Palliative care made visible: Developing a rural model for the Western Cape Province, South Africa.

Victoria O’Brien,Zilla North,Elmari De Klerk-Green,Hilary Grey,Louis S Jenkins,Helise Schumann,Margie Munnings

doi:10.4102/phcfm.v11i1.2147

Abstract

IntroductionCaring for people with life-threatening illnesses is a key part of working in health care. While South Africa launched the National Policy Framework and Strategy for Palliative Care 2017–2022, integrating palliative care into existing public health care is in its infancy. Most patients in the Western Cape have poor access to palliative care, an inequality felt hardest by those living in rural areas.Building the modelIn 2018, with district wide institutional managerial support, a palliative care model for rural areas was initiated in the Western Cape. The process involved setting up hospital- and community-based multi-professional palliative care teams, initiating weekly palliative care ward rounds, training champions in palliative care and raising awareness of palliative care and its principles.DiscussionEstablishing regular ward rounds has changed the way patients needing palliative care are managed, particularly in challenging the mindsets of specialist departments. The emergence of the multi-professional team listening and planning together at the patient’s bedside has restored some of the dignity and ethos of patient-centred care, which is a core principle of the provincial Health Care 2030 vision.ConclusionIn a short time period, we have managed to build a service that aims to improve care for palliative patients in rural areas. Its strength lies in a multi-professional patient-centred approach and improved communication between different components of the health system, providing a more seamless service that supports patients when they need it most.

Highlights

Caring for people with life-threatening illnesses is a key part of working in health care
A recent study in Malawi described the impact of end-stage renal disease on patients and families[3]; there remains a paucity of publications on palliative care in Africa
The training and local presentations have opened the eyes of many colleagues to the discipline and its principles, leading to the message being passed on in various work environments. This has been seen in many outcomes including better pain control for patients, with ward staff reporting an improvement in pain management from 41% to 67% since the inception of the ward rounds

Summary

Introduction

The World Health Organization (WHO) estimates that each year 40 million people worldwide need palliative care, with only 14% receiving it.[1]. The training and local presentations have opened the eyes of many colleagues to the discipline and its principles, leading to the message being passed on in various work environments This has been seen in many outcomes including better pain control for patients, with ward staff reporting an improvement in pain management from 41% to 67% since the inception of the ward rounds. The model has been shared with the rural districts and the chief director for rural health in the province It has received widespread support, acknowledging the need for high-quality palliative care, and seeing an opportunity to improve existing aspects of continuity of care in the management of chronic diseases across the whole health spectrum

Discussion

Conclusion

Findings

Data availability statement