“Strengthening Health Systems by Integrating Palliative Care”

Integrating Palliative Care in the Curriculum of Health Professionals in Institutions of Higher Learning   Bernadette Basemera, PO, APCA September 2012

“Strengthening Health Systems by Integrating Palliative Care”

Objectives of the workshop   To share approaches, lessons and best practices for palliative care integration in medical and nursing curricula in Kenya, Malawi and Botswana   To discuss challenges and strategies for further strengthening and integrating palliative care in existing medical and nursing curricula

“Strengthening Health Systems by Integrating Palliative Care”

Format of the workshop     Short overview of some ongoing work aimed at integration in medical, nursing etc   Panel & plenary discussions   Panelists – Botswana, Kenya, Malawi

“Strengthening Health Systems by Integrating Palliative Care”

Background     In 2007, APCA entered into a formal partnership with the Institutive of Health Sciences in Gaborone aimed at strengthening the capacity of HTI to provide quality palliative care education and training for healthcare workers in Botswana and supported by AIHA/Twinning Centre   In 2008 a conference on PC: an essential part of medical and nursing training, for 10 African countries where the Botswana model was shared – Diana Fund - to identify priorities and strategies to address urgent need for more qualified health professionals to deliver quality PC - Participants developed country action plans - Kenya & Malawi funded to implement action plans

“Strengthening Health Systems by Integrating Palliative Care”

Background contd   A 2nd education conference was held in 2011 to review progress, share challenges & lessons   Tanzania, Namibia & Zimbabwe also supported to integrate

“Strengthening Health Systems by Integrating Palliative Care”

Framework/Approach for PC integration A 5 step framework for PC integration into health teaching institutions curricula Step one: Generating the evidence •  Situation analysis and needs assessment across teaching institutions to generate evidence of existing gaps for PC •  To support advocacy and plan strategically for integration

“Strengthening Health Systems by Integrating Palliative Care”

Step two- Buy-in and obtaining commitment from institutional leadership   Awareness creation & sensitization on Palliative care - workshops, meetings - Resources, materials   Sharing gaps and recommendations from SA   Consensus on priorities/joint planning – Action plan   Key stakeholders include; deans of medical and heads of nursing schools, MoH officials, professional councils, regulatory bodies, national PC associations, PC providers

“Strengthening Health Systems by Integrating Palliative Care”

Step three: Wider support from departments of the institution   Awareness creation & sensitization of heads of departments, lecturers & tutors   A PC working group for institutional coordination or focal person

“Strengthening Health Systems by Integrating Palliative Care”

Step four:Training of lecturers in PC   Introductory competency based PC course: theory 5 days and 5-10 day experiential clinical placement within an established PC site   Clinical placements have to be set up in advance to be successful   Orientation to Teaching in PC   Follow-up & mentorship critical   More specialized training opportunities   Provision of PC reference materials

“Strengthening Health Systems by Integrating Palliative Care”

Step five: Course plan & curricula review   May start with course plan as curriculum review time comes   Model for review – based on local processes - Can be done on institutional basis or as a group of institutions together to come up with a standardised module i.e. Malawi PC module - The module needs to be approved by relevant bodies e.g. MoH

“Strengthening Health Systems by Integrating Palliative Care”

Step 5: Contd.   Course plan and/or curricula review - workshop to agree: where, how long, which year, how, theory and practical , examinable   Curricula approval process- Professional bodies e.g. nurses, medical, pharmacy etc - MoH, Education - Institutional Academic Board - National Academic Board - Board of Affiliated Health Training Institutions - Unified Board of Affiliated Institutions

“Strengthening Health Systems by Integrating Palliative Care”

Some successes from the framework/approach   PC integrated in IHS family nurse practitioners curriculum, Course plans 4 other programs and PC examinable in 5 programs   17 institutions in Kenya integrated PC in curricula & examinable   10 institutions in Malawi   1 institution in Tanzania, and post graduate programme launched   In medical and nursing curricula in Uganda   Zimbabwe completed national situation analysis in all teaching institutions   Namibia – Schools of SW and Nursing starting integration   A guide for PC Teaching methodologies drafted and tested

“Strengthening Health Systems by Integrating Palliative Care”

Facilitating factors   Conducive policy environment - supportive policy environment that explicitly mentions PC   Buy in from institutional leadership   Local & institutional coordination   Regular review for progress & experience sharing   Identification and engagement of key stakeholders   Supporting training of lecturers   Use of locally available expertise & resources including PC sites

“Strengthening Health Systems by Integrating Palliative Care”

Challenges

  Already full curricula – very little space to integrate PC   Limitations on staff time- understaffing, heavy teaching load   Few lecturers with PC qualifications – lack of degree level training in PC   Location and availability of clinical placement sites – there still few well developed centres of excellence in PC delivery   Competing priorities for institution

“Strengthening Health Systems by Integrating Palliative Care”

Acknowledgement   IHSG   KEHPCA   PACAM   Donors- Diana fund, Twinning Center, RHAP Tanzania, RHAP regional   All institutions   APCA team

“Strengthening Health Systems by Integrating Palliative Care”

Panel discussion   each country to give experiences relating to: - approaches used - lessons learnt – what worked and what did not work - challenges encountered and their solutions   Strategies for further strengthening

“Strengthening Health Systems by Integrating Palliative Care”

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