Delegates from Central Asia (Afghanistan and Tajikistan), South Asia (Pakistan and India) and East Africa (Tanzania and Kenya) met at the end of June in Dar Es Salaam in a unique workshop focused on integrating palliative care services within the Aga Khan Development Network (AKDN).
AKDN, via the Aga Khan Health services (AKHS) and the Aga Khan University, manages more than 200 health facilities – including a network of hospitals and health centers – and provides primary health care and curative care in Afghanistan, India, Kenya, Pakistan, Syria, Tajikistan and Tanzania. AKDN also provides technical assistance to government in health service delivery in Kyrgyzstan, Mali and Mozambique.
The delegates included doctors, nurses, CEOs and other executives as well as volunteer representatives from AKDN.
Until recently AKDN have had limited involvement in palliative care delivery. However, Princess Zahra Khan and the AKDN Health Coordinator, Dr Gijs Walraven have been very keen that this gap in the delivery to the ten thousands of patients who daily receive care at AKDN facilities is addressed.
At the outset of the workshop, the Princess spoke of the long tradition that AKDN has had in providing care surrounding the start of life but that those approaching the end of life, when they are particularly vulnerable, also need good care.
She encouraged delegates entering the annual budget process in AKDN that they take account of the need to integrate palliative care across the range of primary, secondary and tertiary services that the network currently delivers.
The two day event was hosted by Dr Gijs Walraven and was facilitated by Professor Max Watson from the Northern Ireland Hospice and Dr Gayatri Palat from the Two Worlds Palliative Care programme in Hyderabad in South India.
The workshop began by reviewing the results of a baseline survey of the palliative care needs from each of the six countries. The survey, which took nearly two years to complete, was carried out by AKDN staff and volunteers, highlighted the challenges and potential opportunities for initiating and integrating palliative services.
Common themes emerging included:
- the need for training for both generalist and specialist health care workers
- the need for ready availability of appropriate medications, especially for pain
- the need for specific communication training for professionals
- the importance of family involvement and empowerment in their caring role
- unease about the name 'palliative care' in “our context”; and
- the importance of cultural, ethical and religious issues.
Prof. Watson and Dr Palat then provided an international perspective on challenges and strategies that others have faced in integrating palliative care services across the world and highlighted the particular experience of the Hyderabad service which has developed since 2007.
The workshop then focused on developing practical action plans and strategies to help address the issues highlighted in the baseline survey for each of the countries involved. The groups were clearly engaged as they debated how best to support such work and how to share resources and materials both within countries and across the AKDN.
Finally the delegates considered two potential training strategies to support the integration of palliative care services:
- a Champions for Change programme aimed at providing identified champions with the skills of leadership and motivation to pioneer developments in a one year programme; and
- a Village Health Workers programme aimed at providing local health workers with the skills and support to develop local community based approaches to improving end of life care in the village setting.
While palliative care is but one of many pressing needs faced across AKDN, the determination, energy and commitment of the senior staff represented in Dar Es Salaam was very impressive and provides real grounds for optimism that palliative care for patients is set to be integrated across AKDN over the coming years.
Professor Max Watson is Medical director at Northern Ireland Hospice, and Dr Gayatri Palat is Director of the Palliative Access Programme Two Worlds Cancer Collaboration – INCTR Canada.