Palliative Care in Rwanda: Aiming for Universal Access

Krakauer, Eric L.; Muhimpundu, M.A.; Mukasahaha, Diane; Tayari, Jean-Claude K; Ntizimira, Christian; Uhagaze, Blaise; Mugwaneza, Théodosie; Ruzima, Aimable; Mpanumusingo, Egide; Gasana, Magnus; Karamuka, Vincent; Nkurikiyimfura, Jean-Luc; Park, Paul; Barebwanuwe, Peter; Tapela, Neo; Elmore, Shekinah N.C.; Bukhman, Gene; Leng, Mhoira; Grant, Liz; Binagwaho, Agnès; Sezibera, Richard

doi:10.1016/j.jpainsymman.2017.03.037

Cited by 15 publications

(31 citation statements)

References 7 publications

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“…Despite the progress made with the development of palliative care policy and community-based services, 41 health care providers still consider palliative care as a fifth wheel in cancer care. Patients are primarily referred for terminal care, and there is still fear of prescribing opioids, which is why there is still a low level of opioid use in Rwanda.…”

Section: Cancer Diagnostics Treatment and Palliative Carementioning

confidence: 99%

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

Rubagumya

Costas‐Chavarri

Manirakiza

et al. 2020

JCO Global Oncology

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Rwanda is a densely populated low-income country in East Africa. Previously considered a failed state after the genocide against the Tutsi in 1994, Rwanda has seen remarkable growth over the past 2 decades. Health care in Rwanda is predominantly delivered through public hospitals and is emerging in the private sector. More than 80% of patients are covered by community-based health insurance (Mutuelle de Santé). The cancer unit at the Rwanda Biomedical Center (a branch of the Ministry of Health) is responsible for setting and implementing cancer care policy. Rwanda has made progress with human papillomavirus (HPV) and hepatitis B vaccination. Recently, the cancer unit at the Rwanda Biomedical Center launched the country’s 5-year National Cancer Control Plan. Over the past decade, patients with cancer have been able to receive chemotherapy at Butaro Cancer Center, and recently, the Rwanda Cancer Center was launched with 2 linear accelerator radiotherapy machines, which greatly reduced the number of referrals for treatment abroad. Palliative care services are increasing in Rwanda. A cancer registry has now been strengthened, and more clinicians are becoming active in cancer research. Despite these advances, there is still substantial work to be done and there are many outstanding challenges, including the need to build capacity in cancer awareness among the general population (and shift toward earlier diagnosis), cancer care workforce (more in-country training programs are needed), and research.

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Section: Cancer Diagnostics Treatment and Palliative Carementioning

confidence: 99%

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

Rubagumya

Costas‐Chavarri

Manirakiza

et al. 2020

JCO Global Oncology

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“…In addition, multiple other terms were used to refer to what we have framed as ‘integration of PC within a health system’—such as ‘joining’, ‘inclusion’, ‘incorporation’, ‘implementation’ or ‘embedding’. Interventions aimed to ‘connect and relate with palliative care’ ( Downing et al , 2015 , p. 367), ‘link’ or create ‘linkages’ with PC services or ‘coordinate’ PC services ( DesRosiers et al , 2014 ; Grover et al , 2017 ; Krakauer et al , 2018 ). The terms ‘development’ and ‘integration’ were often used interchangeably—usually referring to newly mandated provision of PC by a public health service—sometimes where there was no previous PC service at all, and sometimes as a shifted accountability from a different part of the health system [e.g.…”

Section: Resultsmentioning

confidence: 99%

“…Six articles described interventions targeting the whole population on a national scale ( Stjernsward, 2002 ; Freeman et al , 2016 ; Grant et al , 2017 ; Kamonyo, 2018 ; Krakauer et al , 2018 ). Notably, three of these interventions were in Uganda, where PC is said to be the most integrated in Africa ( Lynch et al , 2013 ).…”

Section: Resultsmentioning

confidence: 99%

Approaches to integrating palliative care into African health systems: a qualitative systematic review

Court

Olivier

2020

Health Policy and Planning

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Africa is characterized by a high burden of disease and health system deficits, with an overwhelming and increasing demand for palliative care (PC). Yet only one African country is currently considered to have advanced integration of palliative care into medical services and generalized PC is said to be available in only a handful of others. The integration of PC into all levels of a health system has been called for to increase access to PC and to strengthen health systems. Contextually appropriate evidence to guide integration is vital yet limited. This qualitative systematic review analyses interventions to integrate PC into African health systems to provide insight into the ‘how’ of PC integration. Forty articles were identified, describing 51 different interventions. This study found that a variety of integration models are being applied, with limited best practices being evaluated and repeated in other contexts. Interventions typically focused on integrating specialized PC services into individual or multiple health facilities, with only a few examples of PC integrated at a population level. Four identified issues could either promote integration (by being present) or block integration (by their absence). These include the provision of PC at all levels of the health system alongside curative care; the development and presence of sustainable partnerships; health systems and workers that can support integration; and lastly, placing the client, their family and community at the centre of integration. These echo the broader literature on integration of health services generally. There is currently a strong suggestion that the integration of PC contributes to health system strengthening; however, this is not well evidenced in the literature and future interventions would benefit from placing health systems strengthening at the forefront, as well as situating their work within the context of integration of health services more generally.

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“…These are largely run by charitable organizations, such as Hospice Africa Uganda, founded in Kampala in 1993 and Pallium India founded in Kerala in 2003 (34,35). Recently, national governments have begun to integrate existing palliative care efforts into the public health system (36)(37)(38). Palliative care and hospice organizations in low-resource regional settings have created palliative care networks, including the African Palliative Care Association (APCA) founded in 2002 and the Indian Palliative Care Association (IPCA) founded in 1994 (35,39).…”

Section: Palliative Infrastructure and Recent Developmentsmentioning

confidence: 99%

“…Within palliative care, there already exist several models for home-based care by health professionals or trained, lay providers. Hospice Africa Uganda, Pallium India, and the national palliative care programs referenced earlier provide a percent of their services to patients at home (36)(37)(38). CanSupport, a non-governmental organization in Delhi, provides home-based palliative care with multidisciplinary teams including physicians, nurses, and social workers (52).…”

Section: Staffingmentioning

confidence: 99%

Global palliative radiotherapy: a framework to improve access in resource-constrained settings

Elmore¹,

Grover²,

Bourque³

et al. 2019

Ann. Palliat. Med.

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Radiotherapy is an essential component of cancer therapy. Lack of access to radiotherapy in lessdeveloped countries prevents its use for both cure and symptom relief, resulting in a significant disparity in patient suffering. Several recent initiatives have highlighted the need for expanded access to both palliative medicine and radiotherapy globally. Yet, these efforts have remained largely independent, without attention to overlap and integration. This review provides an update on the progress toward global palliative radiotherapy access and proposes a strategic framework to address further scale-up. Synergies between radiotherapy, palliative medicine, and other global health initiatives will be essential in bringing palliative radiotherapy to patients around the globe.

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Palliative Care in Rwanda: Aiming for Universal Access

Cited by 15 publications

References 7 publications

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

Approaches to integrating palliative care into African health systems: a qualitative systematic review

Global palliative radiotherapy: a framework to improve access in resource-constrained settings

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