Aregay Atsede, O'Connor Margaret, Stow Jill, Ayers Nicola, Lee Susan
Health and Nursing Sciences, University of Agder, Høvågveien 140, Kristiansand, 4604, Norway.
School of Nursing, Mekelle University, Tigray, Ethiopia.
Palliat Care Soc Pract. 2023 Sep 11;17:26323524231198542. doi: 10.1177/26323524231198542. eCollection 2023.
Ethiopia has a national palliative care guideline, and palliative care is explicitly recognised in the country's healthcare policy and health sector transformation plans. However, palliative care is not fully delivered in the regional public hospitals and primary health care units.
This study explores perceived policy barriers to deliver palliative care services in rural and regional healthcare settings, which primary healthcare units largely serve.
Face-to-face interviews were conducted in a rural region of Ethiopia.
Forty-two participants were recruited from a variety of health settings including primary, secondary and tertiary levels across the region. Interviews were conducted with policymakers from the regional health bureau, pharmacists, medical doctors, health officers (clinical officers) and nurses, including chief nursing officers in leadership roles at all levels of healthcare institutions. Data analysed using thematic analysis.
Participants described several barriers related to healthcare policy, including lack of government priority and focus on palliative care; lack of health professionals' awareness of the national palliative care plans and guidelines; and lack of palliative care integration into the existing healthcare system and the national budget. Participants remarked that palliative care services in the region were mainly limited to HIV patients, often managed with external support and, hence unsustainable.
Policy priority and focus is a fundamental component for the provision of palliative care because lack of focus and support from the government have led to inadequate access to palliative care for all in need. Hence, as participants suggested, palliative care should be integrated into all healthcare levels, particularly into the primary health care units and the health extension programme, to facilitate health extension workers to support millions living in rural areas.
埃塞俄比亚有国家姑息治疗指南，姑息治疗在该国的医疗政策和卫生部门转型计划中得到明确认可。然而，区域公立医院和初级卫生保健单位并未充分提供姑息治疗。
本研究探讨了在农村和区域卫生保健环境中提供姑息治疗服务所感知到的政策障碍，而这些环境主要由初级卫生保健单位服务。
在埃塞俄比亚的一个农村地区进行了面对面访谈。
从该地区包括初级、二级和三级等各类卫生机构招募了42名参与者。对区域卫生局的政策制定者、药剂师、医生、卫生官员（临床官员）和护士进行了访谈，其中包括各级医疗机构担任领导职务的首席护理官。使用主题分析法对数据进行分析。
参与者描述了与医疗政策相关的几个障碍，包括政府对姑息治疗缺乏优先重视和关注；卫生专业人员对国家姑息治疗计划和指南缺乏认识；以及姑息治疗未纳入现有的医疗系统和国家预算。参与者指出，该地区的姑息治疗服务主要限于艾滋病毒患者，通常在外部支持下进行管理，因此不可持续。
政策优先和关注是提供姑息治疗的基本要素，因为政府缺乏关注和支持导致所有有需要的人获得姑息治疗的机会不足。因此，正如参与者所建议的，姑息治疗应纳入所有医疗层面，特别是纳入初级卫生保健单位和卫生推广计划，以便卫生推广工作者能够支持数百万农村居民。
