Palliative care lacking as demand outstrips capacity

Uganda on October 12, 2024, will join the World to celebrate Hospice and Palliative Care Day, with a call to improve access to pain relief medicines and palliative care.

According to the 2017, Lancet Commission report, only 55,000 (11%) of 500,000 citizens have access to pain relief medicines and palliative care. 

This overwhelming gap has severe consequences, leaving patients to endure unbearable pain, psychological distress and social loneliness.

Palliative care refers to specialised medical care that focuses on providing relief from pain and other symptoms of a serious illness. It can help to cope with side effects from medical treatments.

Health ministry permanent secretary Dr Diana Atwine in a statement read by the Director Curative Services Dr Charles Olaro, acknowledges the challenge.

“We have made progress in integrating palliative care into our national policy, but the demand far outstrips our capacity,” the statement reads.

According to the statement read during a media briefing held on October 7, 2024, at the health ministry offices in Kampala, access to palliative care is everyone’s business but remains a challenge with less than 15% of those in need receiving it, especially in low- and middle-income countries. Uganda only 11%.

Atwine said: "As we celebrate this year’s Hospice and Palliative Care Day, we must be both ambitious and realistic in our goals for palliative care services in Uganda".

"The ministry recognises palliative care as an integral part of our healthcare system and we remain committed to expanding those services at all levels of care from national referral hospitals and specialised hospitals to health centers III in the most remote areas of the Country," she added.

The world Hospice and Palliative Care Day will be commemorated on Saturday and in Uganda, it has been a week-long commemoration with main activities to be held on October 11, 2024, at Ndeere Center in Ntinda, Kampala.

This year’s theme is: Committed to Strengthening Palliative Care as a Component for Comprehensive Care in Uganda.

Palliative Care Association of Uganda executive director Mark Donald Mwesiga echoed this sentiment: “Civil society organisations are crucial in advocating for palliative care, supporting education and training of health workers, and providing services”.

However, the health ministry has made efforts to expand palliative care services, including increasing access to oral liquid morphine, a crucial pain management medication, funding constraints still hinder the expansion of services and training for healthcare, he said.

"It’s not just about dying’: Morphine is the perfect drug to treat severe pain on a daily basis when other pain medicines did not work well or cannot be tolerated".

According to Mwesiga, morphine belongs to the group of medicines called narcotic analgesics (pain medicines).

Morphine was first introduced in Uganda 30 years ago, but as the burden of cancer increases, thousands of people still lack access to even basic treatment or pain relief.

Bulasio Kibirige, 90 years old, was diagonosed with prostate cancer in 2010 shared his journey in receiving palliative care from Hospice Africa.

“I take Morphine liquid on a daily basis to relieve pain, after I proceed to do my work and even today as I came here, I climbed the stairs without being helped," he said.

Assistant commissioner of Palliative Care and Hospice Services at the ministry Dr Moses Muwanga attributed Uganda as a leader in Africa in ensuring availability of oral morphine, which remains affordable and accessible to those who need it most.

“The Government covers all the cost of oral liquid morphine through the donors and so it's free of charge at all accredited public health facilities,” he said.

Palliative care is largely an outpatient service, with most patients receiving care in their homes or communities. However, Uganda’s healthcare system struggles to provide adequate support, leaving many without access to essential medications, psychological support, and social services.

“Most patients require palliative care in the comfort of their own homes, but we lack the resources to provide comprehensive community-based care,” Muwanga explained.

“Donor support has been crucial, but we need to explore sustainable funding models to ensure continuity of services,” he said.