SA should take better care of its dying – experts

They said that simply by implementing its own policy framework and using home-based care for just half of all South Africans needing palliative care, the government could save R3.3 billion per year – and fund direly needed universal home-based palliative care.

The private sector, meanwhile, could save R571 million per year by using globally recommended home-based care, HBC.

The appeal came shortly after the first national collaborative palliative care conference ended in Cape Town on 29th April.

The palliation experts said studies from the SA Medical Research Council and others clearly showed that palliative care was cost-effective, cost-saving and added value not only to the patients and their families but also to the healthcare system. However, the implementation of palliative care was currently primarily the ambit of non-governmental organisations and a few lone champions within the public and state sectors.

For example, there were just two state posts for paediatric palliative care in the entire country – one doctor post in KwaZulu Natal for just 10 hours per week, and one nurse post in the Western Cape. In addition, a lack of funding had led to the devastating closure of more than half of Hospice and Palliative Care Association, HPCA, member hospices in the last 10 years, reducing the number from more than 200 hospices to just 89 at present.

A joint statement by the Palliative Care for Children South Africa (PatchSA), the Association of Palliative Care Practitioners of South Africa (PALPRAC) and the HPCA declares;

“At some stage of our lives most of us will require some level of palliative care but only 18% of adults and 5% of children who require palliative care in South Africa can access it. As a result, most of the affected adults and children are left to suffer needlessly and many die without dignity or support and without the appropriate care for their physical comfort or their cultural, social, spiritual, and emotional needs.”

Palliative care is an interdisciplinary approach to care that is aimed at improving a person’s quality of life and preventing suffering for patients with life-threatening and life-limiting illnesses and their families. The interventions that are provided are comprehensive and incorporate physical care, psychosocial and spiritual support. Ideally, these interventions should be offered from the point of diagnosis, alongside curative treatments if these are applicable.

As an outcome of their own national palliative care conference, the organisers submitted a letter to President Ramaphosa ahead of this week’s Presidential Health Summit on 4-5 May 2023. It called upon government to fulfil its responsibility to the World Health Organization’s  declaration to monitor the achievement of the health-related Millennium Development goal to improve palliative care provision in the country by taking the following urgent steps:

• To create a permanent position within the Department of Health for the Deputy-Director coordinating palliative care across the country. Currently, the post is donor funded and has been extended one year at a time since Mr. Lawrence Mandikiana was appointed in 2020.
  
  
• To require the Health Professionals Council of South Africa (HPCSA), the South African Nursing Council (SANC) and Council for Social Service Professions (SACSSP) to integrate palliative care into undergraduate curricula for all health professions (including Allied Health Care workers) and to recognise this as a specialised discipline.
  
  
• To revise the current implementation plan and budget (that has been extended until 2024) in a transparent and collaborative manner that involves the palliative care sector and contains clear and monitorable indicators.
  
  
• To allocate funding that supports the implementation plan and is in line with the World Health Assembly resolution (67.19 of 2014, clause 2) to “ensure adequate domestic funding and allocation of human resources, as appropriate, for palliative care initiatives, including development and implementation of palliative care policies, education and training, and quality improvement initiatives, and support the availability and appropriate use of essential medicines, including controlled medicines.

“We are all morally obliged to ensure that palliative care becomes everyone’s business and that it is available to all who need and want it. There is no good reason, including budget constraints, for not taking urgent and immediate action to provide it,” the three local palliative care associations concluded.