Lack of access to opioids for pain control, specifically morphine, and very limited funding for essential services, are key issues being addressed by delegates who have converged on Johannesburg from hospices and palliative care services all over Africa and many parts of the world. Pain management is a cornerstone component of palliative care, which is a holistic approach to life limiting illness, often the only appropriate approach in African countries where the physician patient ratio can be 1 doctor for 27,000 people, and more than 80% of patients present too late in their disease process for cure to be a viable option. Recent data suggests that moderate to severe pain is untreated in more than 88% of all cancer deaths because of lack of morphine.
The conference is emphasizing political as well as clinical collaboration, and a joint session of Ministers of Health from all over Africa, including a representative of the African Union, issued a consensus statement calling for integration of palliative care into all levels of national health planning. One high point among many was a presentation by Dr. Mabvuto Kango from the African Union, who reported on an October 2012 meeting between Drug and Crime Control and Health Ministers in Addis Ababa. The AU issued an “African common position on controlled substances and access to pain management drugs … promoting good practices in drug policy development and implementation.” It looks like great collaborative model for other countries to keep an eye on.
The rule to date has been restrictive national laws that favor law enforcement over access to narcotic drugs. Combined with fears of addiction, diversion, lack of trained personnel at all levels of the health system, and scarce resources, the very limited availability of opioids means that millions of people suffer and die in excruciating pain. The African exceptions are Uganda, where the government subsidizes morphine for its population, and South Africa, considered a high-income country and a continent leader in palliative care. The APCA conference is giving a much needed political and evidence based boost to countries that still have a way to go.
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