A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa

Oladayo Afolabi; Anna Peeler; Kennedy Nkhoma; Catherine Evans; Mary Abboah-Offei; Eve Namisango; Adwoa Bemah Boamah Mensah; Jane Bates; Dorothee van Breevoort; Duncan Kwaitana; Modai Mnenula; Edwina Addo Opare-Lokko; Dickson Chifamba; Lovemore Mupaza; Lindsay Farrant; Joy Hunter; Richard Harding

doi:10.1016/j.jpainsymman.2025.03.018

A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa

Oladayo Afolabi, Anna Peeler, Kennedy Nkhoma, Catherine Evans, Mary Abboah-Offei, Eve Namisango, Adwoa Bemah Boamah Mensah, Jane Bates, Dorothee van Breevoort, Duncan Kwaitana, Modai Mnenula, Edwina Addo Opare-Lokko, Dickson Chifamba, Lovemore Mupaza, Lindsay Farrant, Joy Hunter, Richard Harding

Research output: Contribution to journal › Article › peer-review

Abstract

Context: The number of people needing palliative care is rapidly increasing in sub-Saharan Africa (SSA). Healthcare systems in SSA are heterogenous, so broadly defining and operationalizing primary palliative care is a major obstacle to achieving Universal Health Coverage. We aimed to conceptualize and operationalize primary palliative care in SSA by developing an evidence-based logic model and consensus definition. Methods: We purposively sampled expert participants in a workshop in Harare, Zimbabwe. They collaboratively developed a logic model using the Centers for Disease Control and Prevention's guide for developing and using logic models and a consensus definition using modified nominal group technique. Results: Twenty-four primary palliative care experts comprised of researchers (70.1%), physicians (37.5%) and nurses (29.2%) from 8 countries (7 in SSA) participated. Twenty (83.3%) participants fell into multiple role categories. Primary palliative care essential resources (i.e., medications, funding, health workers), activities (i.e., clinical guidelines and referral pathway development, education), outputs (i.e., care pathways, cost-benefit ratios), and outcomes (i.e., improved quality of life, skilled primary palliative care workforce, reduced health-related suffering) relevant for countries in SSA were identified. To define primary palliative care in SSA, participants identified and ranked crucial components, including holistic care (provided by health workers with role-appropriate training), culturally congruent delivery of care, and accessibility at the entry point of healthcare systems. The definition highlights that “primary” pertains to how people access care, rather than who or where it is provided. Conclusion: The identified essential components of primary palliative care address the region's specific context, challenges and strengths. Training the existing primary healthcare workforce in palliative care and providing necessary support and resources must be prioritized in order to improve outcomes in SSA.

Original language	English
Pages (from-to)	106-114
Number of pages	9
Journal	Journal of pain and symptom management
Volume	70
Issue number	1
DOIs	https://doi.org/10.1016/j.jpainsymman.2025.03.018
Publication status	E-pub ahead of print - 25 Mar 2025

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Afolabi, O., Peeler, A., Nkhoma, K., Evans, C., Abboah-Offei, M., Namisango, E., Mensah, A. B. B., Bates, J., van Breevoort, D., Kwaitana, D., Mnenula, M., Opare-Lokko, E. A., Chifamba, D., Mupaza, L., Farrant, L., Hunter, J., & Harding, R. (2025). A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa. Journal of pain and symptom management, 70(1), 106-114. Advance online publication. https://doi.org/10.1016/j.jpainsymman.2025.03.018

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title = "A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa",

abstract = "Context: The number of people needing palliative care is rapidly increasing in sub-Saharan Africa (SSA). Healthcare systems in SSA are heterogenous, so broadly defining and operationalizing primary palliative care is a major obstacle to achieving Universal Health Coverage. We aimed to conceptualize and operationalize primary palliative care in SSA by developing an evidence-based logic model and consensus definition. Methods: We purposively sampled expert participants in a workshop in Harare, Zimbabwe. They collaboratively developed a logic model using the Centers for Disease Control and Prevention's guide for developing and using logic models and a consensus definition using modified nominal group technique. Results: Twenty-four primary palliative care experts comprised of researchers (70.1%), physicians (37.5%) and nurses (29.2%) from 8 countries (7 in SSA) participated. Twenty (83.3%) participants fell into multiple role categories. Primary palliative care essential resources (i.e., medications, funding, health workers), activities (i.e., clinical guidelines and referral pathway development, education), outputs (i.e., care pathways, cost-benefit ratios), and outcomes (i.e., improved quality of life, skilled primary palliative care workforce, reduced health-related suffering) relevant for countries in SSA were identified. To define primary palliative care in SSA, participants identified and ranked crucial components, including holistic care (provided by health workers with role-appropriate training), culturally congruent delivery of care, and accessibility at the entry point of healthcare systems. The definition highlights that “primary” pertains to how people access care, rather than who or where it is provided. Conclusion: The identified essential components of primary palliative care address the region's specific context, challenges and strengths. Training the existing primary healthcare workforce in palliative care and providing necessary support and resources must be prioritized in order to improve outcomes in SSA.",

