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Palliative Care: Benefit to Health Systems. Zodwa Sithole Advocacy Manager HPCA South Africa XVII International AIDS Conference Mexico City August 2008. Introduction .

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Palliative Care: Benefit to Health Systems

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Palliative Care: Benefit to Health Systems

Zodwa Sithole

Advocacy Manager

HPCA South Africa

XVII International AIDS Conference

Mexico City

August 2008


  • Strengthening health systems and structures is increasingly recognized as a key method of improving health service delivery.

  • Within palliative care, a significant amount of palliative care and support is provided by community organisations or Non Governmental Organisations.

  • While this is important, this model is often not sufficient to reach all those who require palliative care. A integrated public health system approach therefore needs to be taken to address the gaps in palliative care provision.

WHO definition includes:

“Palliative Care is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.”

In the HIV setting, palliative care should be provided in conjunction with HAART.

Where Palliative Care is provided

  • Home based care

  • Outpatient care: Clinic/GP/Specialist Practice

  • Outreach Services, e.g. Roadside Clinic

  • Hospital based palliative care teams

  • Day care

  • Hospice inpatient care

  • Workplace programs

  • School programs

Who provides palliative care

  • Health workers (physicians, nurses, community caregivers)

  • Friends, relatives

  • Others in the community can be trained to ensure that the patient is comfortable

What is a health system?(WHO, 9 Nov 2005)

The World Health Organization states that a health system consists of all organizations, people and actions whose primary intent is to promote, restore or maintain health. This includes efforts to influence determinants of health as well as more direct health-improving activities.

What is a health system?

A health system is more than the pyramid of publicly owned facilities that deliver personal health services.

What is a health system?

It includes many people from family caregivers and peer supporters to sub-specialist at tertiary care centers

How hospice and palliative care support health systems

Four key elements

  • Based on the WHO definition, WHO advocates for palliative care provision to have four key elements.

Drug availability

Education in palliative care

Policy development

Implementation of palliative care programs

Public Health Approach

(Stjernsward, 2007)

Six Key Areas identified by WHO in Health systems: (WHO, 9 Nov 2005, WPCA policy statement, 2008)

1.Goodhealth services deliver effective, safe, quality personal and non-personal health interventions as appropriate, with minimum waste of resources.

The Link:

  • Palliative care implements quality care for people with life limiting illness in an effective, safe, cost-effective manner.

  • Palliative care improves quality of care across a health system ensuring patient dignity

  • Caregiver support includes psychosocial care, nursing, medical and spiritual care, whatever the disease.

Six Key Areas identified by WHO in Health systems: (WHO, 9 Nov 2005, WPCA policy statement, 2008)

2.A well-performinghealth workforce that is responsive, fair and efficient to achieve the best possible health outcomes, given available resources and circumstances

The Link:

  • Multidisciplinary education and training across all levels of a health system, from community members to health professionals

  • Palliative care training can help staff retention and avoid burnout

  • Palliative care support for task shifting, e.g. trained nurses prescribing opioids (Uganda) and training of community health workers to provide palliative care in the home

Six Key Areas identified by WHO in Health systems: (WHO, 9 Nov 2005, WPCA policy statement, 2008)

3.A well-functioning health information system is one that ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status.

The Link:

  • Palliative care monitors the needs of people with life threatening illness and provides information on key outcomes, such as the Palliative Outcome Scale (POS)

Six Key Areas identified by WHO in Health systems: (WHO, 9 Nov 2005, WPCA policy statement, 2008)

4.A well-functioning health system ensures equitable access to essential medical products, vaccines and technologies of assured quality, safety, efficacy and cost-effectiveness, and their scientifically sound and cost-effective use

The Link:

  • Palliative care ensures the availability of and access to opioid analgesics

  • Palliative care requires effective drug procurement, distribution and quality assurance systems that work in conjunction with other essential medicine systems

Six Key Areas identified by WHO in Health systems: (WHO, 9 Nov 2005, WPCA policy statement, 2008)

5.A good health financing system raises adequate funds for health, to ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient.

The Link

Palliative care should be included in national health care financing.

Six Key Areas identified by WHO in Health systems: (WHO, 9 Nov 2005, WPCA policy statement, 2008)

6.Leadership and governance involves ensuring strategic policy frameworks exist combined with effective oversight, coalition building, regulation, attention to system-design and accountability.

The Link:

The WHO Public Health Strategy for palliative care includes:

  • Development of national palliative care guidelines

  • integration of palliative care into the national health plan

  • Monitoring of clinical and training programs

  • Monitoring of services delivery and standards


  • Health systems would benefit from the inclusion of palliative care – in particular its conception of the health workforce, access to controlled medications and its community based method of care provision

  • Palliative care bridges vertical systems focused on specific diseases such as cancer, HIV/AIDS, and TB thereby improving overall patient care


  • Further research is required to identify best practices from organisations that provide palliative care and how this has benefited health systems. This evidence can contribute to the development of national guidelines and policies.

  • Technical support and advice must be supplied to governments to develop palliative care programs


  • Palliative care services improve health systems

  • Support for and provision of palliative care should be included in national health plans

  • Integrated into undergraduate and postgraduate medical, nursing, and social work curricula

  • Palliative care should be provided at home or in hospital and based on the needs of the patient

Thank You

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