Health and Nursing Sciences, University of Agder, Kristiansand, Norway.
School of Nursing, Mekelle University, Tigray, Ethiopia.
BMC Palliat Care. 2023 Oct 17;22(1):156. doi: 10.1186/s12904-023-01283-5.
Palliative care is limited in Ethiopia, particularly in rural areas, where more than 78% of the population live. Current initiatives and research are focused on urban settings and are primarily donor dependent. This study aims to explore the status of palliative care, enabling factors and implementation challenges in Ethiopia's rural and regional health care settings.
A qualitative regional case study was conducted with health professionals drawn from different health care settings, academic institutions and included health planners and practitioners. Focus groups were conducted with rural community members and face- to face- individual interviews were conducted with health professionals working in numerous roles as well as academic leaders.
Participants indicated that despite a few leaders being aware of the inclusion of palliative care in the Ethiopia national policies and guidelines, palliative care is not, integrated into the existing health care system. Other participants responded that palliative care is not well integrated into the undergraduate and postgraduate courses except for limited content in the diploma and a few postgraduate courses. Participants described the challenges for palliative care implementation as follows: many lacked awareness about palliative care; and chronically ill patients other than those with HIV received inadequate care, limited to physical care, some pain management, and psychosocial support rather than comprehensive palliative care. In addition, some participants perceived that palliative care was not within the remit of their service, so families and patients were forced to seek alternative or informal care, including from traditional healers.
Enablers for the improvement of palliative care access in rural and regional health care were identified, including better integration of palliative care into the national health care plan and guidelines; palliative care content in university and college courses; and use of mobile phone technology to facilitate care. And policy makers and responsible stakeholders could consider the palliative care implementation in rural and regional health care settings through a combination of home, community and facility-based models.
在埃塞俄比亚，包括农村地区在内的姑息治疗非常有限，而超过 78%的人口都生活在农村地区。当前的举措和研究主要集中在城市地区，并且主要依赖捐助者。本研究旨在探讨姑息治疗在埃塞俄比亚农村和地区卫生保健环境中的现状、有利因素和实施挑战。
采用定性区域案例研究方法，从不同的卫生保健环境、学术机构中抽取卫生专业人员，包括卫生规划者和从业人员。与农村社区成员进行焦点小组讨论，并与从事各种角色的卫生专业人员以及学术领导人进行面对面的个人访谈。
参与者表示，尽管有少数领导人意识到将姑息治疗纳入埃塞俄比亚国家政策和准则，但姑息治疗并未纳入现有卫生保健系统。其他参与者则表示，姑息治疗除了在文凭和少数研究生课程中有有限的内容外，并未很好地纳入本科和研究生课程。参与者描述了姑息治疗实施面临的挑战如下：许多人对姑息治疗缺乏认识；除了艾滋病毒患者以外，慢性病患者接受的护理不足，仅限于身体护理、一些疼痛管理和心理社会支持，而不是全面的姑息治疗。此外，一些参与者认为姑息治疗不属于他们服务的范畴，因此，家庭和患者被迫寻求替代或非正式的护理，包括传统治疗师。
确定了改善农村和地区卫生保健中姑息治疗机会的有利因素，包括将姑息治疗更好地纳入国家卫生保健计划和准则；在大学和学院课程中纳入姑息治疗内容；以及利用移动电话技术促进护理。决策者和负责的利益相关者可以考虑通过家庭、社区和机构为基础的模式相结合，在农村和地区卫生保健环境中实施姑息治疗。
