Need to Incorporate Palliative Care Services in Universal Health Coverage

Dr John Weru, Assistant Professor and Consultant Palliative Physician at Aga Khan University Hospital, Nairobi.

By Dr John Weru

As the world marks the Hospice and Palliative Care day on Saturday October 12th under the theme Palliative Care: it’s “My Care, My Right.”   We need to appreciate the applicability of this service for the realization of quality health care and its importance in Universal Health Cover (UHC).

This year’s theme fits well with the Kenya Health Act 2017, 5 (1) which states that every person has the right to the highest attainable standard of health which shall include progressive access for provision of promotive, preventive, curative, palliative and rehabilitative services.

Many people are being affected by chronic non-communicable diseases (NCDs) in Kenya and globally. Primary care-led management of these chronic diseases, including palliative care, is essential to deliver cost-effective UHC that does not impose financial hardship on people with NCDs.

Efforts to achieve primary care-led UHC provide an opportunity to ensure that palliative care is being delivered at the primary care level and all other stages of care from level one to level six health facilities. The aim is a holistic approach to care for patients and families, coordination of care, and person-centred care within a wider context.

The theme My Care, My Right means that palliative care can be a subject of sabotage by the public, even though it is a right. Further, together, every person impacted by a life limiting illness can influence their policy makers to prioritize palliative care financing under UHC. Therefore, a key action for the campaign is calling on governments to listen to people who need to access palliative care and support the inclusion of the essential package of palliative care in all national UHC discussions, policies and schemes.

In addition, this theme also means that communities need to ensure that patient’s right to care are supported. Specifically addressing the premise that if care is a patient’s right, how can UHC support the care givers to improve their well-being under Sustainable Development Goals.

To achieve this, all cadres of clinicians require clinical competencies and resources. This is especially limited in our setting and it is the high time that clinicians are trained and appreciate the role palliative care play in health care delivery. Palliative care is provided by multidisciplinary teams which include doctors, nurses, counsellors, spiritual care givers, nutritionists, pharmacists, family members and volunteers. These teams work with patients and their families to clarify goals of care and provide symptom management, psycho-social and spiritual support.

Palliative care is appropriate at any age and at any stage in a serious illness and can be provided as the main goal of care, or along with curative treatment. Although it is an important part of end-of-life care, it is not limited to that stage, a misconception that is very common among health care professionals and the population at large. This gives a big challenge to palliative care professionals in providing timely palliative care services as patients are referred late to these services.

Palliative care can be provided across multiple settings including in hospitals, at home, as part of community palliative care programs and in skilled nursing facilities. Thus, the scope of palliative care within health care systems is wide and its development is vital to enable realization of UHC globally and the Big Four agenda in Kenya.

Dr John Weru is the Assistant Professor and Consultant Palliative Physician at Aga Khan University Hospital, Nairobi.