Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa.

This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.

The Zimbabwe Rural Palliative Care Initiative: PCI-Z.

The Zimbabwe Rural Palliative Care Initiative is a program to increase access and expand palliative care in rural Zimbabwe. The goal was to add palliative care to existing home-based care teams comprising indigenous rural volunteers. Palliative care expertise is being developed through training and ongoing mentorship provided by Island Hospice Service, headquartered in the capital city of Harare. Specific outcomes relative to palliative care are reported, using the African Palliative Care Association African Palliative Outcome Scale, the Karnofsky Performance Scale, and a Supervision and Mentorship Checklist. Positive impact is documented, and there is significant opportunity for similar outcomes on a national scale.

Early Evidence from Results-Based Financing in Rural Zimbabwe

Results-based financing (RBF) is an innovative approach to health system financing which pays providers for verified outputs. In July 2011; through a World Bank grant; Zimbabwe commenced an RBF project to improve utilization of quality maternal; neonatal and child health (MNCH) services. This article discusses its early results. A statistical analysis of intervention districts and control districts shows that RBF districts demonstrate higher increases in utilization levels for the MNCH services than control districts. Month-on-month growth rates for antenatal care; perinatal referrals and growth monitoring are statistically significant after the intervention; whilst they were not before the intervention and no significant trend was found in control districts. Qualitative study provides insight in the mechanisms through which RBF contributed to better performance: the use of contracts; increased autonomy of health facilities; increased community involvement; intrinsic motivation of health-care workers; existence of a reliable health information system; abolishment of user fees; improved supervision of health facilities; separation of functions; and the Government of Zimbabwe's results-based management (RBM) policy