Transcript Advancing Palliative Care Globally

Improving Palliative Care at a
Global Level
Kathleen M. Foley, MD
Patient Advocacy Meeting
Budapest
June 29-30,2009
2002 WHO Definition of
Palliative Care
"Palliative care is an approach which
improves quality of life of patients and their
families facing life-threatening illness,
through the prevention and relief of
suffering by means of early identification
and impeccable assessment and treatment of
pain and other problems, physical,
psychosocial and spiritual"
Palliative Care as a Public
Health Issue
affects all people
 need for better information on endof-life care
 potential to prevent suffering
 potential to prevent disease
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Palliative Care as a
Prevention Model
 prevents
needless suffering
 provides peer education
 provides patient centered care
 incorporates self-management
programs
The continuum of palliative
care
Life
Closure
Therapies to modify disease
(curative, restorative intent)
Diagnosis
6m
Therapies to relieve suffering,
improve quality of life
Actively
Dying
Death
Bereavement
Care
WHO Public Health Model
Policy
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Drug
Availability
Education
Implementation
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WHO Public Health Model
Policy
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Drug
Availabilit
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Education
Implementation
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WHO Public Health Model
Policy
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Consumption of Morphine in Europe
mg/capita, 2001
Mg/capita
70
60
50
40
30
Global mean
5.4 mg/capita
20
Source: International Narcotics Control Board; United Nations Demographic Yearbook
By: Pain & Policy Studies Group, University of Wisconsin/WHO Collaborating Center, 2004
Ukraine
1.3 mg/capita
10
0
160
2006 Global Consumption
of Morphine
Global mean, 5.9847 mg
COUNTRY
Mg/capita
Albania
0.4644
Armenia
0.8187
Georgia
1.8200
Hungary
2.1643
Moldova
1.0331
Romania
0.0837
Serbia
0.1339
Ukraine
1.7845
140
120
100
80
60
Moldova
Hungary
40
Serbia
Armenia
Georgia
Albania
Ukraine
20
0
154 Countries
Sources: International Narcotics Control
Board; United Nations population data
By: Pain & Policy Studies Group, University of
Wisconsin/WHO Collaborating Center, 2008
Romania
EURO Consumption of Morphine, 2006
EURO mean, 12.5917 mg
Global mean, 5.9847 mg
180
160
COUNTRY
140
120
100
80
Armenia
60
Georgia
40
Hungary
0
Sources: International Narcotics Control
Board; United Nations population data By:
Pain & Policy Studies Group, University of
Wisconsin/WHO Collaborating Center, 2008
Albania
0.4644
Armenia
0.8187
Georgia
1.8200
Hungary
2.1643
Moldova
1.0331
Romania
0.0837
Serbia
0.1339
Ukraine
1.7845
Serbia
Ukraine
Albania
Moldova
20
Mg/capita
Romania
World Health Assembly
Cancer Prevention and Control 58.22
25 May 2005
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Urges member states to ensure the medical
availability of opioid analgesics
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Requests the WHO Director General
(1) to explore mechanisms for funding cancer
prevention, control and palliative-care,
especially in developing countries.
(2) to examine with the International Narcotics
Control Board how to facilitate the adequate
treatment of pain using opioid analgesics.
INCB
Annual Report for 2004
March 2005
“In view of the continued inadequate global
consumption of opiates for the treatment of
pain, the Board reiterates that it would
welcome a further increase in global demand
for opiates. The Board encourages
Governments to take steps to increase the
medical use of opiates in their countries in
order to meet their real needs for the treatment
of pain.”
WHO Access to Essential
Medicines Program
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Created an office for controlled substances
as essential medicines
Appointed Willem Scholten as program
director
To develop a strategic plan with NGO
partnerships
WHO Access to Essential
Medicines Program
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To focus on low and medium
resource countries
To support pain and palliative care as
a human right
Publications on International
Palliative Care Issues
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Journal of Pain and Symptom Management
Volume 33 ,Number 5 May, 2007:
Advancing Palliative Care: The Public
Health Perspective
Health Economics and Palliative care; What
We Know and What We Need to Know. In
press, 2008
World Cancer Declaration 2008
Outlines the critical steps needed to build the
basis for sustainable delivery of effective
cancer prevention, early detection, treatment
and palliative care worldwide
World Cancer Summit, Geneva,2008
World Cancer Declaration 2008
Based on:
Article 25 of the Universal Declaration of
Human Rights declares that “everyone has
the right to a standard of living, adequate
for health and well being for himself and his
family, including medical care.”
2020 Goals
7.
many more cancer patients in pain will have
access to effective pain control measures
Intermediate Targets
7. the number of cancer patients with access to
appropriate treatment, rehabilitation and palliative care
in adequately equipped treatment facilities
9. the number of cancer patients in pain worldwide
that have access to effective pain control
30
Strategies for the advancement
of Palliative Care as a Human
Right
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Submission to the committee ICESCR
Submission to the office of the Special Rapporteur to the
UN Human Rights Commission on the right to health
Promotion of an International Convention on Pain
Encourage human rights organizations to become involved
in advocacy for palliative care
Use current declarations (Cape Town, Korea, Budapest) as
advocacy tools with your government
www.equalpartners.inf
o
“Please , do not make us suffer
anymore…….”
Access to Pain Treatment as a Human Right
In this 47-page report Human Rights Watch said that countries could significantly
improve access to pain medications by addressing the causes of their poor availability.
