Palliative care intervention on the basis of need not diagnosis/prognosis should be achieved wherever possible. Models of care that take account of pain, other symptoms and psychological/social problems among patients and families are being developed. This is particularly true in heart failure and HIV patients, who access treatment during an unpredictable disease trajectory that mirrors a chronic rather than rapidly progressive terminal condition. Families and friends also suffer difficulties as patients move towards the end of life and we have been developing and testing a complex intervention for this population. The HIV epidemic and rising cancer incidence in Africa have necessitated a growing palliative care movement. We have strong research partnerships with academic and clincial institutions in Africa where we have undertaken pain and symptom research as well as the development and validation of an outcome scale (APCA African POS). This has led directly to a 5-centre full clinical audit cycle in Africa, and to a multi-centre evaluation in East Africa.