Edinburgh Napier University

  Background/aims: Palliative care is recognized as an essential component of Universal Health Coverage that must be provided at all levels of healthcare to address the rising trend of serious health-related suffering. The limitations of primary palliative care implementation in sub-Saharan Africa (SSA) must be understood to successfully deliver care in this context. We synthesized select primary palliative care interventions in six SSA countries to identify the contextual barriers and facilitators and the implementation strategies employed to address them.

Methods: We used an implementation-focused formative evaluation design involving a two-stage process of semi-structured interviews with seven implementation site leads supplemented by a review of study-related documentation. Data were analysed using framework analysis underpinned by the relevant constructs of the Consolidated Framework for Implementation Research.

Results: Facilitators to successfully implementing primary palliative care interventions included 1) the relative advantage of each intervention compared with standard care (i.e., emphasis on a person-centred approach, expansion of palliative care eligibility to those with COPD, stroke and multimorbidity), 2) engaged primary care providers and champions, 3) broad, sustained engagement with policymakers, managers, providers, patients and families, and 4) availability of linked healthcare records. Barriers included 1) inconsistent staffing and training needs for the diverse workforce, 2) Broken referral linkages, 3) Inconsistent national and local policies, and 4) physical infrastructural limitations (i.e., lack of private and accessible spaces).

Conclusions: These context-specific facilitators, barriers and recommendations should be considered to bolster implementation processes in future primary palliative care research in SSA. Advocacy is needed to ensure adequate investments in the design, equipping and staffing of primary healthcare in to properly support patients with serious illnesses and families.