“THET project right in line with WHO resolutions” writes Professor Scott Murray

Scott THET project right in line with WHO resolution

Professor Scott Murray

St Columba’s Hospice Chair of Primary Palliative Care

 

 

Decades ago the World Health Organisation defined palliative care as a comprehensive, caring approach to delivering care for people with advanced progressive illness.  However, since then palliative care has largely developed into a specialist service delivered in and from hospices for people who generally have cancer in economically developed countries.

To counter this, the WHO have passed their first ever resolution about palliative care in May 2014!  This landmark resolution states that all member states should

  • Develop, strengthen and implement care policies to support the strengthening of health systems and to integrate evidence-based, cost effective and equitable palliative care services
  • Provide basic support, including through multi-sector partnerships, with trained professionals supporting families, community volunteers and other individuals acting as caregivers
  • To offer ongoing Palliative care training and education for all health workers from basic training to intermediate training and specialist training
  • Review National health policies and legislation

In 2012 the THET “Integrate” project set out to integrate palliative care approaches into the catchment area of three hospitals in each of four African countries – Kenya, Uganda, Rwanda and Zambia.  There already were a number of small Centres of Excellence of Palliative Care in these countries but the vision was to integrate the approach of comprehensive care for people with all illnesses, not just cancer, in these hospitals and the smaller hospitals and clinics in their catchment areas.

Since 2012 over 200 hospital doctors and nurses, who spend most of their time dealing with patients in general, have been trained so they can use this palliative approach as they deliver care in smaller hospitals and at health clinics. Additionally Pharmacists, Social Workers, Priests, Physiotherapists have attended hospital sensitisation or basic training sessions. Structures have been set up so that such people can be trained and supported in their usual place of duty.  The main challenge is identifying people who would benefit from this approach from the thousands of patients that healthcare workers in Africa see daily.

The starting of such integrated care is more challenging to set up and sustain than small specialist units.  However this is the only way that the vast majority of people in Africa may access end of life care.  Many useful lessons have already been identified and “Most Significant Change” stories have been very vivid in highlighting how the staff on the ground feel about being enabled to provide this approach to people who are dying.  The Integrate project will be evaluated in 2015 and will have many lessons which can be used by the WHO as an early demonstration project so that these lessons can reach many other hospitals in Africa and other low resource settings throughout the world.