Global Health Academy

Evaluation of Three Palliative Care Programmes

Caring for the dying is a critical part of health systems.

When many health systems in low income countries are already struggling to deliver curative and preventive care can we really prioritise palliative care?

Is it more important to care for the living and those starting life, than to care for those coming to the end of their lives? These are difficult questions, with difficult answers.

We argue that caring for the dying is not optional, but a critical part of health systems. Perhaps the way a society care for their dying reflects how well a society cares for their living.

Individuals, their families and local communities

Richard Smith, who leads the United Health Chronic Disease initiative, recently reviewed a book for the British Medical Journal by the philosopher Todd May.

In his book simply called 'Death', May argues that the fact that we die is the ‘single most important thing about us’. May sees death as central to life, and he believes those who reject its centrality are denying the power of life as well as the power of death.

Our own health systems have been death denying, which has made them much poorer than they might be. We can learn lessons form other health systems, particularly systems in low income countries, where communities capacity to talk about death is so much greater than ours.

We know that the one thing we all share, regardless of who we are and where we live, is the fact that we die. What we don’t share is the opportunity for a ‘good death’.

Tragically those who die from chronic diseases, especially in many low income countries, are probably going to die in more pain. The journey towards death will probably be over a much longer period, and the cost of dying and death from a chronic disease may be the factor that pushes families into an unbearable cycle of poverty.

Primary Palliative Care Team

The Primary Palliative Care Team at the University is a multi-disciplinary team drawn from hospital, hospice, primary care and social science settings.

The team seeks to understand patient and carer perspectives both from local contexts and global contexts. It uses qualitative methods, and integrates these with professional views in order to make recommendations for service development in Scotland. It has also been engaged in innovative public health palliative care work in a number of African countries.

Programmes in Kenya, Malawi and Uganda

These evaluations of programmes outline some of the issues that palliative care programmes are facing. They also show some of the amazing work that teams carry out with almost no resources.

Funding

This project was funded by the Palliative Care Initiative (PCI) of The Diana, Princess of Wales Memorial Fund.