70% of Health Facilities In Uganda Can’t Offer Palliative Care Services

A majority of health facilities accredited to provide palliative care in Uganda are failing to live to the required standards. 

Palliative Care Association of Uganda Chairperson, Mark Donald Mwesiga says 77 out 226 health facilities can ably provide the care needed by patients in critical pain.

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Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with a life-threatening illness. 

It prevents and relieves suffering through the early identification, correct assessment, and treatment of pain and other problems, whether physical, psychosocial, or spiritual.    

Palliative care accredited facilities are supposed to provide six types of services: outreach, home visits, psychosocial, legal, bereavement, and spiritual support, but only for an average of 7 months a year due to lack of facilitation and transportation.    

Palliative care is required for a wide range of diseases. The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases (, cancer, chronic respiratory diseases, AIDS, and diabetes. Many other conditions may require palliative care, including kidney failure, chronic liver disease, and multiple sclerosis among others.

A recent study in Uganda found that more than a third of the patients were diagnosed with non-communicable diseases, highlighting their significance alongside cancer and HIV/AIDS as conditions requiring palliative care. 

Mwesiga and other Ugandan researchers in April this year published findings from the quantitative descriptive study of key palliative care indicators 2018-2020. 

The study whose findings have been published in BMC Palliative Care journal provides an overview of the availability of palliative care services in the country and the challenges and gaps in Uganda prior to the global COVID-19 pandemic.      

According to the study, there were 226 accredited palliative care facilities across Uganda’s 135 districts in 2020.Thirty districts lacked any accredited palliative care facility. The study found that almost a third of the districts in Elgon, a sub-region in Eastern Uganda, had no palliative care facilities.

Districts with the most palliative care services were Kampala ,  Wakiso, Tororo , Jinja, Kabarole, Masaka, Mbarara, Ntungamo and Rukungiri each had five accredited facilities.

It found that the majority (68.1%) of accredited facilities were public, and private facilities received slightly more pain-relieving morphine.        

The Ministry of Health is supposed to accredit facilities that offer oral liquid morphine, a drug that Uganda innovated to manage pain in patients.

Morphine is however a restricted drug due to the risk of abuse, and addiction. It can also cause fatal breathing problems if not properly prescribed.      

Palliative care Service providers have in the past complained about the restrictions and rigorous process of ordering morphine from National Medical Stores and Joint Medical Stores. 

The Director of Clinical Health Services,  Dr. Charles Olaro told URN in an interview that the stocking of facilities is based on what they demand.

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He however acknowledges that the palliative care service coverage is not equitable as some areas have a big concentration of health facilities accredited than others. Olaro said that the ministry will soon start alignment access to ensure access for all.

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The World Health Organisation has issued guidelines for countries to follow to put in place an essential palliative care package but Uganda still doesn’t have a guiding national policy despite starting this process over ten years ago.

The lack of policy according to Mwesiga affects how quickly access can be enabled everywhere in the country.  

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