Palliative care for older people - World Health Organization ...

individuals and their families. Health systems havefour functions: financing (revenue collection, fundpooling and purchasing); resource generation(human resources, technologies and facilities);delivery of personal and population based healthservices; and stewardship (health policy formulation,regulation and intelligence) (5).When the health systems approach is applied topalliative care, issues such as the following shouldbe addressed: how health governance should reactto the challenges and what needs to be done interms of legal requirements for integrating palliativecare into existing health systems settings; how thefunding of health systems can influence optionsto better integrate palliative care and facilitatethe cooperation of health and social services;the human resource implications of integratingpalliative care in terms of education and retrainingof existing professionals and professions or creatingnew job profiles; and the expected effects on theorganization and the provision of services.The WHO health systems approach is a holisticway of providing health care services, and itemphasizes the need to be aware of the context inwhich new services are being introduced: the localhealth care structure (centralized such as in theUnited Kingdom versus horizontally delegated suchas in Germany); health service provision (generalpractitioner gatekeeping versus direct access tospecialists); funding and human resources; culturalsensitivity; and equity. In accordance with thisprinciple, an example of better practice in palliativecare can only be adopted successfully in a systemin which it is introduced as part of a continuumof services. This resonates strongly with the TallinnCharter: Health Systems for Health and Wealth (6),which commits WHO European Member States toimproving people’s health by strengthening healthsystems while acknowledging social, cultural and© Barbara Gomeseconomic diversity across the European Region.To be sustainable, the examples of better palliativecare for older people offered here need to be firmlyintegrated into health care systems. The followingcharacteristics need to be considered whenadopting examples in countries.• The service or intervention needs to be tailoredto national demographic, economic, social,cultural and political factors, taking account ofthe country’s health care system.• The example should be adopted while consideringother services and needs.• The necessary infrastructure may need to beadopted to ensure that examples are transferablefrom one country to others.• These examples should be integrated within ahealth system that provides appropriate,accessible, high-quality, acceptable, culturallysensitive, coherent, consistent and equitableservices to everyone in need.“How people die remains in the memory ofthose who live on.”7