BUILDING MOMENTUM FOR GLOBAL PALLIATIVE CARE:...
Transcript of BUILDING MOMENTUM FOR GLOBAL PALLIATIVE CARE:...
BUILDING MOMENTUM
FOR GLOBAL PALLIATIVE
CARE: HEALING NATIONS Dr Liz Grant
Assistant Principal
University of Edinburgh
Director Global Health Academy
From the Lancet Commission
Anthony Capon
“We, the Peoples”
An agenda of the people, by the people,
and for the people - the road is
mapped
It will be for all of us to ensure that the
journey is successful.
intercultural understanding,
tolerance, mutual respect, and an
ethic of global citizenship and
shared responsibility.
Global Health Academy
Themes of the 17 goals
People
• End poverty and hunger, in all their forms and dimensions, Ensure everyone can fulfil
their potential in dignity and equality ( healthy lives) and in a healthy environment.
Planet
• Protect the planet from degradation, including through sustainable consumption and
production, sustainably managing its natural resources and taking urgent action on
climate change
Prosperity
• All human beings can enjoy prosperous and fulfilling lives and that economic, social
and technological progress occurs in harmony with nature.
Peace
• Foster peaceful, just and inclusive societies which are free from fear and violence.
Partnership
• A revitalised Global Partnership for Sustainable Development, based on a spirit of
strengthened global solidarity, focussed in particular on the needs of the poorest and
most vulnerable and with the participation of all countries, all stakeholders and all
people
The language of the SDGs
• Ending hunger and
poverty
• Promoting wellness ,
health for all
• Protecting the planet
from abuse
• Building safe prosperity
• Providing safe places to
live
• Fostering peace
• “The healing of the
nations”
• “Preferential Options
for the Poor”
• “Leaving no-one
behind”
Healing our planet, the healing of the
nations Preamble to the Sustainable Development Goals - to heal our planet - the healing of the nations
Revelation 22:2
• On either side of the river was the tree of life, bearing twelve kinds of fruit, yielding its fruit every month; and the leaves of the tree were for the healing of the nations.
Ezekiel 47:12
"By the river on its bank, on one side and on the other, will grow all kinds of trees for food Their leaves will not wither and their fruit will not fail. They will bear every month because their water flows from the sanctuary, and their fruit will be for food and their leaves for healing."
Leaves
• Extraordinary ecosystem
• Photosynthesis - ( sunlight, water and C02
coveted into food and oxygen)
• Cooling, medicine, buildings, plates and
utensils, dyes
• Papyrus
Palliative Care – contribution to the
SDGs.
“The quality signatures
of a nation – how it
deals with birth and
death”
Liz Grant
Living - © Jo
Spiller
Unforgettable journeys
Though we are all born
equal we are born into,
and we die in, very
unequal circumstances.
We cannot change the
inevitability of death but we
can begin to change these
unequal circumstances
Through the keyhole - © Jo Spiller
Universal Health Coverage – ambition
of every country • Everyone receives the health services they need without
suffering financial hardship. It includes the full spectrum of
essential, quality health services, from health promotion to
prevention, treatment, rehabilitation, and palliative care.
• Everyone accesses the services that address the most
important causes of disease and death, and ensures that
the quality of those services is good enough to improve
the health of the people who receive them.
• Protects people from the financial consequences of
paying for health services out of their own pockets
reducing the risk that people will be pushed into poverty
What UHC is not Things that are not included in the scope of UHC:
1. UHC does not mean free coverage for all possible health interventions, regardless of the cost
2. UHC is not just about health financing. It encompasses all components of the health system: health service delivery systems, the health workforce, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms, and governance and legislation.
3. UHC is not only about ensuring a minimum package of health services, but also about ensuring a progressive expansion of coverage of health services and financial protection as more resources become available.
4. UHC is not only about individual treatment services, but also includes population-based services such as public health campaigns, adding fluoride to water, controlling mosquito breeding grounds, and so on.
5. UHC is comprised of much more than just health; taking steps towards UHC means steps towards equity, development priorities, and social inclusion and cohesion.
