Asian countries need to build palliative care capacity
Many countries in the Asia-Pacific region rank low in the 2015 Quality of Death Index, highlighting the need to develop palliative care in these areas, according to Professor Cynthia Goh, chair of the Asia Pacific Hospice Palliative Care Network (APHN), who delivered a presentation at the 7th Association of South-East Asian Pain Societies Congress held in Yangon, Myanmar.
Some of these countries that performed poorly included Malaysia (with a score of 46.5 percent), Thailand (40.2 percent), Indonesia (33.6 percent), Vietnam (31.9 percent), Sri Lanka (27.1 percent), India (26.8 percent), China (23.3 percent), Myanmar (17.1 percent), Philippines (15.3 percent) and Bangladesh (14.1 percent).
Only four Asian countries made it to the top 20: Taiwan (with a score of 83.1 percent), Singapore (77.6 percent), Japan (76.3 percent) and South Korea (73.7 percent).
“Richer countries do better,” said Goh.
The 2015 Quality of Death Index assesses the quality of palliative care for adults across 80 countries, representing 85 percent of the global adult population. Its results are based on interviews with more than 120 palliative care experts, detailed background research and third-party data.
The score is measured using five categories: palliative and healthcare environment (20 percent weighting), human resources (20 percent), affordability of care (20 percent), quality of care (30 percent), and community engagement (10 percent).
With the appalling performance of many Asia-Pacific countries in the Quality of Death Index, Goh recommended the development of palliative care in the region.
“Something must be done,” she said. “But how do we even start?”
Seed and soil principle
APHN, which is headed by Goh, partnered with the Lien Foundation, a philanthropic house in Singapore, to initiate the Lien Collaborative for Palliative Care (LCPC). Conceptualized in 2012, LCPC aims to help build palliative care capacity in the Asia Pacific region, focus on countries with few or no services, and integrate with mainstream government health system.
The programme brings together international and local expertise, palliative care service providers, tertiary hospitals and cancer centres, funders, local participants and nongovernment organizations (NGOs), and doctors, nurses and medical social workers.
The “seed and soil principle” was used in choosing the countries that will benefit from LCPC.
“We had to have contacts in the [beneficiary] country; the community needs to be ready and [should] want to develop palliative care; the health authorities need to be receptive; and [there must be] a health institution supportive of hosting the training,” Goh explained.
Three of the countries chosen for the programme included Myanmar, Bangladesh and Sri Lanka. Goh said that building palliative care capacity in these areas was not a walk in the park because of the challenging operating environment.
“We were working in low- and middle-income countries, fluid political development, war and unrest, fast-changing environments, hierarchical societies, a mix of ethnicities, [and] a variety of religion,” she said.
Despite these difficulties, LCPC succeeded in developing palliative care competencies in the said countries.
In Myanmar, for instance, six in-country teaching modules have already been completed, 26 trainers have been issued certificates, two services are up and running (in Yangon General Hospital and Mandalay Hospital), five doctors have received 3-month overseas clinical fellowships, and oral morphine tablets are being manufactured locally. A mentoring programme is also expected to begin soon.
In Sri Lanka, five in-country modules have been completed (with the last one slated in March), and one new service is up and running (National Cancer Institute Maharagama). Oral morphine tablets have been available even before the programme started, and a postgraduate diploma in Palliative Medicine is now recognized by the College of Medicine Sri Lanka.
LCPC got sidetracked for a time in Bangladesh due to civil unrest and terrorist bombing, but the country had already completed four in-country teaching modules (5th module in April). One new service is now available at the National Institute of Cancer Research and Hospital. Clinical fellowships have also been awarded to two doctors, and three medical students have started training on palliative care. On drug availability, oral morphine tablets have become available after conducting a narcotics seminar.
APHN is a charitable NGO registered in Singapore in 2001, with more than 200 organizational members that support or provide palliative care, and more than 1,300 individual members working in the field in the Asia Pacific region.