King's College London

TY - JOUR

T1 - An Analysis of Palliative Care Development in Africa: A Ranking based on Region-Specific Macro-Indicators

AU - Rhee, John Y.

AU - Garralda, Eduardo

AU - Namisango, Eve

AU - Luyirika, Emmanuel

AU - de Lima, Liliana

AU - Powell, Richard A.

AU - López-Fidalgo, Jesús

AU - Centeno, Carlos

PY - 2018/5/22

Y1 - 2018/5/22

N2 - Context To date, there is no study comparing palliative care (PC) development among African countries. Objective To analyze comparatively PC development in African countries based on region-specific indicators. Methods Data were obtained from the APCA Atlas of PC in Africa and a comparative analysis conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the WHO public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52/54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator. Results Surveys were received from 89% (48/54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in specialized services were Uganda, South Africa, and Nigeria; in policies, it was Botswana followed by parity among Ethiopia, Rwanda, and Swaziland; in medicines, it was Swaziland, South Africa, then Malawi; in education, it was equivalent between Uganda and Kenya, then Ghana and Zambia. Conclusion Uganda, South Africa, and Kenya are the highest performing countries and were the only ones with composite scores greater than 0.5 (50%). However, not one country universally supersedes all others across all four PC dimensions. The breakdown of rankings by dimension highlights where even high-performing African countries can focus their efforts to further PC development.

AB - Context To date, there is no study comparing palliative care (PC) development among African countries. Objective To analyze comparatively PC development in African countries based on region-specific indicators. Methods Data were obtained from the APCA Atlas of PC in Africa and a comparative analysis conducted. Nineteen indicators were developed and defined through qualitative interviews with African PC experts and a two-round modified Delphi consensus process with international experts on global PC indicators. Indicators were grouped by the WHO public health strategy for PC dimensions. These indicators were then sent as a survey to key informants in 52/54 African countries. Through an expert weighting process and ratings from the modified Delphi, weights were assigned to each indicator. Results Surveys were received from 89% (48/54) of African countries. The top three countries in overall PC development were, in order, Uganda, South Africa, and Kenya. Variability existed by dimension. The top three countries in specialized services were Uganda, South Africa, and Nigeria; in policies, it was Botswana followed by parity among Ethiopia, Rwanda, and Swaziland; in medicines, it was Swaziland, South Africa, then Malawi; in education, it was equivalent between Uganda and Kenya, then Ghana and Zambia. Conclusion Uganda, South Africa, and Kenya are the highest performing countries and were the only ones with composite scores greater than 0.5 (50%). However, not one country universally supersedes all others across all four PC dimensions. The breakdown of rankings by dimension highlights where even high-performing African countries can focus their efforts to further PC development.

KW - palliative care development

KW - Africa

KW - atlas

KW - public health

KW - ranking

U2 - 10.1016/j.jpainsymman.2018.05.005

DO - 10.1016/j.jpainsymman.2018.05.005

M3 - Article

JO - Journal of Pain and Symptom Management

JF - Journal of Pain and Symptom Management

SN - 0885-3924

ER -