Atlas of Palliative Care in the Eastern Mediterranean Region

Abstract

BACKGROUND Information on the state of palliative care development in Eastern Mediterranean countries is scant. This study is the first of its kind in conducting a systematic descriptive analysis of palliative care development in the region. AIMS To describe the current status of palliative care in the Eastern Mediterranean Region according to the World Health Organization (WHO) public health strategy for integrating palliative care: policies, opioid accessibility, services availability, and educational programs plus palliative care professional activity. METHODS Surveys were sent by email to two leaders of palliative care in each country. A follow-up telephone interview was conducted with one leader from each available country. A scoping review of the state of palliative care in Eastern Mediterranean countries using the WHO palliative care public health strategy was conducted using PubMed, CINAHL, Embase, and Google Scholar. RESULTS Sixty eight percent (15/22) of countries in the EMRO region responded to the survey. Of the fifteen participating countries, Saudi Arabia had the highest number of total palliative care programs across the Eastern Mediterranean region, followed by Egypt and Jordan, while Iraq and the Occupied Palestinian Territories reported no palliative care programs. Saudi Arabia, Iran, and Lebanon have official licensing programs in palliative care for physicians, and a further four countries (Egypt, Jordan, Oman, and Qatar) have developed other advanced training programs (such as Masters or Diploma). In terms of education, Jordan, Oman, and Lebanon report having at least one medical school teaching palliative care as an independent subject, though four additional countries (Egypt, Kuwait, Pakistan, and Tunisia) report teaching palliative care integrated into other subjects. There are no nursing schools in the region that teach palliative care as an independent course. In terms of policies, only Tunisia has a stand-alone national palliative care plan. However, 73% (11/15) of participating countries reported having a section for palliative care within their national cancer plan/strategy. In terms of medicine availability, Saudi Arabia reported the highest opioid consumption in morphine equivalence, excluding methadone, at 33.55 mg/capita/year in 2015, with the next highest being Kuwait at 5.59 mg/capita/year. Finally, in terms of professional activity, Morocco, Tunisia, Lebanon, Jordan, Saudi Arabia, Kuwait, and Iran reported having national palliative care associations, though not all are currently active. CONCLUSION Palliative care remains underdeveloped in most countries. Efforts and resources should be mobilized to address the gaps identified to ensure that palliative care becomes accessible across the region.

The Atlas of Palliative Care in the Eastern Mediterranean Region is a joint project between the Lebanese Center for Palliative Care – Balsam and the ATLANTES Research Program at the Institute for Culture and Society, University of Navarra, Spain. The World Health Organization (WHO EMRO) contributed to the project offering financial support for the printed version of this Atlas. The International Association for Hospice and Palliative Care (IAHPC) provided funding for design and printing.