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 p...
The Palliative Care Initiative in Zambia  (DPOWMF 2008-10) C ost £380,000 <ul><li>Small grants (£20k each) to eight PC org...
1. Government policy <ul><li>Supported the national organisation PCAZ in order to lead in palliative care  </li></ul><ul><...
2.  Education   <ul><li>Expert staff trainers  </li></ul><ul><li>Trained  at Cancer Hospital and UTH </li></ul><ul><li>Mul...
3. Drug availability   <ul><li>Funded by True Colours Trust  </li></ul><ul><li>Employs a specialist palliative care nurse ...
Delays and frustrations <ul><li>The synergy was lost (funding delays) </li></ul><ul><li>The national morphine co-ordinator...
Where are we now?   <ul><li>Morphine roll out is proceeding slowly </li></ul><ul><li>Pilot sites identified, but who can p...
Positive outcomes <ul><li>There will soon be a number of  qualified DLD students in Zambia to act as “cheer leaders” and a...
The way forward?? <ul><li>Twinning?  </li></ul><ul><li>Training? </li></ul><ul><li>Can we influence key players?  </li></u...
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A public health approach to palliative care

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A public health approach to palliative care

  1. 1. A public health approach to palliative care Dr Dorothy Logie FRCP, FCRGP, MPH
  2. 2. Government policy Education (professionals and public) Drug availability The 3 foundations for sustainable delivery of palliative care (The WHO Approach)
  3. 3. The Palliative Care Initiative in Zambia (DPOWMF 2008-10) C ost £380,000 <ul><li>Small grants (£20k each) to eight PC organisations for running costs for one or two years </li></ul><ul><li>Supporting five DLD students to study pc for 18 months (with Nairobi Hospice) </li></ul><ul><li>Funded expert-led multidisciplinary short training courses for health professionals and carers in several venues </li></ul><ul><li>The intention was to enable a synergy of training and advocacy to coincide with the national roll-out of morphine </li></ul>
  4. 4. 1. Government policy <ul><li>Supported the national organisation PCAZ in order to lead in palliative care </li></ul><ul><li>Encouraged PCAZ to join the technical health working group </li></ul><ul><li>PC in the Zambian National Health Strategic Plan (2011-2015) </li></ul><ul><li>Medical council recognition for hospices </li></ul>
  5. 5. 2. Education <ul><li>Expert staff trainers </li></ul><ul><li>Trained at Cancer Hospital and UTH </li></ul><ul><li>Multi disciplinary training of health staff </li></ul><ul><li>Hands on ward training </li></ul><ul><li>Also similar training in the community in several locations (not TOT) </li></ul><ul><li>Funded 5 DLD students for Masters in pc based in Nairobi </li></ul>
  6. 6. 3. Drug availability <ul><li>Funded by True Colours Trust </li></ul><ul><li>Employs a specialist palliative care nurse and a full time co-ordinator for the morphine roll-out </li></ul><ul><li>Morphine roll-out planning is with a national planning committee (including drug enforcement agency) </li></ul><ul><li>Morphine fact book </li></ul>
  7. 7. Delays and frustrations <ul><li>The synergy was lost (funding delays) </li></ul><ul><li>The national morphine co-ordinator resigned </li></ul><ul><li>Attrition of pc trained staff </li></ul><ul><li>No money for follow up training </li></ul><ul><li>Resignation of one DLD student </li></ul><ul><li>Insufficient mentors </li></ul><ul><li>Many hospices under threat of closure </li></ul><ul><li>Still red tape around morphine access </li></ul><ul><li>Changes of staff and PCAZ Board members, including new Director </li></ul><ul><li>Problems at MOH </li></ul>
  8. 8. Where are we now? <ul><li>Morphine roll out is proceeding slowly </li></ul><ul><li>Pilot sites identified, but who can prescribe? </li></ul><ul><li>Support from chief pharmacist at Cancer Hospital and Director of Clinical services, MOH </li></ul><ul><li>Groundswell of support amongst medical profession but lingering suspicion and red tape </li></ul><ul><li>Concern over hospice funding as USAID uncertain and reduced </li></ul><ul><li>Geographical inequity of access to pc </li></ul>
  9. 9. Positive outcomes <ul><li>There will soon be a number of qualified DLD students in Zambia to act as “cheer leaders” and as mentors </li></ul><ul><li>PCAZ has just received significant donor funding </li></ul><ul><li>APCA standards for hospices are being introduced </li></ul><ul><li>PC is in the National Health Strategic Plan (2011-15) </li></ul><ul><li>PCAZ received the APCA award for “outstanding progress in pc”. Namibia September 2010 </li></ul>
  10. 10. The way forward?? <ul><li>Twinning? </li></ul><ul><li>Training? </li></ul><ul><li>Can we influence key players? </li></ul><ul><li>Should the influence be from neighbouring countries? </li></ul><ul><li>Pain relief is an urgent need </li></ul><ul><li>Nurse training for prescribing and links with home-based care </li></ul>

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