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Education And Debate

Quality care at the end of life in Africa

BMJ 2003; 327 doi: (Published 24 July 2003) Cite this as: BMJ 2003;327:209
  1. Cecilia Sepulveda, coordinator (,
  2. Vincent Habiyambere, medical officer2,
  3. Jacinto Amandua, commissioner of clinical services3,
  4. Margaret Borok, lecturer4,
  5. Ekie Kikule, executive director5,
  6. Barbara Mudanga, principal head officer6,
  7. Twalib Ngoma, executive director7,
  8. Bogale Solomon, radiation oncologist8
  1. 1Programme on Cancer Control, World Health Organization, Avenue Appia 20, CH-1211 Geneva 27, Switzerland
  2. 2HIV/AIDS Care, World Health Organization, Geneva, Switzerland
  3. 3Ministry of Health, Kampala, Uganda
  4. 4Department of Medicine, University of Zimbabwe Medical School, Harare, Zimbabwe
  5. 5Hospice Africa Uganda, Kampala, Uganda
  6. 6AIDS/STD Unit, Community Based Care, Ministry of Health, Gaborone, Botswana
  7. 7Ocean Road Cancer Institute, Dar es Salaam, Tanzania
  8. 8Radiotherapy Centre, Addis Ababa University, Addis Ababa, Ethiopia
  1. Correspondence to: C Sepulveda

    Each year about 0.5% of the total population in Botswana, Ethiopia, Tanzania, Uganda, and Zimbabwe die from HIV/AIDS or cancer. The members of a WHO project to improve palliative care in these countries discuss their work. The greatest needs of terminally ill patients were for adequate pain relief, accessible and affordable drugs, and financial support to counter the loss of income of both patient and family caregiver. Special emphasis should be given to home based palliative care provided by trained family and community caregivers to counteract the severe shortage of professional healthcare workers

    Each year in Africa about 2.5 million people die from HIV/AIDS, and more than 0.5 million die from cancer.1 2 Many of these deaths are accompanied by suffering that could be avoided or relieved if adequate palliative care were provided. Quality care at the end of life is a global public health problem.3 4

    What is palliative care?

    Palliative care, as defined by the World Health Organization (WHO), is an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention and relief of suffering by means of early identification and careful assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.2 4 5 Palliative care regards dying as a normal process and offers support to help the patient and family cope during the patient's illness and in the bereavement period.

    What can be done to relieve pain?

    WHO has developed a relatively inexpensive yet effective method for relieving cancer pain in about 90% of patients6 7 that can be easily extended to patients with HIV/AIDS. Despite this low cost approach, many countries in the developing world provide limited or no palliative care services. A main obstacle is the insufficient availability of opioid drugs because of regulatory and pricing obstacles, …

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