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Palliative care in Africa: the need

The need for palliative care in Africa can seem overwhelming – but at APCA we focus on the enormous opportunities that exist for us and all our stakeholders to make a positive difference to the lives of people with life-limiting illnesses and their families.

By 2009, an estimated 22.5 million people in Sub-Saharan Africa were living with HIV/AIDS, representing 67 per cent of the global disease burden, with 1.8 million new infections reported in that year alone.  In addition, there were more than 700,000 new cancer cases and nearly 600,000 cancer-related deaths in Africa in 2007. Cancer rates on the continent are expected to grow by 400 per cent over the next 50 years. There's also a growing concern that as people's lifestyles, nutritional habits and work patterns change, Africa may experience an increase in chronic, life-limiting diseases. While palliative care offers support for people with any life-limiting illness – such as motor neuron disease, emphesema or renal failure – in practice, the commonest in Africa are AIDS and cancer (often found together, as there are many cancers to which people with AIDS are especially susceptible).

Unmet demand
For the overwhelming majority of Africans who currently endure these and other progressive, life-limiting illnesses, access to culturally appropriate holistic palliative care (including effective pain management) is simply not available.  A survey of hospice and palliative care services on the continent found that 45 per cent of African countries had no identified hospice or palliative care activity, and only nine per cent could be classified as having services approaching some measure of integration with mainstream health provision.

Despite Africa's existing disease burden, in 2008 the vast majority of morphine was consumed in industrialised countries. The regional mean in Africa was only 0.33mg compared with the global mean of 5.98mg .  Moreover, to date only three African countries have palliative care integrated into their national health policies and strategies (Uganda, South Africa and Tanzania), while Swaziland, Rwanda and Zambia have developed draft policies that are subject to approval by their health ministries.  Only five countries across Africa have palliative care integrated in the curriculum of health professionals, of which only two (Uganda and South Africa ) have recognised palliative care as an examinable subject.

Following the WHO estimation of the need for palliative care as one per cent of a country's total population, approximately 9.67 million people need palliative care in Africa.  The continent still faces an extreme shortage of health care professionals. Tanzania has two doctors and 37 nurses per 100,000 people; Mozambique, three doctors, 21 nurses; Cote D'Ivoire, 12 doctors, 60 nurses. Even South Africa has only one specialist nurse per 39,400 cancer patients. 

Opportunities for change

This vast unmet need for palliative care can only be addressed by the public health approach to palliative care delivery advocated by the WHO and supported by APCA. This ensures the right policy frameworks, resourcing and educational structures are in place for palliative care to reach every man, woman and child in need.

APCA focuses on the enormous opportunities that exist for us and our stakeholders to make a positive difference to people's lives.