In Kenya, Article 43 of the Constitution states, “Everyone has the right to the highest attainable standard of health.” Well, during a palliative care advocacy training at Rosa Mystica Centre in Nairobi, lawyer Melba Katindi put it clear; that this is a prerogative and hence no patient should be begging to have access to quality health services in Kenya. Nonetheless, is this the case with patients in need of palliative care? No, most of them have no access to this care and hence the need for advocacy.
A report released in 2014 by Worldwide Palliative Care Alliance (WPCA) indicates that palliative care is relatively new to national health systems and particularly in low and middle income countries; Kenya is not excluded. That explains why Kenya Hospice and Palliative Care Association (KEHPCA) has been vocal in advocating for integration of these services in our health system. It is also the reason why from 3rd to 5th May 2017, KEHPCA conducted a palliative care advocacy training that brought together palliative care healthcare practitioners from 24 counties in Kenya. This was through the support of the Open Society Initiative for Eastern Africa (OSIEA), a great advocate of palliative care globally.
During the training; Dr. Esther Muinga, the coordinator of pain relief at KEHPCA, introduced the delegates to palliative care concepts; care that is aimed at improving the quality of life of patients with life-threatening illnesses. This care is holistic; focusing not only on treating the patient’s pain but also on psychological, spiritual and emotional needs of the patients. It should be noted that every patient in need should be provided with this care from the time of diagnosis to death.
Dr. Muinga brought to our attention the WPCA palliative care development map; Kenya is ranked number (4a), which is the preliminary integration stage. According to WPCA (2014), this stage is characterized by a variety of palliative care providers and types of services; awareness of palliative care on the part of health professionals and local communities; the availability of morphine and some other strong pain-relieving medicines but to list a few. She highlighted that Kenya is determined to grow into stage (4b), best referred to as advanced integration. It is characterized by comprehensive provision of all types of palliative care by multiple service providers; broad awareness of palliative care on the part of health professionals, local communities and society in general; unrestricted availability of morphine and all other strong pain-relieving medicines but to name a few. The only way to stage (4b) is advocacy.
Advocacy is the public support for or recommendation of a particular cause or policy. Dr. Asaph Kinyanjui, Director of Programs at KEHPCA highlighted five tips to successful advocacy; one priority, a benefits solution, identification of a VITO, being focused and maintaining purposeful communication. Being new knowledge, the participants picked VITO (Very Important Top Officials) as the bottom line to advocating for palliative care in their counties. At no given time should one present so many needs to VITO because they probably do not have a lot of time to listen. Therefore, the only way to succeed in advocacy is by taking one step at a time. Besides, in advocacy benefit solution should be presented; make people understand the benefit they will get or the problem they will solve if a particular cause is implemented. Finally, remain focused. In advocacy, there are times when one will receive positive or negative response but either way one should still be determined to fight for the change they desire.
Dr. Killingo said that through advocacy, Kenya now has access to opioids such as morphine and more people have access to palliative care services. He noted that advocacy is still needed because there are people who do not know the benefits of this care. To date, 22 Counties in Kenya lack access to these services. Moreover, some patients hold myths and misconceptions about this care and hence do not seek for it. To have this care fully integrated in our health services he reiterated that passion is needed because it is not an easy job at all. He noted that there is need to address some of the barriers to access palliative care. These include; bad governance, bad policy execution and lack of knowledge on this care.
“Our core business in palliative care focuses on quality of life. We do not have a choice but to advocate for it,” Said Dr. Killingo. He encouraged the participants to always know that at the end of the day, they work to improve the quality of a patient’s life. They should offer their services with a lot of love and compassion.
Dr. Faith Mwangi-Powell, a palliative care advocate shared with the participants her journey towards putting palliative care in Africa on the map through the African Palliative Care Association, where she served as the director previously. “You cannot advocate for something you have no passion about!” she emphasized.
Lawyer Melba Katindi said that every health practitioner should have the laws that govern their practice on their finger tips. That is the only way to live up to the highest expected standards as health workers.
Finally, Emma Wanyonyi from the International Institute for Legislative Affairs (IILA) took participants through the national and county budget making process. Each county member should have their say in their region budget plans through public participation forums. The participants were encouraged to actively advocate for palliative care in the budget activities within their counties.
“Palliative care remains a right to all and hence advocacy in Kenya remains mandatory. KEHPCA will continue working with all relevant stakeholders so as to ensure that palliative care integration is achieved across the 47 counties in Kenya,” said Dr. Ali, the Executive Director at KEHPCA.