OA55†Impact of community health workers for continuum care of palliative care at community level integrated in rwanda public health system.

BACKGROUND: Multi-disciplinary palliative care for patients with any disease is rarely integrated into the public healthcare system at all levels in Africa. In Kigali, Rwanda, we have developed palliative care services in a district general hospital and linked these services to home care using community health workers. In addition, the Ministry of Health recently approved a palliative care training curriculum for community health workers employed by the government who will expand and make sustainable palliative home care. AIM: The impact of Community health workers helped the district hospital to map patients with chronic diseases, palliative care and identify symptoms for better orientation. METHOD: At Kibagabaga Hospital, the public hospital for Gasabo District that includes 60% of the population of Kigali, we initiated a training of 481 community health workers (CHW), 1 CHW/per village for continuing care and retro-information to the District Palliative Care team through Health centre. RESULTS: As of June 2014, community health workers had identified 432 patients and report has been sent to the district palliative care team for mapping. Anecdotal data indicates a high level of satisfaction by patients and family members with palliative care assisted at community level and a reduced stress of continuum care. CONCLUSION: It is feasible to integrate palliative care for patients at community level into public healthcare systems in Africa using Community health workers.

Palliative care in Africa: a global challenge.

We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said 'in the middle of difficulty lies opportunity' and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, Rwandan healthcare workers are proving how palliative care can be successfully integrated into a healthcare system. As a global healthcare community, we should be asking what opportunities exist to do this across the African continent. Champions of palliative care have a chance to forge lasting collaborations between international experts and African healthcare workers. This global network could not only advocate for palliative care programmes but it would also help to create a culture where palliative care is viewed as a necessary part of all healthcare systems.