Skip to main content

A Public Health Approach to Integrate Palliative Care into a Country’s Health-Care System: Guidance as Provided by the WHO

  • Reference work entry
  • First Online:
Textbook of Palliative Care

Abstract

Many people across the globe are in need of quality palliative care (PC), of which a majority live in low- and middle-income countries. However, many still see their needs unmet. It is estimated that only 14% of people in need of PC actually receive it. To improve access to PC as a core component of health systems, the WHO developed evidence-based tools on how to integrate PC into national health systems, across disease groups and levels of care. The current chapter provides an overview of this WHO Public Health Approach to Palliative Care, and discusses the seven components that were set out as a practical guidance for policy makers and program managers at national or subnational level to plan and implement PC services integrated into existing healthcare services. The components discussed are: (1) the development of appropriate PC policies, (2) the scaling up and integration of PC into the healthcare system, (3) the improvement of pain relief medicines access, (4) the strengthening of human resources for PC, (5) the establishment of palliative care services, (6) the setting of standards for evaluating PC services, and (7) the costing of PC services.

The following chapter is largely based by on the following publication by the WHO:

World Health Organization. Planning and Implementing Palliative Care Services: A Guide for Programme Managers. World Health Organization. 2016.

The full report can be downloaded for free at: apps.who.int/iris/bitstream/10665/250584/1/9789241565417-eng.pdf

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 819.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,099.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • African Palliative Care Association. Standards for quality improvement [Internet]. Quality palliative care integrated into health systems using APCA standards. 2018. Available at https://www.africanpalliativecare.org/integration/standards-for-quality-improvement/

  • Connor S, Bermedo M. Global atlas of palliative care at the end of life. 2014. Available at http://www.who.int/cancer/publications/palliative-care-atlas/en/.

  • Defilippi K, Downing J. Feedback from African palliative care practitioners on the use of the APCA POS. Int J Palliat Nurs. 2013;19(12):577–8, 580–1.

    Article  Google Scholar 

  • Desrosiers T, Cupido C, Pitout E, van Niekerk L, Badri M, Gwyther L, et al. A hospital-based palliative care service for patients with advanced organ failure in sub-Saharan Africa reduces admissions and increases home death rates. J Pain Symptom Manag. 2014;47(4): 786–92.

    Article  Google Scholar 

  • Government of India. Narcotic drugs and psychotropic substances amendment act 2014. Gazette of India, 2014. Available at http://www.indiacode.nic.in/acts2014/16%20of%202014.pdf.

  • Guidelines for developing palliative care services. Hyderabad: MNJ Institute of Oncology & Regional Cancer Centre; 2009.

    Google Scholar 

  • Harding R, Higginson IJ. Inclusion of end-of-life care in the global health agenda. Lancet Glob Health. 2014;2(7):e375–6.

    Article  Google Scholar 

  • Harding R, Selman L, Powell RA, Namisango E, Downing J, Merriman A, et al. Research into palliative care in sub-Saharan Africa. Lancet Oncol. 2013;14(4):e183–8.

    Article  Google Scholar 

  • Harding R, Albertyn R, Sherr L, Gwyther L. Pediatric palliative care in sub-Saharan Africa: a systematic review of the evidence for care models, interventions, and outcomes. J Pain Symptom Manag. 2014a;47(3): 642–51.

    Article  Google Scholar 

  • Harding R, Simms V, Penfold S, Downing J, Powell RA, Mwangi-Powell F, et al. Availability of essential drugs for managing HIV-related pain and symptoms within 120 PEPFAR-funded health facilities in East Africa: a cross-sectional survey with onsite verification. Palliat Med. 2014b;28(4):293–301.

    Article  Google Scholar 

  • Higginson IJ, Hart S, Koffman J, Selman L, Harding R. Needs assessments in palliative care: an appraisal of definitions and approaches used. J Pain Symptom Manag. 2007;33(5):500–5.

    Article  Google Scholar 

  • Jacinto A, Masembe V, Tumwesigye NM, Harding R. The prevalence of life-limiting illness at a Ugandan National Referral Hospital: a 1-day census of all admitted patients. BMJ Support Palliat Care. 2015;5(2): 196–9.

    Article  Google Scholar 

  • Kumar S, Numpeli M. Neighborhood network in palliative care. Indian J Palliat Care. 2005;11(1):6.

    Article  Google Scholar 

  • Lewington J, Namukwaya E, Limoges J, Leng M, Harding R. Provision of palliative care for life-limiting disease in a low income country national hospital setting: how much is needed? BMJ Support Palliat Care. 2012;2(2):140–4.

