The APCA Atlas of Palliative Care in Africa 2017 has been developed
by a partnership of the following institutions: the African Palliative
Care Association, the Arnhold Institute for Global Health at the Icahn
School of Medicine at Mount Sinai, the International Association for
Hospice and Palliative Care, and the ATLANTES Research Program
at the Institute for Culture and Society at the University of Navarra.
Rhee JY, Luyirika E, Namisango E, Powell RA, Garralda E, Pons JJ, et al. APCA Atlas of Palliative Care in Africa. Houston: AHPC Press; 2017.
Since Wright & Clark’s book on palliative care in Africa in 2006, there
has not been a comprehensive overview describing the state of palliative
care development in African countries.
To describe the current state of palliative care (PC) development in
Africa according to the WHO’s Public Health Strategy for integrating
PC: policies, availability and access to medicines, education, and
Qualitative interviews were conducted with 16 Country Experts
(March-August 2016). From those interviews, 367 indicators were
derived, 130 after exclusion criteria and content analysis were performed.
The Country Experts rated the indicators for validity & feasibility,
a 14-member international committee of experts participated
in a two-round modified UCLA-RAND Delphi consensus, and the
co-authors (November-December 2016) ranked the indicators. The
final 19 indicators were further defined and sent to 66 Key Country
Informants from 51 African countries (January-March 2017). RESULTS
Surveys were received from 89% (48/54) of African countries. Uganda,
South Africa, and Kenya have the highest number of specialised
hospice and PC services (71% of identified PC services); 19% (9/48)
have no identified hospice and PC services. 22% (12/48) indicated
having stand-alone PC policies, and 42% (20/48) reported having
a dedicated person for PC in the Ministry. Zambia, Uganda, South
Africa, Kenya, Ghana, and Egypt reported some official form of physician
accreditation. Opioid consumption per capita was low (75%
countries had <1 mg consumption/capita/year) compared to the
global average (43mg/capita/year), with highest consumption in
Mauritius, South Africa, Namibia, and Morocco. 54% (26/48) reported
having a national PC association.
This study shows that there is limited PC development in Africa,
but there is also a significant improvement in the number of countries
with hospice and PC services, compared to previous reports.
Improvements in advocacy were identified, with more than half of
countries reporting a national PC association. Governments need to
take the steps to improve education, increase the number of services,
and ensure safe access to opioids.