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Senegal Makes Strides on Palliative Care

Other Countries in Francophone Africa Should Follow Suit

During a morphine shortage, a cancer patient in Dakar cluthes onto the railing of her hospital bed because she is in pain and the medication she needs is unavailable. © 2013 Angela Chung/Human Rights Watch

When it comes to end-of-life care and pain treatment, Francophone Africa has a long way to go. But, Senegal is one country working to change this.

A 2012 study found 16 of 22 countries in Francophone Africa have no healthcare providers specializing in palliative care, which focuses on pain treatment and quality of life. Yet, each year about 912,000 people there, including 214,000 children, require palliative care. That number is likely to grow.

In countries with limited resources, where death from malaria or respiratory infections is common, palliative care is often viewed as a luxury. However, our work in Senegal with local partners and the health ministry shows progress can be made.

In 2013, Human Rights Watch found that only a few hospitals in the capital, Dakar, provided palliative care for patients with end-stage cancer. Also, the amount of morphine the country used was enough to treat just 179 patients with advanced cancer or AIDS – although about 70,000 people there required palliative care each year.

At the root of the issue was the absence of a national policy, a lack of training and education for healthcare workers, and challenges with the procurement and prescription of morphine.

Since 2014, however, the Senegalese government has taken steps to improve access to palliative care. It boosted its national estimate for morphine from 1,180 grams in 2012 to 40,329 grams. It has begun buying oral morphine tablets for public hospitals. It changed regulations limiting the prescription of morphine to seven days at a time – forcing patients at the end of life to travel long distances to get a new prescription – to 28 days. The World Health Organization (WHO) has worked with the ministry to train physicians, pharmacists, and health workers on using morphine. The hospital with the country’s largest adult cancer unit hired a palliative care specialist. The health ministry has worked with Human Rights Watch on a needs assessment study, the result of which are forthcoming.

Despite this progress, much remains to be done. Most hospitals do not offer palliative care services to incurable patients. Most health workers have no training in palliative care. And morphine is available almost only in the capital. But with leadership in the health ministry, pressure from civil society, and assistance from international actors like WHO, significant progress in addressing these challenges is within reach.

Hopefully, other West African countries will also take these steps.

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