A model for delivering cost-effective palliative care in a resource scarce setting in Ethiopia

Abstract

Palliative care model development greatly varies between countries based on their socioeconomic status, cultures, religious beliefs and presence of sufficient health, infrastructure, in order to meet the unique needs of patients with life-threatening illnesses. Furthermore, a palliative care model that can be established in developed countries may not necessarily work in developing countries. Therefore, the purpose of this study was to develop a cost-effective palliative care model that is suitable to the Ethiopian setting. The objectives were to explore the nature and extent of existing palliative care services in Ethiopia, determine the factors that impact on effective application of palliative care in Ethiopian setting, as well as explore best-practice palliative care models that are available internationally, with specific emphasis on resource-poor contexts and to develop an appropriate model of palliative care in Ethiopia. The researcher used a qualitative approach using constructivism paradigm to understand and explore palliative care situation in Ethiopia in order to develop a palliative care model. Purposive sampling technique was employed to select key informants and group discussants at different levels of health system, ranging from national levels to frontline health extension workers so as to get adequate information about palliative care experiences. Specifically, data were collected from different Key informants such as policy makers, programe and hospital managers, non-governmental organizations, religious leaders, health professionals and frontline health workers. Besides, group discussions were also held with nurses. Accordingly, 29 key informants interviews were conducted and five focus group discussions were done with nurses who were working at four chronic illness hospitals of Jimma Zone. Data transcription and translation were done verbatim. Atlas ti 7.1 software assisted data management and analysis. All ethical principles and the trustworthiness of the data were maintained throughout the research process. Moreover, the researcher included analyses of available literature of existing palliative care delivery models in different settings so as to capture global perspectives and factors that would play a role in shaping the delivery of palliative care services and taken into account, in the development of customized palliative care model for Ethiopia context. Following in-depth understanding of the factors that play a role in shaping the palliative care process, the researcher developed and validated data which were then used to derive a contextually relevant palliative care model, “P-care model” for the Ethiopia context. This model meets the prominent challenges and gaps related to patients, health professionals, health system and challenges non-governmental organizations are facing in implementing palliative care services in Ethiopia. The researchers ensured the clarity, consistency, relevance, comprehensiveness, adaptability, practicability and usefulness of the model within the Ethiopian context. The model was validated through collecting feedback and input from senior practitioners in the field and key role players such as policy makers, managers, program officers and academic staff and researchers. Finally, based on the feedback and input , the palliative care model was further refined and recommendations were forwarded to policy makers ,clinicians ,academic staff, researchers and non-governmental organizations. Moreover, in order to create awareness for health professionals, training was given on palliative care in Jimma Medical Centre and Shanen Gibe General Hospital. In conclusion, although there was a significant encouragement for palliative care movement in Ethiopia, from practical application, it had a narrow scope in its coverage and implementation. Therefore, the palliative care model developed from this research may help to deliver cost-effective palliative care for patients with life-threatening illnesses in resource poor settings. This can be achieved through integration of community-based palliative care approach using public health methods to address the above gaps and challenges in resource scarce settings, and it may also be useful in other settings as well.