Current state of palliative care in Uganda

Abstract

The need for palliative care in Uganda has exponentially increased due to the ageing population, the increased number of non-communicable diseases and the high prevalence of HIV/acquired immune deficiency syndrome (AIDS). The World Health Organisation (WHO) estimates that 1% of the population needs palliative care; therefore, as the current population of Uganda is 40,308,000, an estimated 403,080 people need palliative care. Uganda has made significant progress in palliative care services and research since 1993, when palliative care was introduced. Uganda was the highest-ranking African country and 35th ranking country worldwide in the Quality of Death Index of 2015 out of 80 countries assessed for quality and availability of palliative care services for adult populations in the world. Uganda had the largest number of palliative care services among the countries surveyed in Africa for the recent African Palliative Care Association (APCA) Atlas of 2017. In 2019, 90% of the 112 districts in Uganda had palliative care services. Most palliative care services were developed in the pre-antiretroviral treatment era as a response to the HIV/AIDS epidemic and its complications, including cancer. Most palliative care services offer care mainly for HIV/AIDS and cancer patients, with a few now taking on other illnesses that cause serious health-related suffering. The majority of palliative care services in Uganda are health facility-based. Home-based and community-based services are few and are mainly provided by non-government organisations. The palliative care service matrix for palliative care services in Uganda includes pain and symptom control, social and psychological support, patient and family healthcare education, cancer screening, day care services, food and school education support, provision of antiretroviral therapy, HIV testing, transport assistance and bereavement support. Community and hospital volunteers have played a big role in palliative care in Uganda, which bridge healthcare professionals with the community. This chapter discusses the current state of palliative care services in Uganda. Focus will be on services that offer home-based and community-based palliative care, as most people live in rural areas with little access to health facilities; this is where most people should receive most of their care as the majority of patients prefer to die at home. The five-pillar approach to the integration of palliative care into health systems, as proposed by the World Health Organisation, has been pivotal in the palliative care development in Uganda. Therefore, this chapter will highlight the development and current state of palliative care using these pillars. The challenges faced by palliative care in Uganda will also be discussed.