Support palliative care

By Richard A. Powell

IN 2008, an estimated 106,000 Ugandans died from non-communicable diseases (NCDs), 25% of all deaths that year.

NCDs, which include cardiovascular diseases, cancers, chronic respiratory conditions and diabetes, comprise the majority of deaths worldwide and are on the increase.  

According to a recent World Health Organization report, of the 57 million global deaths in 2008, 36 million (63%) were due to NCDs.  It is estimated that they will account for 52 million deaths annually by 2030 – the combined populations of Malawi, Rwanda, Senegal and Uganda, every year!

The human cost of NCDs is matched by their financial burden.  The World Economic Forum estimates that the economic impact of the five leading NCDs could total $47 trillion worldwide over the next 20 years.

It is timely, then, that this year’s theme for World Hospice and Palliative Care Day focuses on how people living with non-infectious conditions can benefit from palliative care.  

Unfortunately, nearly 80% of NCD deaths occur in low and middle income countries, where palliative care, which seeks to improve the quality of life of patients and their families facing pain and other physical, psychosocial and spiritual problems associated with life-threatening illnesses, is often unavailable.  

The world day, therefore, seeks to raise awareness (amongst the general public, but critically also policy makers) of how palliative care can improve the quality of life for people with NCDs and their families.

Encouragingly, in September high level representatives from UN member states met in New York pledging to address the growing burden of NCDs.  At this meeting, delegates also recognised the need to increase access to palliative care in their countries.  

On the surface, the meeting was a wonderful development; not only are NCDs being taken seriously globally, but palliative care is also being recognised as a critical component in national health systems combating a growing NCD disease burden.  

This positions palliative care, traditionally operating in the shadows of service provision on the continent, under a spotlight that can illuminate its special contributions to addressing the unmet needs of people with serious and chronic illnesses. However, current provision of palliative care in Africa is patchy.  For the overwhelming majority of Africans who currently endure life-limiting illnesses, access to holistic palliative care is at best limited, at worst non-existent.

So whilst the inclusion of palliative care in the UN political declaration is a positive development, it does not mean that patients will necessarily benefit from it tangibly.  

Words do not necessarily equate to action.  What is needed to ensure that the New York meeting does not simply add another desirable ‘must do’ item to an already lengthy and unfulfilled list, is a serious investment in palliative care as a discipline combined with its effective integration into mainstream health services.

Patients needing palliative care in Africa are already underserved, pain is not fully addressed, and not for lack of trying amongst committed but over-stretched staff.  Broadening the eligibility criteria for a range of new diagnostic groups will only exacerbate service provision challenges unless practical steps are addressed.

This world day, therefore, not only highlights the need to address the growing problem of NCDs, but also urges the governments around the world (especially in Africa) to support the UN’s commitment to improving access to palliative care.  

Without the necessary funding to ensure that palliative care can succeed in answering the call to address NCDs, we will simply be positioning it to fail when we have the power to ensure its success.

*Writer is the Director of Learning and Research African Palliative Care Association Kampala