Pain, Palliative Care

“A Silk Purse from a Sow’s Ear?” The 2011 WPCA Global Palliative Care Report Card

This World Hospice and Palliative Day, Oct 8th, 20011, the World Palliative Care Alliance (@thewpca) released a new report, Mapping Levels of Palliative Care Development: A Global Update 2011. Commendations to the principal authors, Tom Lynch, David Clark and Stephen Connor who make comparisons with a previous 2006 report.

They analyze, using a method that they indicate is limited, the current state of palliative care in each country. They point out that a major limitation is that the majority of the data coming from “key persons” in each country and they even highlight where there may be bias of inaccuracy. But some of the key findings of the report.

  • 42% of the world’s countries have no palliative care services.
  • 20 countries have climbed from “no known activity/capacity building” to some form of palliative care (Africa 9, Middle East 5 and the Americas 3).
  • African countries moved (Kenya, South Africa, Tanzania, Zambia and Zimbawe are classified as having “preliminary integration” with Ugands having “Advanced Integration.”

So a lot to be celebrate, but celebrate with caution (hence the sow’s ear!” Progress is being made but is this a true measure.

It is interesting to watch countries such as the UK really question how well they are doing in terms of the provision of palliative care.  Do the vast distances required for clinicians to travel in outback Australia prevent them from having “advanced integration?”  And does the lack of health insurance for millions in the US, prevent them from having advanced integration, despite the Hospice Medicare benefit?

And can countries that have very low morphine consumption really talk about integration of  palliative care (accepting that palliative care is not just about morphine). Can countries that are classified by the WHO in the World Health Report 2000, as not having strong health care systems, really be approaching integration?

Appreciate your discussion on this very important report from WPCA.


About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide


One thought on ““A Silk Purse from a Sow’s Ear?” The 2011 WPCA Global Palliative Care Report Card

  1. Thanks Jim, we did try to consider these questions carefully and we do know from the 2006 report that palliative care development is closely related to the Human Development Index generally. Having countries rate themselves using the criteria provided eliminated some of the perceived disparities of the last report but in the end is always subjective. The important thing is to track and report on palliative care development as a means of advocacy since we all know how far we still need to go. Every report like this I’ve ever seen can be criticized for methodology but we need to start somewhere and continue to refine methods as we go forward with the limited data available. Each report will hopefully improve on methods and I do think progress is being made. Thanks to PPSG for help in developing the opioid use data that will come out next Spring when we do the larger “Global Atlas of PC” with WHO, that will also include the mapping report.

    Posted by Stephen Connor | October 10, 2011, 10:34 PM

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