Palliative Care Makes Only Limited Gains in Africa
Icahn School of Medicine at Mount Sinai student leads first comprehensive analysis of African palliative care literature over past 12 years
Palliative care has increased in Africa over the past 12 years but only in a small subset of countries, according to a review published today in Lancet Oncology. This research was led by John Y. Rhee, a fourth-year medical student at the Icahn School of Medicine at Mount Sinai (ISMMS).
Palliative care—defined by the World Health Organization (WHO) as an approach that improves the quality of life of patients and their families facing life-threatening illness through the prevention and relief of suffering with physical, psychosocial and spiritual care—is developing rapidly around the world, but progress varies greatly by region. Only limited data exists on palliative care development in Africa.
To better understand palliative care progress across the African continent, Mr. Rhee and his team conducted a country-specific scoping review of peer-reviewed literature on palliative care development in each African country over the last 12 years, using the WHO definition of palliative care but taking into account the resource constraints of Africa. A scoping review is a preliminary assessment of the potential size and scope of available research literature that aims to identify the nature and extent of research evidence about a particular issue.
“We undertook this project with the hope of providing evidence for palliative care advocates on the ground in Africa,” said Mr. Rhee. “Without benchmarks, it is difficult to measure progress and set goals for the future.”
According to this literature review, palliative care has grown in Africa over the past twelve years but mainly in a small subset of countries (26 countries, 48 percent of African countries). The majority of palliative care services were concentrated in Kenya, South Africa, and Uganda, and 14 (26 percent of African countries) countries experienced a growth in palliative care services. The number of countries with policies and/or guidelines related to palliative care has grown; however, postgraduate educational opportunities in the field remain sparse (only available in Kenya, South Africa, Uganda, and Tanzania).
Opioid consumption and access has remained very low across the continent, which is a barrier to pain management, one of the most important components of palliative care. Information on palliative care is also unevenly distributed, with growth in a subset of African countries but minimal to no identified development in the majority of countries.
“We know that underserved populations are more likely to be diagnosed with late-stage illness and have worse health outcomes,” said Prabhjot Singh, MD, PhD, Director, The Arnhold Institute for Global Health, and Chair, Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai. “Lack of access to quality palliative care leads to increased suffering for vulnerable populations. Globally, we face common challenges in delivering low-cost, high-quality health care at scale. John Rhee’s research identifying gaps in access to palliative care in Africa is essential to addressing structural inequities in care delivery, and building healthier communities.”
The authors suggest that African countries focus on decreasing barriers to opioids and increasing postgraduate educational opportunities, which may lead to increasing the number of trained professionals who may drive service provision and policies. Future research on professional activity and capacity building specific to the African context is also needed.
Using the findings from this scoping review, Mr. Rhee co-created the APCA Atlas of Palliative Care in Africa (APCA Atlas) which was released at the 15th World Congress of the European Association for Palliative Care in Madrid in May 2017. This was the first comprehensive publication on African palliative care to be published in more than 10 years.
This research was funded by TheArnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, the Institute for Culture and Society at the University of Navarra, the International Association for Hospice and Palliative Care, and the African Palliative Care Association.
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The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.