International Association for Hospice and Palliative Care Inc.

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144th session of the Executive Board<br>24 January - 1 February 2019
Agenda Item: 
5.5.2 Community health workers delivering primary health care: opportunities and challenges

Community health workers are key to delivering palliative care in rural and low resource settings, and for frail elders unable to leave their beds and travel to clinics or hospitals. This is confirmed by recent studies from Malawi, California, and Oregon, among others, which are using “up-stream,” community-based palliative care workers to support people with serious illness or chronic diseases before they end up in the hospital,causing greater financial and health harms. In Bangladesh, community health workers – called palliative care assistants (PCAs) –deliver palliative care to patients with chronic or life-threatening illnesses to Rohingyas refugees.The PCAs deliver medications, provide basic nursing care and monitor symptoms.They are supported by a palliative care physician who develops management plans for the patients and trains them to implement these plans. Rwanda has identified community health workers who can deliver palliative care in the villages and rural districts, enabling people to die at home, which is their preferred option. Patients suffer from cancer, HIV, renal failure, heart failure and progressive neurologic disease, Patient consumption of morphine tablets at home is monitored.Before this program, no morphine was available, only paracetamol or ibuprofen prescribed at the health centres or private pharmacies. Now, Rwanda produces its own morphine syrup which is free for patients. it is important to include basic palliative care training for community health workers. They help prevent further health related harm for patients and families and promote family health. Palliative care is not an optional add on but an essential element of the curriculum of community health workers. Our global membership can help member states with training and implementation upon request. I thank you.