WHO FACT SHEET 2017 http://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
How can palliative care exemplify what
UHC is? Palliative care is about being able to choose the best and right and most timely intervention,– good PC can prevent unnecessary, inappropriate and costly practice.
MMPCU has modelled practice which answers the following questions –
What do we need to do to speak together about the right time to provide care/ and the time not to provide costly ineffective care
Whose responsibility is it and how to we encourage joint responsibility to share the core objectives of holistic person centred care?
• “my heart has become less heavy, I feel at peace, my pain is less’
How can palliative care exemplify what
UHC is?
Palliative care impacts all components of the health system
Palliative care demonstrates what can happen when we recognise the vulnerability of “health” and the value of care for the dignity of life, not the cure of a disease.
“before I thought it (palliative care) was about giving up” (Nurse, Kenya)
“Now I have the heart of listening to the patients, talking, counselling and assessing them” (Nurse, Uganda)
Creates
new
norms
Global perspective; palliative care
• Lancet Commission report Oct 2017
„Alleviating the
access abyss in
palliative care and
pain relief-an
imperative of
universal health
coverage‟
The added value of palliative care within a health
system to deliver healthy lives for all
Palliative care brings a deeper
understanding of the vocation of
care within Universal Health Care
(UHC)
• Demonstrates not linear
strengthening but relational
strengthening
Palliative care asks us to think of
the values underpinning UHC
• The why of care? - palliative care
shows the “heart” of care – caring
for people because our patients are
our brothers and sisters
Palliative care models holism -
• rationale for care of the whole
person, dealing with their physical,
spiritual, emotional and social
needs.
How can palliative care exemplify UHC?
PATIENTS Who receive care and who also give of themselves as they care for loved ones
• A PARADIGM that places all people regardless of age, disease, place at the centre of care
• POLICIES that support a vision of care for all at all ages
• A PROGRAMME and PLANS that capture the vision, and outline the way in hospitals, districts and ministry
• PRECEPTORSHIP - training pre service curricula and in service
• A referral PATHWAY to ensure consistency of care
• PROTOCOLS to ensure confidence to make right decisions at the right time
• PURPOSEFUL PRESCRIBING (forms, people and places)
• PROCUREMENT Systems – making drugs consistently available
• PERFORMACE Systems ( enabling tools to ensure quality and capture change)
• PARTNERSHIPS A network of support - a net that works
• PASTORAL care and support
• PRESENCE both a physical presence and being physically present
PEOPLE All who plan, deliver, oversee and participate in care
How to evidence the microcosm of the
health system that is PC
How can palliative care exemplify what UHC is?
Not about minimum package of health services, but about a progressive expansion of coverage of health services and financial protection –
embedded in Palliative Care is engagement – it‟s everyone‟s business, the work of all.
MMPCU’s link Health worker programme
PC teaches us holism – recognition that the professions engaged and the team of carers is ever widening,
Recognition that patients‟ worries are not just about physical illness but about life – “who will look after my shamba?”, “who will feed my children?” “ how can I cope in the face of war, destruction and hopelessness?”
UHC is comprised
of much more than
just health; taking
steps towards UHC
means steps
towards equity,
development
priorities, and
social inclusion and
cohesion
Not about can we afford to deliver PC but can we
afford not to.
Lack of Palliative Care often means:
• Losing land and savings
• Out of pocket expenditure with no incoming redress
• School dropout because no money for fees
• Girls taken out of school to be carers
“material wealth strongly predicts the wealth of offspring via intergenerational wealth transfer. Ultimately, when parents lose their wealth to medical costs, future generations are gravely affected” (1)
1.Anderson, R. E., & Grant, L. (2017). What is the value of palliative care provision in low-resource settings?. BMJ Global Health, 2(1), https://doi.org/10.1136/bmjgh-2016-000139
2.World Health Organization. Chronic disease and health promotion. http://www.who.int/chp/chronic_disease_report/part2_ch2/en/index5.html
“existing knowledge underestimates the
implications of chronic diseases for poverty
and the potential that chronic disease
prevention and health promotion have for
alleviating poverty in low and middle income
countries.” (2)
How can palliative care exemplify
what UHC is?
UHC not just individual treatment services, but
population-based services such as public health
campaigns –
This is our call to action: palliative care is a public health
emergency
Global Pathways to build momentum
in palliative care • Principles of co-creation – participation, shared ethos
and values, purpose
• Preparing the ground - shared vision of change, why it
is necessary, resilience, clear direction, optimism
• Partnerships - clarity on who, why, when, where
• The Planet – not just one more isolated issue – health is
interconnected to who we are, how we are doing, why we
are here, where our world is going and what we are
moving towards.
Paradigm of
Palliative care Global and
national movement for palliative care National Architect
ure Service infrastru
cture family and
community -
People
You and Me
Building a Model – MMPCU, APCA and University of
Edinburgh leading the way.
Core component
s of a Palliative
Care system
Creating the
conditions for change
Supporting Sustainable systems
A proof of concept
A set of system
strengthening
programmes
Evidence based/
evidence generating
programmes:
• how to,
• what to,
• when to
• where to
• why it matters
Overall added
value Making visible that
palliative care is
An approach
A service
A system
And that good
palliative care
creates a new
paradigm for health
Using a 4 Pillar Strategy to enable participation, to build preparedness, to establish pathways,
to change the paradigm
ADVOCACY –
Palliative care in national health plans
Greater awareness at all health service levels and in community
Global recognition
SERVICE DELIVERY –
Palliative care services delivered in hospitals, health centres, communities with support and resources
STAFF CAPACITY – Adequate number of generalists and specialists able to provide palliative care within hospital and health centre networks
PARTNERSHIP –
Strengthened links, active mentorship programmes
Integration: lesson learned
• Capacity building
• Curriculum integration
• Leadership training
• Mentorship
• Research and
evidence base
Grant L et al Integrating palliative care
into national health systems in Africa: a
multi–country intervention study June
2017 Journal of Global Health
Integration - the tipping points
• Concurrent Interventions
• Having champions / “movers and shakers” in Palliative Care
• A critical mass of staff
• Clarity in the process – a documented familiar system of referrals , protocols, pathways
• A hospital system of care to refer to and from
• Community understanding
• Preceptorship – clinical placement and mentoring
• Coordinated external and internal messaging,
• Specialist training linked to a wider training for all
• Ongoing training
• A movement with encouragement and engagement
• A shift in thinking
The Pathway: Journeying together in a systematic way
Governance and Leadership - not sporadic but
measured and visionary, management commitment.
Services: Flexible work plans developed to fit within local
vision and current system of care, structures in place
Medicines, Technology, Resources, Space, Protocols
Human Resources: The right sort of training for hospital-
identified teams • Training is only as valuable as its power to change – so identifying things that
will enable change/ and the stages of change
• Capturing and building on change - dynamic work
• Working with mentors to be a support for implementation, rather than
trainers/ teachers.
A Sharing Learning Network
The quality signatures of
a nation – how it deals
with birth and death
@photography
jospiller
“Palliative
Care also
benefits other
non-palliative
care patients,
because it is
changing the
system for
everyone”
Waiting - © Mhoira Leng
• focuses on health systems rather than specific diseases
• urges palliative care integration into health worker training and education at all levels
• advocates for universal coverage
• highlights training needs inc. primary care, oncology, paediatrics, geriatrics and internal medicine
• urges governments to
fund palliative care
WHA Resolution on Palliative Care 2014
Lancet Commission on Global Access to Palliative care
and Pain Relief 2018
• focuses on Serious Health related Suffering
• Delineates an essential package of palliative care services urges palliative care integration
• advocates for holistic access to pain relief – morphine within a UHC framework
The legacy: Going forward
• What we can do: tell the story through the experiences of people – incorporating the problems and the solutions into the story (with the evidence)
• Conviction of why it matters and why the status quo is no longer tenable once the story has been told