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We all wish to die well – what can we and the Kampala Declaration do to achieve this goal?

Author: Dr Faith Mwangi-Powell and Richard A. Powell, Founding Directors: MWAPO Health Development Group
09 September 2016

At the recently concluded 5th International African Palliative Care Conference held in Kampala, Uganda, high-level decision makers from African governments, the United Nations, the African Union, the World Health Organization and leading palliative care experts and service providers discussed the future of palliative care in Africa.

Chaired by the Honourable Dr Jane Ruth Aceng, Minister of Health of the Republic of Uganda, and Dr Bernard Tei Dornoo, Chairperson of the African Palliative Care Association, the 2nd African Ministers of Health session focussed on the 2014 World Health Assembly (WHA) resolution: ‘Strengthening palliative care as a component of comprehensive care throughout the life course'.

Following a productive discussion, the attending Ministers adopted the ‘The Kampala Declaration’, reaffirming their commitment to the WHA resolution. In addition, they pledged themselves to two key areas:

  • Invest in essential technologies (e.g., radiotherapy units for cancer treatment and palliation) that contribute to quality palliative care services, and;
  • Provide leadership at the highest level to ensure the implementation of the WHA resolution.

The declaration provided a significant backdrop for the strategic advocacy dialogue that occurred on the following day at the conference. 

The strategic advocacy dialogue

Through a workshop hosted by the Open Society Foundations, advocacy leaders from various fields of health, including palliative care, deliberated on the question of what can be done better on the continent to ensure national and global palliative care commitments are attained.

A consensus emerged that more needs to be done to strengthen strategic advocacy work. Drawing on the experiences and successes of, and lessons learned by, human rights, communications and health movements (including harm reduction, HIV, access to medications) and previous advocacy successes within palliative care and pain relief, the workshop aimed to: 

  1. provide inspiration for future palliative care advocacy; and
  2. utilise innovative approaches (such as narrative change) to drive demand for care, human rights-based advocacy, accountability and budget advocacy to increase international and domestic financing for palliative care. 

Critical lessons included reframing the palliative care narrative and amplifying positive stories of change to inspire and strengthen its public ownership to create demand for care.  

A key strategy was to use positive personal stories of good care – the champion patient approach – to empower its beneficiaries to drive service-level advocacy.  

Building leadership

Building leadership around strategic advocacy also emerged as fundamental approach from the other fields of health discussed, as a critical ingredient for continually building advocacy credibility. 

At the policy level, it was recognised that a great deal of success around mainstreaming palliative care into national, regional and global policies has occurred but their translation into tangible action at the service delivery level is limited.  

Specifically, participants agreed on the importance of translating ‘promises’ embodied in existing frameworks into improved patient-level outcomes.  

This calls for the development of mediating mechanisms (such as governments working with pivotal change makers at all levels) through which their operationalisation is effected, with the cascading down of commitments to ground-level realities.

The operationalisation of policies, which includes the need to break down organisational and disciplinary silos, requires greater and ongoing mainstreaming of palliative care around the global frameworks (e.g.: Universal Health Coverage and the Sustainable Development Goals). 

These are critical opportunities for increasing the scale-up of palliative care, but participants also emphasised the need for prioritising such opportunities.

The elephant in the room

Despite the great enthusiasm and the critical lessons shared at the workshop, the ‘elephant in the room' remained the need for stronger political will and palliative care financing both at the global and domestic level – two issues which both workshop participants and the African Ministers of Health session seemed to tip-toe around.

The Kampala Declaration provides a strong framework through which strategic advocacy discussions can be channelled and through which we call collectively hold policy makers accountable.  

It is also a conduit through which we need to address the urgent requirement for greater political will, increased financing that is commensurate with presenting need and greater ownership of palliative care service delivery at all levels. After all, scaling-up palliative care is ultimately everyone’s business given we all would wish to die well.  

The Kampala Declaration, combined with targeted strategic advocacy have the ability to deliver just that.

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