Mapping Levels of Palliative Care Development: A Global Update

Abstract

Our purpose is to categorize palliative care development, country by country, throughout the world, showing changes over time. We adopt a multi-method approach. Development is categorized using a six-part typology: Group 1 (no known hospice-palliative care activity) and Group 2 (capacity-building activity) are the same as developed during a previous study (2006), but Groups 3 and 4 have been subdivided to produce two additional levels of categorization: 3a) Isolated palliative care provision, 3b) Generalized palliative care provision, 4a) Countries where hospice-palliative care services are at a stage of preliminary integration into mainstream service provision, and 4b) Countries where hospice-palliative care services are at a stage of advanced integration into mainstream service provision. In 2011, 136 of the world's 234 countries (58%) had at least one palliative care service--an increase of 21 (+9%) from 2006, with the most significant gains having been made in Africa. Advanced integration of palliative care has been achieved in only 20 countries (8.5%). Total countries in each category are as follows: Group 1, 75 (32%); Group 2, 23 (10%); Group 3a, 74 (31.6%); Group 3b, 17 (7.3%); Group 4a, 25 (10.7%); and Group 4b, 20 (8.5%). Ratio of services to population among Group 4a/4b countries ranges from 1:34,000 (in Austria) to 1:8.5 million (in China); among Group 3a/3b countries, from 1:1000 (in Niue) to 1:90 million (in Pakistan). Although more than half of the world's countries have a palliative care service, many countries still have no provision, and major increases are needed before palliative care is generally accessible worldwide.

Caregiving and the Family

“…In the case of terminal illnesses where death is inevitable, the goal is to improve the quality of life, by relieving pain, discomfort and ensuring more emotional balance, support, and happiness for the patients. Palliative care is the form of care rendered to terminally ill patients to make pain and sorrow easier to bear though curing is unatainable and death inevitable [27]. Home care is usually more preferable for terminal illnesses as these patients need to feel more accepted and loved in their remaining days [19].…”

Palliative Care, A Reel Challenge in Income and Middle Countries. Example of Morocco

“…The largest part of countries in north-Africa and middle-east was considered as countries with capacity building activity in palliative care or with isolate palliative care provision (Table 2) [6].…”

Do we need a more inclusive model for understanding Ethics in palliative care in the developing countries?

“…The report placed Afghanistan, Bhutan and Maldives in group 1(no known activity), Pakistan, Bangladesh and Sri Lanka in Group 3a (isolated palliative care provision) and India and Nepal in Group 3b (generalized palliative care provision) [13]. These countries have their own set of barriers like poverty and lack of education, awareness and resources.…”

“…Lack of awareness among professionals, administrators, educators and the public along with narcotic regulation also add to the list of barriers [9] . At the same time they also come with the unique strength associated with an intact family structure and values and spiritual lifestyle [13][14]. Because of the uniqueness of the ethical dilemmas and issues of the region it is difficult to explain them with the western model of palliative care ethics.…”