Logie Dorothy Elizabeth, Harding Richard
BMJ Support Palliat Care. 2012 Sep;2(3):264-9. doi: 10.1136/bmjspcare-2012-000232.
The provision of palliative and end-of-life care for patients with progressive disease is inadequate worldwide. The WHO strategy to develop a public health system of palliative care at the national level proposes a quadripartite approach: policy, education, drug availability and implementation. This is particularly necessary in low income countries facing a high disease burden with low resources. To date there have been no published evaluations of advocacy strategies aiming to use the WHO approach to enhance access to palliative care.
To evaluate the Palliative Care Initiative which implements the WHO approach to strategically improve palliative care throughout Zambia, using a multiple methods rapid field evaluation.
Eight hospices and palliative care organisations in Zambia were part-funded over 2 years (2009-11) and were thus able to expand their services, offer a reliable supply of drugs, secure fuel for transport, and support home carers. Simultaneously, an extensive programme of rural and urban training resulted in staff being more confident in caring for the dying with improved attitudes to the concerns of very ill patients and their families. A multi-agency morphine pilot project led by the Palliative Care Association of Zambia and the Ministry of Health resolved some of the obstacles and increased morphine availability although its use remains low. Palliative care is now being considered by the technical working group at the Ministry of Health.
For palliative care to thrive in any resource-poor country it must be integrated into the public health system and secure long-term funding.
在全球范围内，为患有进展性疾病的患者提供姑息治疗和临终关怀服务的情况并不理想。世界卫生组织提出在国家层面建立姑息治疗公共卫生系统的战略，采用四方途径：政策、教育、药物供应和实施。这对于面临高疾病负担且资源匮乏的低收入国家尤为必要。迄今为止，尚未有关于旨在利用世界卫生组织方法来增加姑息治疗可及性的宣传战略的公开评估。
采用多种方法进行快速实地评估，以评价实施世界卫生组织方法在赞比亚战略性改善姑息治疗的姑息治疗倡议。
赞比亚的八家临终关怀和姑息治疗组织在两年（2009 - 2011年）间获得了部分资金，从而得以扩大服务，提供可靠的药物供应，确保运输燃料，并支持家庭护理人员。同时，广泛的城乡培训计划使工作人员在照顾临终患者方面更有信心，对重病患者及其家属的关切态度有所改善。由赞比亚姑息治疗协会和卫生部牵头的多机构吗啡试点项目解决了一些障碍并增加了吗啡的可及性，尽管其使用率仍然较低。赞比亚卫生部技术工作组目前正在考虑姑息治疗问题。
姑息治疗要在任何资源匮乏的国家蓬勃发展，就必须融入公共卫生系统并获得长期资金。
