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A public health approach to palliative care

A public health approach to palliative care



Dorothy logie presentation

Dorothy logie presentation



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    A public health approach to palliative care A public health approach to palliative care Presentation Transcript

    • A public health approach to palliative care Dr Dorothy Logie FRCP, FCRGP, MPH
    • Government policy Education (professionals and public) Drug availability The 3 foundations for sustainable delivery of palliative care (The WHO Approach)
    • The Palliative Care Initiative in Zambia (DPOWMF 2008-10) C ost £380,000
      • Small grants (£20k each) to eight PC organisations for running costs for one or two years
      • Supporting five DLD students to study pc for 18 months (with Nairobi Hospice)
      • Funded expert-led multidisciplinary short training courses for health professionals and carers in several venues
      • The intention was to enable a synergy of training and advocacy to coincide with the national roll-out of morphine
    • 1. Government policy
      • Supported the national organisation PCAZ in order to lead in palliative care
      • Encouraged PCAZ to join the technical health working group
      • PC in the Zambian National Health Strategic Plan (2011-2015)
      • Medical council recognition for hospices
    • 2. Education
      • Expert staff trainers
      • Trained at Cancer Hospital and UTH
      • Multi disciplinary training of health staff
      • Hands on ward training
      • Also similar training in the community in several locations (not TOT)
      • Funded 5 DLD students for Masters in pc based in Nairobi
    • 3. Drug availability
      • Funded by True Colours Trust
      • Employs a specialist palliative care nurse and a full time co-ordinator for the morphine roll-out
      • Morphine roll-out planning is with a national planning committee (including drug enforcement agency)
      • Morphine fact book
    • Delays and frustrations
      • The synergy was lost (funding delays)
      • The national morphine co-ordinator resigned
      • Attrition of pc trained staff
      • No money for follow up training
      • Resignation of one DLD student
      • Insufficient mentors
      • Many hospices under threat of closure
      • Still red tape around morphine access
      • Changes of staff and PCAZ Board members, including new Director
      • Problems at MOH
    • Where are we now?
      • Morphine roll out is proceeding slowly
      • Pilot sites identified, but who can prescribe?
      • Support from chief pharmacist at Cancer Hospital and Director of Clinical services, MOH
      • Groundswell of support amongst medical profession but lingering suspicion and red tape
      • Concern over hospice funding as USAID uncertain and reduced
      • Geographical inequity of access to pc
    • Positive outcomes
      • There will soon be a number of qualified DLD students in Zambia to act as “cheer leaders” and as mentors
      • PCAZ has just received significant donor funding
      • APCA standards for hospices are being introduced
      • PC is in the National Health Strategic Plan (2011-15)
      • PCAZ received the APCA award for “outstanding progress in pc”. Namibia September 2010
    • The way forward??
      • Twinning?
      • Training?
      • Can we influence key players?
      • Should the influence be from neighbouring countries?
      • Pain relief is an urgent need
      • Nurse training for prescribing and links with home-based care