Country leadership in palliative care

Palliative care (PC) development in any region is dependent on the quality of leadership in each country. PACED and other non-governmental organizations (NGOs) that work on PC development have as one of their main aims to build up and support emerging PC leaders so they can be more effective champions for PC in their country and region. There is opportunity for this to be mutually beneficial as we are all lifelong learners and can benefit from each other’s experience and knowledge in an atmosphere of mutual respect and cultural humility.

Helping to help develop palliative care leaders cannot be done by parachuting in with single visits or training sessions. There must be ongoing relationships that may last many years. The process of PC development often happens in fits and starts with many obstacles that must be overcome through perseverance. The public health model for palliative care has many interlocking components that have to be addressed sometimes simultaneously and sometimes in sequence. For example, training in pain management when opioids are not yet available is ineffective. Implementing services before laws and policies are in place may not be possible. Public education and medical education need to be done in parallel.

Medical education needs to be developed at multiple levels in each country such that it includes undergraduate education in medical schools, nursing colleges, and universities; as well as post graduate programs and continuing medical education. Recognition of PC as a specialization in the health care system is an important goal and only comes about when a critical mass of competent clinical palliative care leaders and educators is achieved.

Ongoing mentorship is an important part of leadership development and should be embedded into all training programs as a part of ‘bedside’ teaching. Palliative care cannot just be taught in classrooms but has to include direct experience in caring for patients with PC needs and the opportunity to discuss difficult cases and problems with an experienced colleague.

Many different stakeholders need to be engaged during the PC development period to succeed. These include medical and nursing leaders and their universities; NGOs advocating for health and human rights; government ministries and political leaders; existing health care delivery organizations; and so forth. Through inclusion, organizations and individuals will come to understand and ‘buy in’ to the need for and development of PC in their country.

Political leadership is also very important and necessary to make progress in a country. Getting leaders to prioritize support for palliative care can be difficult as there are many health care priorities to be considered. Making the case for the value of PC to every health care system is necessary by using evidence to show how PC improves quality of life by anticipating and preventing health crises that result in unnecessary and unintended health care utilization and cost. However, it is not enough to focus on cost effectiveness, we must keep quality of care always in mind as our goal and show political leaders that it is a necessary social good that all citizens will value as a requirement for a just and equitable society.

Ultimately making good quality PC available to more people in any country requires strong, competent, dedicated leaders. Leadership in PC can emerge spontaneously but can be nurtured and encouraged through the kinds of relationships that we hope to develop through PACED.

Stephen Connor is Executive Director of the World Hospice Palliative Care Alliance.