Caring for the sick now a public health priority for developing countries

Palliative care is commonly used in developed countries to improve the quality of life of patients with life-threatening illnesses, through strategies aimed mainly at pain relief.

Of the 57 million people dying worldwide each year, 6 million deaths are caused by cancer and 3 million from HIV/AIDS, with the majority of both occurring in developing countries.

These figures indicate the large number of people experiencing incapacitation and pain through shortness of breath, constipation, diarrhoea, nausea as well as distress, depression and anxiety.

New research published in the Journal of Public Health Policy, prepared by research staff at The George Institute for International Health, the School of Public Health at the University of Sydney and the Department of Palliative Medicine at Calvary Hospital, highlights that a potential 100 million people in these poorer nations could benefit from palliative care services, including family members and close companions.

Lead author of the paper Dr Ruth Webster, a Research Fellow at The George Institute, says that "The scale of this epidemic of death and dying requires acknowledgement and priority as a public health issue, with more than just an emphasis on prevention of these diseases and their cure. Around 100 countries around the world have palliative care services, however only 6per centare located in Asia and Africa, where the highest demand for the services is".

"Palliative care is not on the health agenda of governments as a public health problem, which is extremely detrimental to the populations that most need these services. WHO has recommended that all countries have a policy to implement these types of services, but despite this, one only African country, has made this a priority, Uganda. South Africa has recently included palliative care in their new health policies." added Dr Webster.

The review found three specific barriers to implementing palliative care in developing countries - government commitment, opioid availability and education. While pain management is only part of the picture, the availability of opioids and morphine is extremely difficult for developing countries. Webster says that policy makers and health professionals need to understand that lifting unnecessary regulations is vital for the large number of ill people needing care.

The authors recommend training and education as a key part to developing palliative care programs. "Experience shows that training programs for health professionals is an essential and rewarding step to build capacity in developing countries. Educating family members and utilising volunteer caregivers, in conjunction with publicly raising the profile of palliative care services, is essential so that people know what options are available and what is the best option for a particular illness."

Dr Webster adds "Palliative care needs to be appropriate to each particular country's culture, resources and existing health problems. Local healers for example can play a key role in symptom relief. We acknowledge care of this kind is difficult to establish in poorer countries, but urgent steps must be taken to deliver these services."