Palliative care making a difference in rural Uganda, Kenya and Malawi: three rapid evaluation field studies

Three palliative care programmes in Uganda, Kenya and Malawi were studied using rapid evaluation field techniques in each country, triangulating data from three sources: interviews with key informants, observations of clinical encounters and the local health and social care context, and routine data from local reports and statistics.We interviewed 33 patients with advanced illness, 27 family carers, 36 staff, 25 volunteers, and 29 community leaders and observed clinical care of 12 patients. In each site, oral morphine was being used effectively. Patients valued being treated with dignity and respect. Being supported at home reduced physical, emotional and financial burden of travel to, and care at health facilities. Practical support and instruction in feeding and bathing patients facilitated good deaths at home.In each country mobile phones enabled rapid access to clinical and social support networks. Staff and volunteers generally reported that caring for the dying in the face of poverty was stressful, but also rewarding, with resilience fostered by having effective analgesia, and community support networks.Programmes were reported to be successful because they integrated symptom control with practical and emotional care, education, and spiritual care. Holistic palliative care can be delivered effectively in the face of poverty, but a public health approach is needed to ensure equitable provision.Living and dying with incurable illness in poverty and pain is all too common in sub-Saharan Africa [1,2]. With minimal resources huge shortages of health workers, national health systems in a number of African countries have focussed primarily on preventive, curative and maternal health services, responding to a set of immediate (and development agency identified "best buys" in healthcare through their Essential (or Basic) health packages. In many countries minimal or no resources have been dedicated to supportive or palliative care. However various national and pan-Afri