Chronic diseases and health promotion

Part Three. What works: the evidence for action

Chapter Two. Review of effective interventions

Palliative care. Spotlight: India, Africa

Palliative care concentrates on the management of life-threatening chronic diseases and on supporting people so that they can achieve the best quality of life possible. Although typically associated with life-threatening cancer, it is often needed in other chronic conditions. Palliative care ranges from personal care and assistance in daily living to counselling and pain management. Palliative care is an urgent need worldwide. It is an integral part of long-term care, and even when there is no cure, can improve quality of life and provide a painless and peaceful end to life.

Approaches to providing palliative care will be influenced by health-care infrastructure and resources as well as local cultural and religious values. The current evidence provides little guidance on whether one approach is superior to another and suggests that further studies would be useful.

Spotlight: Palliative care in India

In India, even though palliative care is included in the national cancer control programme, it is mainly provided by nongovernmental organizations. There have been some important successes that might be applied nationally. For example, the Pain and Palliative Care Society in Kerala has developed a network of 33 palliative care clinics providing free care to those who need it, with an emphasis on home care. Trained community volunteers helped in providing care together with families who were trained to ensure the continuity of treatment.

Spotlight: Palliative care in Sub-Saharan Africa

“A Community Health Approach to Palliative Care for HIV and Cancer Patients in Africa” is a joint project in which five countries – Botswana, Ethiopia, Uganda, United Republic of Tanzania and Zimbabwe – and the World Health Organization are working together. The main goal of this project is to improve the quality of life of HIV/AIDS and cancer patients in sub-Saharan Africa by developing comprehensive palliative care programmes with a community health approach.

Uganda is the first country in Africa in which pain relief and palliative care for cancer and HIV/AIDS is a priority in the national health plan. Supported by the work of local nongovernmental organizations, particularly Hospice Africa Uganda, the Ministry of Health has included pain relief and palliative care in the home care package, based on a needs assessment of patients and their caregivers. Services include essential drugs for pain and other symptom relief, food and family support. Palliative care has worked in Uganda because a national programme founded on a public health approach was established, based on the WHO National Cancer Control Guidelines.