    Article  Google Scholar 

  • Logie DE, Harding R. An evaluation of a morphine public health programme for cancer and AIDS pain relief in sub-Saharan Africa. BMC Public Health. 2005;5:82.

    Article  Google Scholar 

  • Merriman A, Harding R. Pain control in the African context: the Ugandan introduction of affordable morphine to relieve suffering at the end of life. Philos Ethics Humanit Med PEHM. 2010;5:10.

    Article  Google Scholar 

  • Morin L, Aubry R, Frova L, MacLeod R, Wilson DM, Loucka M, et al. Estimating the need for palliative care at the population level: a cross-national study in 12 countries. Palliat Med. 2017;31(6):526–36.

    Article  Google Scholar 

  • Murtagh FEM, Bausewein C, Verne J, Groeneveld EI, Kaloki YE, Higginson IJ. How many people need palliative care? A study developing and comparing methods for population-based estimates. Palliat Med. 2014;28(1):49–58.

    Article  Google Scholar 

  • Namisango E, Allsop MJ, Powell RA, Friedrichsdorf SJ, Luyirika EBK, Kiyange F, et al. Investigation of the practices, legislation, supply chain, and regulation of opioids for clinical pain management in southern Africa: a multi-sectoral, cross-national, mixed methods study. J Pain Symptom Manag. 2017;55:851–63.

    Article  Google Scholar 

  • Nemeth C, Rottenhofer I. Abgestufte Hospiz- und Palliativversorgung in Österreich. Vienna: Österreichisches Bundesinstitut für Gesundheitswesen; 2004. Available at http://www.hospiz.at/pdf_dl/oebig_studie.pdf.

  • Quill TE, Abernethy AP. Generalist plus specialist palliative care – creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.

    Article  CAS  Google Scholar 

  • Radbruch L, Payne S, the Board of Directors of the European Association for Palliative Care. White paper on standards and norms for hospice and palliative care in Europe. Part 1. Recommendations from the European Association for Palliative Care. Eur J Palliat Care. 2009;16(6):278–89.

    Google Scholar 

  • Selman LE, Higginson IJ, Agupio G, Dinat N, Downing J, Gwyther L, et al. Quality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study. Health Qual Life Outcomes. 2011;9:21.

    Article  Google Scholar 

  • Smith S, Brick A, O’Hara S, Normand C. Evidence on the cost and cost-effectiveness of palliative care: a literature review. Palliat Med. 2014;28(2):130–50.

    Article  Google Scholar 

  • Stjernswärd J, Foley KM, Ferris FD. The public health strategy for palliative care. J Pain Symptom Manag. 2007;33(5):486–93.

    Article  Google Scholar 

  • Streid J, Harding R, Agupio G, Dinat N, Downing J, Gwyther L, et al. Stressors and resources of caregivers of patients with incurable progressive illness in sub-Saharan Africa. Qual Health Res. 2014;24(3): 317–28.

    Article  Google Scholar 

  • Task shifting: rational redistribution of tasks among health workforce teams. Global recommendations and guidelines. Geneva: World Health Organization; 2008. Available at http://www.who.int/healthsystems/TTR-Task-Shifting.pdf.

  • World Health Organization. WHO model list of essential medicines, 19th list. [internet]. Geneva: World Health Organization; 2015a. Available at http://www.who.int/selection_medicines/committees/expert/20/EML_2015_FINAL_amended_JUN2015.pdf?ua=1.

  • World Health Organization. WHO model list of essential medicines for children, 5th list [Internet]. Geneva: World Health Organization; 2015b. Available at http://www.who.int/selection_medicines/committees/expert/20/EMLc_2015_FINAL_amended_JUN2015.pdf?ua=1.

  • World Health Organization. Planning and implementing palliative care services: a guide for programme managers [Internet]. 2016. Available at http://www.who.int/ncds/management/palliative-care/palliative_care_services/en/.

  • World Health Organization. Questions and answers on universal health coverage [Internet]. WHO. 2018a. Available at http://www.who.int/healthsystems/topics/financing/uhc_qa/en/.

  • World Health Organization. WHO definition of palliative care [Internet]. Geneva: World Health Organization. 2018b. Available at http://www.who.int/cancer/palliative/definition/en/.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Joachim Cohen .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Maetens, A., Cohen, J., Harding, R. (2019). A Public Health Approach to Integrate Palliative Care into a Country’s Health-Care System: Guidance as Provided by the WHO. In: MacLeod, R., Van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-77740-5_122

Download citation

Publish with us

Policies and ethics