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Oceanic Palliative Care Conference 2023
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WITHDRAWN: Impact of Palliative Care Service Decentralization on Peripheral Health Facilities

Oral Presentation Concurrent Sessions
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Oral Presentation - Concurrent Sessions

2:00 pm

14 September 2023

Exhibition Hall Theatre - Level 2

Stream 4B | Concurrent Session | International perspectives

Presentation Streams

Health system reform

Driving stronger health care systems

Presentation Description

Institution: Partners in Health - Neno, Malawi

Introduction: In 2014, World Health Assembly (WHA) called for improved access to palliative care, emphasizing primary health care and community/home-based care. Neno District Health Office in Malawi began implementing palliative care at Neno District Hospital and Lisungwi Community hospital in 2011 and 2018 respectively. In 2021, the district adopted the WHA resolution, decentralizing PC services to two primary facilities. We aimed to assess the impact of service decentralization.

Methodology: We conducted 5 focus group discussions and 10 key informant interviews with adult (18 years and above) palliative care patients and their healthcare providers separately, at two primary health facilities-Ligowe and Magaleta health centers from June to July 2022. Mixed healthcare workers and harmonious patient groups were purposefully selected from key duty stations. All FGD and KII were audio-recorded, transcribed in Chichewa then translated into English. We thematically analyzed the data using Dedoose software.

Results:  Six key themes were generated from the study: (1) Interaction between patients/clients and healthcare workers; (2) Opportunities and threats to service delivery; (3) Agility/Reliability of PC services; (4) Perceived program structure; (5) Facility responsiveness to patient’s needs; and (6) COVID-19 and palliative care.

Overall services were viewed positively. Individual narratives illustrated compassionate and responsive care, with the patient at the center. Acts of compassion appeared to be expressed through the ‘little things’ healthcare workers could do for patients.  Most patients liked that they now traveled a shorter distance to seek the same care they would receive at a secondary-level health facility.

Conclusion: Neno Palliative Care Program successfully decentralized its services to peripheral health facilities, according to patients receiving palliative care and their providers, although it requires more support. The study offers valuable information on how to decentralize the PC services to primary health facilities, benefiting program planners, resource allocators, and implementers for further scale-up processes.

Presenters

Francis Valeta

NCD Manager
Partners in Health

Authors

Authors

Medical Director Beatrice Matanje Dr. - Partners in Health , NCD Manager Francis Valeta - Partners in Health , Chief Medical Officer Chiyembekezo Kachimanga Dr. - Partners in Health , Palliative care nurse Judith Kanyema - Partners in Health , Research Assistance Matamando Mwandera - , Research Associate Mosses Banda - Partners in Health , Research Fellow Manuel Mwalwafu - Partners in Health , Physiotherapist Haules Zaniku - Government of Malawi-Ministry of Health , Nurse in Charge Lucius Horacio - Government of Malawi-Ministry of Health , Director of Health and Social Services Enock Ndarama Dr. - Government of Malawi-Ministry of Health , Research Assistance Kalen Kasambara - Partners in Health , Research Assistance Constance Munthali - Partners in Health , Research Assistance Mike Chasweka - Partners in Health , The Executive Director Lameck Thambo - Palliative Care Association of Malawi , Monitoring Evaluation, and Research Director Fabien Munyaneza - Partners in Health , Clinical Officer Jonathan Kalua - Government of Malawi-Ministry of Health , NCD Research Assistance Stellar Chibvunde - Partners in Health

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