PALLIATIVE Care (PC) is an interdisciplinary medical care giving approach, aimed at optimizing quality of life and mitigating suffering among people with serious, complex and often terminal illness.
It also improves quality of life of patients and their families who face problems associated with lifelimiting and threatening illnesses, through the prevention and relief of suffering by making early identification of a disease, treatment of pain and other problems physical, psychosocial and spiritual.
According to 2021 the World Health Organization (WHO) report, Non communicable diseases(NCDs) are estimated to cause 71 per cent of all deaths globally almost three quarters of all NCDs deaths and 82 per cent of 16 million people died prematurely or before reaching 70 years of age, where PC occur in low and middle income countries.
The medical expert says the rise of NCDs is partly attributed by to increase in the NCDs risk factors, such as the use of tobacco, excess use of alcohol, unhealthy diet and physical inactivity.
In Tanzania NCDs are still the major causes of morbidity and mortality, it contributes significantly to the disease burden especially among adult populations, where WHO estimates that for the year 2018, NCDs contribute to 33 per cent of all deaths occurring in the country.
According to WHO, NCDs kill 41 million people each year that is equivalent to 71 per cent of all deaths globally.
Annually more than 15 million people die from NCDs between the age of 30 and 69, where 85 per cent of those premature deaths occur in low-middle income countries. Among the NCDs, cancer situation is critical, according to WHO report, where it accounts for 5.1 per cent of all in-hospital deaths in the country between 2006 and 2015.
During those years, an agestandardized hospital-based mortality rate due to cancer was 47.8 per 100,000 populations and the total number of deaths was notably higher among individuals in the 15-59 years of age.
It was established by medical experts that late presentation and limited treatment centres are the major challenges that cause high mortality rate for cancer patients in the country.
Due to the challenges, government through the Ministry of Health has been working tirelessly by developing different documents relating to NCD services, including National Health Policy, Health Sector Strategic Plan V (2021-25), NCD Strategic Plan III (2021-26) and the National Cancer Control Strategy (2013-2022) all aimed at addressing the challenges in access and provision of health services to patients.
Despite the efforts taken by the government in developing PC policy guidelines, there are no standards to guide implementation, as the efforts and achievements that have been made by the government, stakeholders and development partners as there are still challenges in the provision of PC services.
Those challenges include inadequate awareness of PC, limited resources for both financial and human, insufficient multispectral collaboration and stakeholder’s coordination, inadequate integration of PC services to the existing health care system and ineffective monitoring and evaluation of the PC services.
That is why the group of nine people from the government and various stakeholders met in Morogoro town recently for a four-day meeting to develop National PC Training Manual and Standard Operating Procedures (SOP), so as to get rid of the existing challenges in the implementation of PC services at health facilities.
The panel included Dr Bakari Salum who is a Non Communicable Diseases Coordinator from President’s Office Regional Administration and Local government (PORALG), Dr Anzibert Rugakingira who is a Non Communicable Diseases Coordinator from the Ministry of Health and Dr Sara Maongezi, the Manager Partnerships (Capacity Building and Communication) from Tanzania Comprehensive Cancer Project (TCCP) of Aga Khan Health Services Tanzania.
Others in the task force were the Palliative Care and Public Health Consultant, Dr Owino Osano from Network Tanzania Palliative Care (PTR-NET), the Acting Palliative and Rehabilitation Coordinator from the Ministry of Health, Dr Mwinyikondo Juma, Cancer Specialist, Dr Harrison Chuwa from Aga Khan Hospital, Mr Nashon Kennedy , the journalist from Tanzania Standard Newspapers( Publisher of Daily News, Habari Leo and Habari Leo Jumapili) who is also the writer of this article and two nursing officers, Ms Lucia Laurean and Ms Asha Gembe from the Ministry of Health.
The formation of SOP will guide stakeholders to address challenges in the development and revision of national health policy, different guidelines and strategies so as to reinforce changes in PC policy guideline, emergence and re-emergence of communicable diseases outbreak, like Covid-19 pandemic in relation to PC needs.
SOP will also be used in different roles of the Ministry of Health and PORALG in provision of health care services, including PC and to enhance access to PC services as the right of every individual in need.
Those standards are based on research, documentation and experience-based evidence, along with an international, regional and national framework for PC service provision.
Officiating the meeting, the Chief Executive Officer of Aga Khan Health Services Tanzania, Mr Sisawo Konteh congratulated the team for the good job they did on behalf of many Tanzanians and praised the Ministry of Health, management of Ocean Road Cancer Institute (ORCI), Arusha Lutheran Medical Centre (Sellian Hospital) and Muheza Hospice Care for realizing the importance of PC care services in the country since the 1990s with other stakeholders.
