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 Settings• Consultation with non-governmental organizations (NGOs)• Inclusion of steps to ensure community involvement26 picas• Recruitment of leaders• Reviewing the role of existing organizations• Identification of resources• Development of a communication strategy• Preparation of a draft national plan• Drawing up a budget for palliative care• Organization of a national conference• Changing legislation if needed• Launching the program with workshopsThe functions of an established national program to provide palliative care are to: 15• Recommend legislative action• Recommend priorities for the investment of additional resources• Encourage the systematic development and coordination of specific palliative careactivities to ensure the best use of available resources for the whole population• Forecast future trends and coordinate the strategic development of health services,health systems such as quality assurance systems, and training and supply of healthprofessionals• Develop and support palliative care programs for smaller populations for jurisdictionswithin the area it covers• Coordinate the work of all agencies that can contribute to palliative care in the areaUNAIDS has developed a four-guide series for the strategic planning process for a national responseto HIV/AIDS, including situation analysis, response analysis, strategic plan formulation,and resource mobilization. 16 The Canadian Palliative Care Association’s consensus documenton Standardized Principles and Practice of Palliative Care presents guidelines for nationalcommittees to follow in developing palliative care standards; it is a clear framework for thisprocess, with sample goals, objectives, essential steps, accompanying policies and procedures,and desirable outcomes (see also http://www.cpca.net). 17XIXIntegrated Community- and Home-based Care PolicyIn order to make services sustainable, the national policy should allocate resources to homebasedcare as well as to in-patient palliative care services and outpatient clinic services. Successfulnational HIV/AIDS palliative care programs that focus attention on integrated community- andhome-based care are seen as the most efficient and cost-effective approach to healthcare delivery.Throughout Africa, model programs are demonstrating the beneficial integration of hospice,community- and home-based care for people with HIV/AIDS. 18 For example, the South CoastHospice in KwaZulu-Natal, South Africa, developed an integrated care program in which patientswith HIV/AIDS are referred to teams of nurses and trained community caregivers whocare for them in their own homes. 19 The program has halved average patient stays at the localhospital, and extended care provided at home costs less than a 2-day stay in the hospital. 20 TheU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 393