author = "Oladayo Afolabi and Anna Peeler and Kennedy Nkhoma and Catherine Evans and Mary Abboah-Offei and Eve Namisango and Mensah, {Adwoa Bemah Boamah} and Jane Bates and {van Breevoort}, Dorothee and Duncan Kwaitana and Modai Mnenula and Opare-Lokko, {Edwina Addo} and Dickson Chifamba and Lovemore Mupaza and Lindsay Farrant and Joy Hunter and Richard Harding",

note = "Copyright {\textcopyright} 2025. Published by Elsevier Inc.",

year = "2025",

month = mar,

day = "25",

doi = "10.1016/j.jpainsymman.2025.03.018",

language = "English",

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Afolabi, O , Peeler, A , Nkhoma, K , Evans, C, Abboah-Offei, M, Namisango, E, Mensah, ABB, Bates, J, van Breevoort, D, Kwaitana, D, Mnenula, M, Opare-Lokko, EA, Chifamba, D, Mupaza, L, Farrant, L, Hunter, J & Harding, R 2025, 'A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa', Journal of pain and symptom management, vol. 70, no. 1, pp. 106-114. https://doi.org/10.1016/j.jpainsymman.2025.03.018

TY - JOUR

T1 - A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa

AU - Afolabi, Oladayo

AU - Peeler, Anna

AU - Nkhoma, Kennedy

AU - Evans, Catherine

AU - Abboah-Offei, Mary

AU - Namisango, Eve

AU - Mensah, Adwoa Bemah Boamah

AU - Bates, Jane

AU - van Breevoort, Dorothee

AU - Kwaitana, Duncan

AU - Mnenula, Modai

AU - Opare-Lokko, Edwina Addo

AU - Chifamba, Dickson

AU - Mupaza, Lovemore

AU - Farrant, Lindsay

AU - Hunter, Joy

AU - Harding, Richard

PY - 2025/3/25

Y1 - 2025/3/25

N2 - Context: The number of people needing palliative care is rapidly increasing in sub-Saharan Africa (SSA). Healthcare systems in SSA are heterogenous, so broadly defining and operationalizing primary palliative care is a major obstacle to achieving Universal Health Coverage. We aimed to conceptualize and operationalize primary palliative care in SSA by developing an evidence-based logic model and consensus definition. Methods: We purposively sampled expert participants in a workshop in Harare, Zimbabwe. They collaboratively developed a logic model using the Centers for Disease Control and Prevention's guide for developing and using logic models and a consensus definition using modified nominal group technique. Results: Twenty-four primary palliative care experts comprised of researchers (70.1%), physicians (37.5%) and nurses (29.2%) from 8 countries (7 in SSA) participated. Twenty (83.3%) participants fell into multiple role categories. Primary palliative care essential resources (i.e., medications, funding, health workers), activities (i.e., clinical guidelines and referral pathway development, education), outputs (i.e., care pathways, cost-benefit ratios), and outcomes (i.e., improved quality of life, skilled primary palliative care workforce, reduced health-related suffering) relevant for countries in SSA were identified. To define primary palliative care in SSA, participants identified and ranked crucial components, including holistic care (provided by health workers with role-appropriate training), culturally congruent delivery of care, and accessibility at the entry point of healthcare systems. The definition highlights that “primary” pertains to how people access care, rather than who or where it is provided. Conclusion: The identified essential components of primary palliative care address the region's specific context, challenges and strengths. Training the existing primary healthcare workforce in palliative care and providing necessary support and resources must be prioritized in order to improve outcomes in SSA.

AB - Context: The number of people needing palliative care is rapidly increasing in sub-Saharan Africa (SSA). Healthcare systems in SSA are heterogenous, so broadly defining and operationalizing primary palliative care is a major obstacle to achieving Universal Health Coverage. We aimed to conceptualize and operationalize primary palliative care in SSA by developing an evidence-based logic model and consensus definition. Methods: We purposively sampled expert participants in a workshop in Harare, Zimbabwe. They collaboratively developed a logic model using the Centers for Disease Control and Prevention's guide for developing and using logic models and a consensus definition using modified nominal group technique. Results: Twenty-four primary palliative care experts comprised of researchers (70.1%), physicians (37.5%) and nurses (29.2%) from 8 countries (7 in SSA) participated. Twenty (83.3%) participants fell into multiple role categories. Primary palliative care essential resources (i.e., medications, funding, health workers), activities (i.e., clinical guidelines and referral pathway development, education), outputs (i.e., care pathways, cost-benefit ratios), and outcomes (i.e., improved quality of life, skilled primary palliative care workforce, reduced health-related suffering) relevant for countries in SSA were identified. To define primary palliative care in SSA, participants identified and ranked crucial components, including holistic care (provided by health workers with role-appropriate training), culturally congruent delivery of care, and accessibility at the entry point of healthcare systems. The definition highlights that “primary” pertains to how people access care, rather than who or where it is provided. Conclusion: The identified essential components of primary palliative care address the region's specific context, challenges and strengths. Training the existing primary healthcare workforce in palliative care and providing necessary support and resources must be prioritized in order to improve outcomes in SSA.

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JO - Journal of pain and symptom management

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A logic model and multinational consensus definition of primary palliative care in sub-Saharan Africa

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