He mentioned some of those stakeholders as Evangelical Lutheran Church of Tanzania, Tanzania Palliative Care Association, Muhimbili National Hospital (MNH), Bugando Medical Centre, KCMC, and Aga Khan Health Services Tanzania (AKHST) for their taking up and strengthening those services in the country.
He said the country is aware that PC is a holistic care provided to patients suffering from long limiting-illness that do not respond to curative treatment for both NCDs such as Cancer, Diabetes, ulcers, pain due to Sickle Cell to children and communicable diseases such as HIV.
“It aims to relieve pain and other distressing symptoms in patients and families facing problems associated with life-limiting or lifethreatening illness”, he said.
Mr Sisawo noted that with the growing burden of NCDs, PC services need to be provided by a multidisciplinary team, composed of doctors, nurses, pharmacists, social workers and allied health service providers in the country. He praised the Ministry of Health and other stakeholders for realizing that PC services are fundamental to people’s health and dignity as it is a basic human right.
“I understand that the National Palliative Care Policy Guidelines have touched all the important areas such as survivorship, end of term illness, bereavement …I am sure you have not left stone unturned,” he explained.
The CEO insisted that integration of PCs into the existing health care systems is a public health approach that will enhance provision of PC at all levels in order to improve quality of life.
“We need to disseminate these guidelines to health care managers, trainers, supervisors, care providers and policymakers, public and private health facilities not forgetting the community,” he said.
He clarified that having documents and not disseminating them is the same as not having them and he urged the Ministry of Health and PORALG to work with stakeholders in making sure the team is disseminating those guidelines to the lowest level of service delivery.
“We should not forget to use these as advocacy tools to reach out to development partners for resources mobilization within and outside the country, because Palliative Care services and Non-Communicable Diseases as a whole is an area that is severely underfunded in Tanzania and globally”, he said.
Public Health Specialist, Ms Irene Mushi said PC is an important aspect in health, clarifying that most patients suffering from NCDs will need PC services at some point in their life. She said PC services help patients and families to increase their quality of life and also mitigate patients’ pain and suffering.
She praised the Ministry of Health and other stakeholders for their efforts in creating policy guidelines and SOPs, adding that it is the first step in building a strong foundation of PC services in the country.
“The next step would be to ensure effective implementation of these guidelines and SOPs at Health Care Facilities. But also more efforts is needed towards providing education and awareness of PC not only to health care workers but also the community in general”, she said.
Ms Mushi expounded that it is a responsibilty of health care workers to be aware of PC as well as the community. She noted that she believe having PC in place more than 80 per cent of patients who need PC services will be able to receive it. Non Communicable Disease Coordinator (PORALG), Dr Bakari Salum said the manual has come at a right time, when the country is in a desperate need of expanding PC services.
“The rise in NCDs including Cancer, call for an urgent action to have equitable distribution of PC services in the country, in which this manual will be an important tool to achieve this target,” he said.
Dr Salum said there is a very good opportunity for expanding PC services due to massive investment made in the health sector, whereby in the past seven years the government has done a tremendous job to construct 102 new district hospitals and more than 600 health centres.
He noted that those health facilities are equipped with medical equipment and health care workers to provide all basic health services, including PC services in the country.
“It is therefore envisaged that with the availability of the PC training manual and good collaboration among all stakeholders, the PC services will be available to all who are in need of it,” he said.
Non- Communicable Diseases Coordinator from the Ministry of Health, Dr Anzibert Rugakingira said PC is the total care provided to people suffering from diseases that do not respond to curative treatment. “It aims to relieve pain and other distressing symptoms in patients and families facing problems associated with life-limiting or threatening illnesses,” he explained.
He said that kind of care is provided by a coordinated team which consists of medical experts, nurses, social workers and allied health service providers.
“Majority of chronically ill and bedridden patients who are at the end of their lives prefer to die at their homes, while surrounded by their loved ones rather than dying in hospitals. In such a situation, these patients are entitled to get Palliative Care at home”, he said.
Dr Rugakingira noted that the Ministry of Health in collaboration with other stakeholders is in process to prepare the national training manuals for palliative care which will facilitate training of palliative care to the healthcare providers.
“This will capacitate healthcare providers with basic palliative care knowledge and skills and enable them to provide palliative care to all patients with life-limiting or life-threatening illnesses which will, in turn, result in the improvement of quality of lives,” he noted.
He added that PC is one of the national responses to the disabilities and suffering emanating from chronic communicable and NCDs, including Diabetes, HIV / AIDS, Cancer, Cardiovascular, Sickle Cell and chronic respiratory diseases.
He noted that the ultimate treatment option for patients suffering from chronic diseases that are in their final stages is the provision of PC which also is fundamental to people’s health and dignity as it is a basic human right.
He says the PC manual will enable health care managers, trainers, supervisors, care providers and policymakers to enhance Palliative Care available in the health care facilities.
The training manual will also serve as a teaching tool for all members of the multidisciplinary team in provision of palliative care.
