The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 19: Palliative Care in Resource-Poor SettingsNational palliative care policies and programs do not need to be specific to HIV/AIDS; they canaddress the needs of patients with any serious life-threatening illness, such as AIDS, cancer,congestive heart failure, neuro-degenerative disorders, and cerebrovascular disease. In fact,generic26palliativepicascare programs can allow for the coordination of a variety of policy agendas andmay help reduce stigma associated with AIDS care. A strategic national program for palliativecare offers the most rational and effective means of improving the quality of life for the greatest13, 14number of patients and families, even where resources are severely limited.STEP 1:GOVERNMENTAL POLICYAdoption of a National Palliative Care PolicyEstablishment of a national policy for palliative care is the best way to ensure quality standards,funding, and accessibility of adequate care for the greatest number of patients and families.A national policy serves as the official recognition of a commitment of financial support; itcan play a major role in facilitating the availability of essential drugs, as well as the necessaryeducational initiatives for healthcare professionals and the public alike, as part of its mandate.Numerous governments have already adopted a national palliative care policy, including Australia,Canada, Spain, Uganda and the United Kingdom. 4A national policy should set priorities that address access to palliative care across all healthcaresettings, including hospitals, clinics, and home-based care. Palliative care needs to be availablein both urban centers and rural areas as an integral part of the essential primary healthcareservices that people can expect. These palliative care services should be sustainable and supportedby healthcare professionals. Government budgets should appropriately address the needfor essential drugs and provide medications and services ranging from durable medical goods tocounseling programs.A number of resources exist to aid the development of a national health policy. WHO’s NationalCancer Control Programs: Policies and Managerial Guidelines can be used as a model for thedevelopment of specific policies, as well as national palliative care and/or AIDS programs ingeneral. 15To integrate palliative care into a national healthcare policy, governments should ensure that: 18• Palliative care programs are incorporated into their existing healthcare systems• Healthcare workers are adequately trained in palliative care and the relief of HIV/AIDS-related pain• National health policies are revised so that equitable support is provided for programsincluding home-based palliative care• Hospitals are able to offer appropriate back-up and support for home-based care• Both opioid and nonopioid analgesics, particularly morphine for oral administration,are availableEstablishment of a national program, in which national healthcare policy is situated, may includethe following activities: 15• Identification and consideration of the capacities of existing healthcare systems392U.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau