Assessment of the Readiness and Availability of Palliative Care Services in Hospitals in Kampala, Uganda

Abstract

Background: In Uganda, there are approximately 350,000 patients with illnesses needing palliative care (Merriman, Mwebesa & Katabira, 2012) and among whom 210,000 persons in painare in urgent need of Palliative care (American Cancer Society, 2014).Further, palliative care was introduced to improve the quality of life of patients and their families who are facing problems associated with life-threatening illness, whether physical, psychosocial or spiritual (Temel, 2010). More still, palliative care reduces unnecessary hospital admissions and the use of health services. However, the use of morphine and other controlled medicines that are essential for palliative careare overly restricted by regulations thereby hindering access to adequate pain relief and palliative care. Furthermore,palliative care has been incorporated into the Uganda’s Health Sector Strategic and Investment Plans but has been hampered by minimal resources and huge shortages of health workers. Further, Uganda has one of the most rapid growth of palliative care in Africa as well as the only country in sub-Saharan Africa graded as having “Stage 4” comprehensive palliative care according to the Global Atlas of Palliative Care (Worldwide Palliative Care Alliance, 2014). Additionally, Uganda was ranked 35th out of 80 countries for the Quality of death Index (Economist Intelligence Unit, 2015). Despite these accolades, hospital based palliative care is not universally available throughout the country. In 2014 the Ministry of Health provided only 103 million Uganda shillings for development of Palliative care in its national budget. This is a small amount to share, and as most hospitals received very little funding for palliative care, it is likely that hospital medical superintendents used discretionary funds to provide the service (O’Brien et al., 2013). Therefore, the objective of this study was to assess the readiness and availability of palliative Care services in hospitals in Kampala, Uganda from April, 2016 to June, 2016. Methods: A cross sectional study design was used. Results: The study found that 7 of the 27 hospitals (26%) were offering palliative care, 6 (22%) had a specialized staff offering palliative care and only 5 (19%) had a staff designated to coordinate palliative care services. Overall, the level of  readiness to provide palliative care was found to be very low with only 3 of the 27 hospitals (11%) demonstrating readiness as per the set criteria (availability of pain medication in stock, availability of morphine in stock and availability of a healthcare worker to provide palliative care).

Conclusion: Readiness and availability of palliative care services is very low among hospitals in Kampala.

Keywords: Palliative Care, Morphine, Readiness, Availability