Progress Update: Palliative Care Development Between 2017 and 2020 in Five African Countries.

CONTEXT: This article provides a progress update on the development of palliative care in five countries in Africa-Kenya, Rwanda, South Africa, Tanzania, and Uganda-between 2017 and 2021, and explores the role of palliative care advocates and the Open Society Foundations in this process. OBJECTIVES: To provide a progress update on the development of palliative care in Kenya, Rwanda, South Africa, Tanzania, and Uganda between 2017 and 2021 and to examine the impact of twenty years of Open Society Foundations support for palliative care in the region on the integration of palliative care into publicly funded health systems. METHODS: In the mid-2000s, palliative care pioneers in these five countries, supported by Open Society Foundations, began to train health care providers and engage policy makers to ensure that people with life-limiting illnesses and their families had access to appropriate services and essential medicines. In the late 2010s, it embraced an approach that mixed strategic communications and advocacy for inclusion of palliative care into universal health coverage with technical assistance. RESULTS: By the mid-2010s, a vibrant palliative care community existed that worked closely with governments to develop palliative care policies, train providers, and ensure access to morphine. By 2021, Kenya and Rwanda had made significant progress scaling up palliative care services as part of the public health care system, and Uganda's government had instructed public hospitals to start providing these services. In South Africa and Tanzania, governments had yet to commit to publicly funded palliative care services. CONCLUSION: The experiences in these countries suggest that mixing advocacy, communications, and technical assistance can lead to substantial progress for patient access although full inclusion in universal health coverage remained uncertain in all but Rwanda.

Palliative Care Volunteers Have High Workload but No Burnout: A Questionnaire Survey from Tanzania.

Background: In Africa, the core of home-based care (HBC) in the villages is provided by volunteer helpers, individuals chosen to provide both support to patients and important information to health officers. Yet, voluntary work in palliative care and the burden of being a volunteer have not been studied in Africa. Objective: To study the content and burden of volunteer work in the palliative home care of Ilembula District Designated Hospital (IDDH), a secondary care institution in Tanzania. Design: A descriptive prospective study using semistructured and closed questionnaires. Setting/subjects: The modified Palliative Care Evaluation Tool Kit (PCETK) and Professional Quality-of-Life Scale (ProQOL) were used to study the work content and workload of 47 volunteers in the palliative HBC of IDDH. ProQOL was translated to Kiswahili. Fifty-seven health care professionals and students validated the translation. Factorial analysis and Cronbach's alphas were calculated for reliability. Results: Responses to PCETK and ProQOL were received from 34 (72%) to 20 (42%) volunteers, respectively. The Kiswahili translation of ProQSL appeared to be highly reliable. On average, a volunteer worked 20 hours/month and had 22 patients. The main activities included helping with daily tasks, preparing meals, assisting with transport, and reporting the patient's clinical condition to the health care officers. The volunteers reported high satisfaction ratings (average 4.2, standard deviations 0.38) and had higher scores than the validation group in the compassion fatigue scale (2.42 vs. 1.55, p < 0.01) but no burnout. Conclusions: The volunteers had high commitment and workload. Even so, coping strategies for dealing with suffering and death should be better addressed in training.

Where there is no morphine: the challenge and hope of palliative care delivery in Tanzania.

BACKGROUND: In Tanzania, a country of 42 million, access to oral morphine is rare. AIM: To demonstrate the effectiveness of palliative care teams in reducing patients' pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain. SETTING: One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania. METHOD: A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years' palliative care experience and no access to strong opioids. RESULTS: Patients and their family caregivers identifid statistically signifiant (p < 0.001) improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when 'bad cases' arose who would likely benefi only from oral morphine. CONCLUSION: People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.

Scaling up palliative care services in rural Tanzania.

Access to palliative care in Tanzania, particularly in rural areas, is limited. The Continuum of Care for People Living with HIV/AIDS in Tanzania (CHAT) project began in 2007 with the goal of expanding coverage of palliative care services. This was done by adding home-based palliative care teams to 13 existing hospitals throughout rural Tanzania. By integrating palliative care teams into the existing hospital structure and by using community resources, CHAT rapidly built a network of care. Community involvement and proper training of palliative care professionals and volunteers have allowed for an increasing number of patients to access and accept palliative care services and for CHAT to provide home-based palliative care, with clinical backup, to those in need.

Care for the most vulnerable children in Tanzania: a faith-based model of care and support for children affected by HIV.

In the fight against HIV and AIDS in sub-Saharan Africa, the plight of orphaned and vulnerable children was long overlooked. The first United Nations report on orphans and vulnerable children did not emerge until 2002 after more than two generations of children and youth had struggled to survive with limited family, institutional, or government support. The major social determinants of health for infants and children with one or more parents dying or dead from HIV include pervasive poverty, weak community social support systems, lack of policy commitment by governments or foreign donors, lack of access to anti-retroviral drugs, limited access to schools, and gender. In this paper, we present a model of care and support to the most vulnerable children (MVC) affected by HIV that brings together faith-based institutions in partnership with the government and community volunteers in 13 rural districts of Tanzania. Although still being implemented, the project has a number of valuable lessons learned for program managers, donors, and researchers working with faith-based organizations in the development and delivery of services to the most vulnerable children in a resource-limited setting.