The Director, General Health Services, Dr. Henry Mwebesa has written to heads of public hospitals in Uganda, directing them to allocate space for palliative care units within hospitals. The letter dated 18th March 2021 was addressed to all Executive Directors of National Referral Hospitals, Directors of Regional Referral Hospitals, and Hospital Superintendents of hospitals.
Dr. Henry Mwebesa
According to Dr. Mwebesa, his directive is based on findings made during support supervision visits by Ministry of Health Officials that many hospitals lack functional palliative care Units. According to the findings, many hospitals do not have space allocated to palliative care units to operate although there is a huge number of patients in need of the service.
Since the advent of the Covid-19 Pandemic in Uganda, the Palliative Care Association of Uganda (PCAU) has been at the forefront of advocating for the continuity of palliative care as an essential service amidst the pandemic. Among other things, PCAU argued the Ministry of Health officials conducts support supervision visits specifically to focus on palliative care services. In addition, PCAU was pushing for the popularization of the recently approved palliative care data collection tools which have been integrated into the Health Management Information System (HMIS).
These engagements are part of PCAU’s ongoing work on ensuring that Universal Health Coverage (UHC) processes in the country embrace palliative care.
The directive hinted on UHC:
“The Ministry of Health acknowledges the fact that Universal Health Coverage (UHC) cannot be attained unless Palliative Care is embraced besides Preventive, Promotive, Curative, and Rehabilitative measure”— Dr. Mwebesa emphasized in the letter
Available data at PCAU shows that in January 2020, a total of 226 health facilities offered some form of palliative care in Uganda. Of these 154 (68.1%) were public facilities and 72 (31.9%) were private facilities. These facilities include hospitals, lower health facilities, and the 13 stand-alone hospices in the country. These facilities are located in only 107 out of the 146 districts in Uganda.
Whereas the facilities offering palliative care are very few, much credit for this goes to PCAU and partners like the African Palliative Care Association (APCA) and Hospice Africa Uganda (HAU). The advocacy and support by these organizations have been key. PCAU for example has held the mantle of supporting the Ministry of Health to accredit health facilities that meet the criteria for ordering, storing, and prescribing oral liquid morphine. PCAU is also supporting efforts on strengthening the supply chain of essential palliative care medicines. This includes controlled medicines used for the management of pain.
Several hindrances delay the offering of palliative care at hospitals in Uganda. The factors include; low numbers of trained palliative care providers, low or lack of support by health facility leadership, issues in the medicines supply chain including inadequate storage facilities for controlled pain relief medicines, low incentives and budgetary allocation to the service, myths, and biases, low support supervision focused on the service among others.
This directive is, therefore, is a move in the right direction. PCAU appreciates and commends the Ministry of Health for this directive. For this directive to be fully implemented, the Government of Uganda needs to establish a National Palliative Care Policy and to improve direct investment in palliative care work. As we continue to advocate for the integration of palliative care into the Uganda health care system and all UHC we appeal to all heads of public hospitals to heed this directive.