa-specific palliative care includes components that carry resource implications. Home and community-based care has been largely successful, but community capacity and the resources and clinical supervision necessary to sustain quality care are lacking. Full-Text PDF