These often include the failure to put in place functioning supply and distribution
systems; absence of government policies to ensure their availability; insufficient
instruction for healthcare workers; excessively strict drug-control regulations; and fear
of legal sanctions among healthcare workers.
http://www.hrw.org/en/reports/2009/03/02/please-do-not-make-us-suffer-any-more
Promoting Hospice & Palliative Care Worldwide
IAHPC 2006
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Developed essential drug list for palliative
care
Drafted WHO monograph on palliative
care
Sponsors international faculty scholars
award
Sponsored 2006 Venice Declaration o the
need for research in palliative care.
Joint Declaration and Statement of
Commitment: Palliative Care and Pain
Treatment as Human Rights
Project coordinated by the IAHPC and
WPCA sign on at www.hospicecare.com
IAHPC List of Essential
Medicines
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34 medications are listed
14 medications currently on the
existing WHO Essential List
IAHPC List of Essential
Medicines
Global Access to Pain Relief
Initiative
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Supported by International Union
Against Cancer (UICC)
-global advocacy initiative
-raise awareness for policy change
-focus on cancer patients
2006 International Pain Policy Fellowship
Dr. Simbo Daisy
Amanor-Boadu
Dr. Henry
Ddungu
Prof. Snežana Bošnjak
Dr. Jorge
Eisenchlas
Nigeria
Serbia
Prof. Rosa Buitrago
Republic of Panama
Mrs. Nguyen Thi
Phuong Cham
Vietnam
Pain & Policy Studies Group
University of Wisconsin
October, 2006 Madison, Wisconsin
Uganda
Argentina
Dr. Marta
Ximena León
Colombia
Mr. Gabriel
Madiye
Sierra Leone
Supported by the
Open Society Institute
IOELC Aims
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To provide research-based information on palliative care in the
global context
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To disseminate this information through the Observatory
website and through other means
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To undertake primary research studies to generate such
information
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To support academic work in resource poor regions
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To work in partnership with key organisations and individuals
Grants Funded
Monitoring—Opioid Consumption
The Romania Project
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WHO workshop in Budapest (2002)
(Bulgaria, Croatia, Hungary, Lithuania, Poland, Romania)
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Prescribing severely restricted in Romania
–- Complicated forms and authorizations
– Dose and time limits; no flexibility
– For incurable cancer, not for HIV/AIDS
Many patients die before obtaining morphine
 35 year-old anti-narcotics law and regs
 Ministry of Health appointed a Commission
 New statute sent to Parliament July 2005
 New regulations to be finalized in 2006
WHO Workshop,
Budapest 2002
Change is possible if we work together
Progress in Europe
1. France:
7 days
28 days
2. Italy:
8 days
1 month;
Rx simpl.
3. Germany:
1 day
no limit
4. Poland:
100 mg
4.0 grams
5. Romania:
3 days
30 days
Mongolia Pain Relief &
Palliative Care Initiative
World
Health Organization
Mongolian
Ministry of Health
Mongolian
Palliative Care
Society
Education . . .
2001-5:
2004:
2004:
2005:
400 doctors, 600 nurses sensitized
(MPCS – Odontuya, OSI )
Established regional training center,
regular journal (MPCS – OSI )
Palliative care recognized as medical
discipline (3 months CAQ )
State University of Ulaanbaater adds
palliative care to medical curriculum
Policy
2002:
2004:
2005:
2006-9:
2006+:
Leadership conference - workgroups
Follow-up conference – policies,
Rx rules change – Palliative care
included in national health plan
Standards for palliative care
National Health Policy Develop
guidelines, train professionals,
Establish MD Teams all aimags, districts
Develop National Cancer Control
Policy
Prescribing Opioids
2002: Only oncologists Rx
10 tabs or amps per Rx per 3 days
2005: Any doctor can Rx,
Amount needed for 7 days
Implementation
2000:
2002:
NCC – 10 bed PCU (OSI )
NCC – PCU  to 16 beds ( MOH )
2002-present: 4 hospices in UB
2006:
20 General Oncologist start
community palliative care network
around aimag and district hospitals
( each will have 2-5 PC beds )
The Ocean Road Cancer Institute
Palliative Care Centre, Tanzania
WHO Community Health Approach to
Palliative Care for HIV and Cancer Patients in
Africa
Model Initiative in Providing Palliative Care
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Uganda Ministry of Health included palliative care in
its National Health Sector Strategic Plan
Uganda developed and funded an essential drug
program and changed restrictive laws to allow oral
morphine in home-based settings
Policy Initiative Examples
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Hungarian Experience
– IPCI sponsored Policy Conference resulted in
Hungarian Health Insurance Fund sponsoring
a pilot program to develop six model palliative
care programs
– Palliative care has been included in the
National Cancer Control Program
– The MOH has committed to develop palliative
care services in all regions in the country by
2010
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Not-for-profit, non-governmental organization
Founded 1998 by International Union against Cancer
(UICC) & Institut Pasteur, Brussels
National Cancer Institute (NCI) assists by providing
financial, technical & intellectual support
Located at Institut Pasteur, Brussels
Branches in USA, France, Egypt & Nepal
Offices in UK, Brazil, India & Tanzania
ADVANCING PALLIATIVE CARE
INTERNATIONALLY
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World Health Organization
Geneva - WHO Cancer Unit
Europe – WHO Aging Program
UN AIDS
Global Fund for TB, Malaria & AIDS
PEPFAR
European Union
European Parliament
Council of Europe
ADVANCING PALLIATIVE CARE
INTERNATIONALLY (NGO’s)
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International Association of Hospice and
Palliative Care
Help the Hospices
OSI’s International Palliative Care
Initiative
National Hospice and Palliative Care
Organization
ADVANCING PALLIATIVE CARE
INTERNATIONALLY (NGO’S)
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International Psycho-oncology Society
(IPOS)
European Federation of IASP Chapters
(EFIC)
European Society of Medical Oncology
(ESMO)