Palliative care in rural and regional health care settings: A qualitative study of enabling factors and implementation challenges

Abstract

Abstract Background: Palliative care is limited or non-existent in Ethiopia, particularly in rural areas where, more than 78% of the population live. Current initiatives and research are focused on urban settings and are primarily donor dependent. This study aims to explore the status of palliative care, enabling factors and implementation challenges in Ethiopia’s rural and regional health care settings. Methods:A qualitative regional case study was conducted with health professionals drawn from different health care settings, academic institutions and included health planners and practitioners. Focus groups were conducted with rural community members and face- to face- individual interviews were conducted with health professionals working in numerous roles as well as academic leaders. Results: Ethiopia’s national policy and guidelines on palliative care, are not integrated into the national and regional health care system. The existing diploma and a few post-graduate curricula at universities and colleges contain limited palliative care content. Data analysis indicated that policymakers, professionals and community members lacked awareness towards palliative care, which started with caring for Human Immunodeficiency Virus (HIV) patients. Those working at all health care levels explained that chronically ill patients other than those with HIV received inadequate care, limited to physical care, pain management, and psychosocial support rather than comprehensive palliative care. Some participants perceived that palliative care was not within the remit of their service, so families and patients were forced to seek alternative or informal care, including from traditional healers. Conclusions: Enablers for the improvement of palliative care access in rural and regional health care were identified, including better integration of palliative care into the national health care plan and guidelines; palliative care content in university and college courses; and use of mobile phone technology to facilitate care. And policy makers and responsible stakeholders could consider the palliative care implementation in rural and regional health care settings through a combination of home, community and facility-based models.