THE DEVELOPMENT OF PALLIATIVE CARE PROVISION, GUIDELINES AND POLICY IN TWELVE COUNTRIES OF EASTERN EUROPE AND CENTRAL ASIA

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OSI Palliative Care Policy Development Conference

• THE DEVELOPMENT OF PALLIATIVE CARE PROVISION,
  GUIDELINES AND POLICY IN TWELVE COUNTRIES OF
  EASTERN EUROPE AND CENTRAL ASIA
• Michael Wright
• International Observatory on End of Life Care
• Lancaster University, UK
• 16-18 October 2003
• Budapest

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Background OSI commission
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Palliative Care in Central/Eastern Europe and
Central Asia, 2002

• Albania
• Armenia
• Azerbaijan
• Belarus
• Bosnia-Herz
• Bulgaria
• Croatia
• Czech Rep
• Estonia
• Georgia

• Hungary
• Kazakhstan
• Kyrgyzstan
• Latvia
• Lithuania
• Macedonia
• Moldova
• Mongolia
• Poland
• Romania

• Serbia
• Montenegro
• Russia
• Slovakia
• Slovenia
• Tajikistan
• Uzbekistan
• Ukraine

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Palliative Care in Central/Eastern Europe and
Central Asia, 2002
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Palliative Care in Central/Eastern Europe and
Central Asia, 2002
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The International Observatory on End of Life Care

• Hospice and palliative care development in every
  country has much to gain from an international
  perspective a vital spur to this could take the
  form of an International Observatory, based on
  the world wide web
• www.eolc-observatory.net

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Aims of the International Observatory

• To provide clear and accessible research-based
  information
• To disseminate this information through the
  Observatory website and through other means
• To undertake primary research studies and reviews
  to generate such information
• To develop a small grants programme to support
  academic work relating to the aims of the
  Observatory in resource poor regions
• To work in partnership with key organisations and
  individuals, nationally and internationally
• www.eolc-observatory.net

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The survey

• The countries
• Bulgaria, Croatia, Czech Republic, Georgia,
  Hungary, Lithuania, Moldova, Mongolia, Poland,
  Romania, Slovakia, Slovenia (12)
• The regions
• The Balkans, Baltics, Central Europe, Eastern
  Europe, Trans-Caucasia, Central Asia (6)
• Method
• -cross-sectional, descriptive survey
• -email questionnaire
• -named individual
• -each of 12 countries
• -100response rate

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Common features
Processes of transition
-movement towards democracy -movement towards
market economy -health systems de-centralising
-insurance-based models of re-imbursement
gaining ground -change in attitudes
We learned in nursing school that you are not
allowed to touch if the patient has a wound or a
fever. You have to try to keep yourself safe. So
patients were really surprised when somebody
comes and takes their hands, shares their grief.
It was something new Gabriela Ticu,(Romania)
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Common features
Processes of transition
-movement towards democracy -movement towards
market economy -heath systems de-centralising
-insurance-based models of re-imbursement
gaining ground -change in attitudes
To the ethos of solidarity as a social,
economic and political movement was added the
ethos of the hospice movement, as a symbol of
humanity Luczak J (1993) Palliative/hospice care
in Poland. Palliative Medicine 7 68
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Common features
Standardised death rates, all ages per 100,000
both sexes, 2001
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Differences
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Services adult
Key points Poland has the broadest range and
greatest number of palliative care services. Home
care features prominently in 9/12 countries.
Lithuania has 82 nursing home services
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Services paediatric
Key points Home care services feature most
prominently, especially in Poland 4/12 countries
make no palliative care provision for children
only 4/12 countries have more than 1 paediatric
palliative care service
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Palliative care association
Key point 11/12 countries have a national
hospice/palliative care association
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Certification program
Key points 6/12 countries have a certification
program for doctors 4/12 for nurses. Only
Hungary and Poland has programs for doctors,
nurses and other professionals
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Palliative care standards
Key points Hungary and Poland are the only
countries with standards in place for inpatient,
home care and other palliative care programs.
Mongolia has developed palliative care standards
in the other category. Inpatient Standards
are being developed in 4/12 countries and home
care standards in 6/12 countries
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National guidelines
Key points All countries except Romania have
national guidelines for the management of acute
pain all except Romania and Bulgaria have for
chronic cancer pain. Only Hungary has
guidelines in place across all categories
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National cancer control policy
Key points 9/12 countries have a national cancer
control policy, of which 4 include palliative
care
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National AIDS policy
Key points 8/12 countries have a national AIDS
policy, of which 3 include palliative care
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Reimbursement
Key points The health care system pays for home
based palliative care in 4/12 countries
inpatient care in 5/12 countries
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Legislation
Key points 4/12 countries Georgia, Hungary,
Poland, Slovakia - have the necessary legislation
for palliative care to be delivered in all four
settings
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Needs assessment
Key points 6/12 countries have undertaken a
palliative care needs assessment
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Barriers to palliative care

• Most frequently mentioned
• -insufficient funding
• -low social and professional awareness of
  palliative care
• -poor pain control
• -the lack of trained staff
• -the absence of legislation.

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Opportunities for palliative care
Most frequently mentioned -the development of
education and training programs -the support of
ministers and a movement towards
legislation -the development of national
standards -the increasing number of palliative
care services, professionals and
volunteers -better pain relief and opioid
availability .
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Conclusions
-A variable pattern of provision and progress
(sparse provision for dying children) -much
developmental work being undertaken -acute
awareness of both the barriers and opportunities
for palliative care development
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Conclusions
Significant developments Mongolian Palliative
Care Society established in 1999 and organized
basic education on palliative care for doctors,
nurses, teachers of the Medical University and
Colleges, translated and published main WHO
guides on palliative care, wrote and published
handbooks for basic and advanced palliative care
education, organized Leadership Conferences on
Palliative care, distributed materials to the
parlament members, ministry of health, advocacy
by TV and radio by financial support of Soros
Foundation. Now all Medical Universities and
Colleges have education program and curriculum on
palliative care. Palliative Care Department was
established in 2000 by financial support of Soros
Foundation. Two home hospices established in
2002,2003 in Ulaanbaatar and Zuunharaa by
activities of palliative care association members.