A quarter of African countries have increased the number of palliative services they offer since 2006. This information comes from research led by the ATLANTES Program of the University of Navarra and published in Lancet Oncology, one of the three major academic journals in the world in oncology.

The study points to uneven growth in the region; just over 80% of the services identified on the continent are found in South Africa, Kenya and Uganda. These three nations have experienced substantial growth over the last 12 years, from 120 services to 210, 8 to 44 and 8 to 34, respectively. On the other hand, services have been created in countries where none existed, including in Namibia, Sudan, Ethiopia, Lesotho, Rwanda, Ivory Coast and Libya.

In addition to the implementation of services, the research team did a literature review and analyzed other indicators surrounding the development of palliative care in Africa, including health policies, the status of education in this discipline, availability of medication to combat pain and vitality of the profession.

There are independent palliative care policies in Malawi, Mozambique, Rwanda, Swaziland, Tanzania and Zimbabwe. In addition, the Ivory Coast, Kenya, Rwanda, South Africa and Tanzania have integrated this kind of care into their national health policies.

The data show that palliative care in Africa relies heavily on foundations and external donors, as in the case of South Africa and Nigeria. On the other hand, access to said care is impeded by economic factors in places like the Ivory Coast and Morocco. The government of Uganda allocates part of its national budget specifically to this area of ​​health care.

Access to medications that mitigate pain

Regarding professional training, it should be noted that there are postgraduate diplomas in palliative care in Kenya, South Africa, Uganda and Tanzania. This medical discipline is included in the curriculum for doctors in Botswana, Ivory Coast, Egypt, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda and Zambia. It is also offered in the curriculum for nurses in Botswana, Kenya, Malawi, South Africa, Uganda and Zambia.

With regard to medications that combat pain, a lack of opiates is widespread in Africa. Countries such as Ivory Coast, Egypt, Nigeria and Rwanda have strict limitations on their use and prescription. Others, such as Tanzania or Ethiopia, require special permits to prescribe or administer morphine. South Africa has the highest consumption of this drug on the continent and Tunisia the highest per capita consumption in a non-English speaking nation.

Finally, concerning the vitality of the profession, it should be emphasized that national palliative care organizations are fundamental for developing the discipline in a variety of countries. The work of the African Association of Palliative Care (APCA), which is an umbrella organization that provides training, support and advocacy in this discipline on the continent, is especially important here.

The main authors of the published article include Carlos Centeno, principal investigator of the ATLANTES Program of the Institute for Culture and Society (ICS) at the University of Navarra; John Rhee, from the Icahn School of Medicine at Mount Sinai, New York; Eduardo Garralda, of the ATLANTES Program at the ICS and of the Institute of Sanitary Research of Navarra (IdiSNA); Carlos Torrado, Santiago Blanco and Ibone Ayala, of the School of Medicine at the University of Navarra; Eve Namisango, of the African Association of Palliative Care and King’s College London; Liliana de Lima, of the International Association of Centers for Care and Palliative Care; and Richard A. Powell of the MWAPO Health Development Group.

This research received financial support from Santander Bank and is part of a larger research project led by the ICS ATLANTES Program to analyze the state of palliative care in Africa. Its central product is the Atlas of Palliative Care in Africa, which collects data from 48 countries.

The total number of hospice services by country from 2006 to 2017 can be found below:

Country	2006	2017
South Africa	120	210
Kenya	8	44
Uganda	8	34
Tanzania	4	20
Zimbabwe	13	13
Malawi	5	9
Nigeria	2	7
Botswana	3	4
Egypt	3	3
Namibia	0	3
Sudan	0	2
Morocco	1	1
Ethiopia	0	1
Gambia	1	1
Lesotho	0	1
Sierra Leon	1	1
Rwanda	0	1
Ivory Coast	0	1
Libya	0	1