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Leaving no one behind: What does palliative care inclusion in Universal Health Coverage for Africa mean?

Author: Dr Emmanuel Luyirika, Executive Director, African Palliative Care Association
13 October 2017

Worldwide, more than 25.5 million people a year (almost half of all deaths in 2015), including 2.5 million children, die with serious physical and psychological suffering as a result of disease, injury or illness according to a major new report published in The Lancet.

The report provides the first worldwide estimates of serious, health-related suffering and the resultant need for palliative care and pain relief. 

Furthermore, the number of people who experience serious health-related suffering is much higher, with an additional 35.5 million people requiring pain relief outside of end-of-life care. More than 80% of these cases are in low- and middle-income countries, where access to immediate release morphine, an essential and inexpensive medicine to alleviate pain, as well any other type of palliative care, is severely lacking.

Africa has the highest number of countries with low or no access to palliative care medicines especially morphine and related palliative care technologies and equipment. Almost half of Africa has no access to oral morphine as par the Lancet Global report on palliative care. This means that Africa has very serious health related suffering for patients with HIV, cancer, cerebrovascular disease, liver disease, ling disease, non-ischaemic heart disease and many other conditions. Many countries tend to legislate and put emphasis on control and prevention of opioid misuse while access to these medicines for medical use is neglected.

Of the 25 Countries with zero morphine for coverage of pain and palliative care 21 are in Africa.

 Our giants as far as access to morphine in Africa is concerned are Tunisia and South Africa which meet about 50% of the need. Then Namibia covers about 29%, Botswana 25% and Mauritius at 22%, Egypt 19% while all others are below 15%.

 The pain crisis is therefore most severe in poor countries especially in Africa.

For Africa to improve this situation and ensure that no one in palliative care need is left behind, the continent needs to strengthen the health systems by improving governance, financing, health worker development, deployment, retention and skilling in palliative care, improve research and provision of affordable morphine preparations especially oral morphine as well as adoption of affordable technologies.

 The Lancet Report estimates that $145 million per year would bring relief to the millions suffering preventable pain globally. Only $1 million is needed to cover the children in low income countries and ensure that no child faces severe pain during or at the end of life.

 The Lancet report recommends an essential package that includes palliative care medicines including morphine, provision of basic and affordable palliative care equipment as well as ensuring that health workers are trained.

 Universal Health Coverage schemes in Africa should include this package so that no patient has to pay out of pocket at the time they need the service. These recommendations are achievable

The report can be accessed at http://www.thelancet.com/commissions/palliative-care?dgcid=twitter_social_palliative-care-comm17&dgcid=TheLancetTwitter_social_lancet&sf121407154=1

The Struggle Continues.

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