Mapping levels of palliative care development: a global view

This pilot study builds on earlier work from the International Observatory on End of Life Care study in Africa, looking at levels of hospice and palliative care development. This report covers 234 countries and categorises provision into four main areas:

• no known hospice-palliative care activity
• capacity building activity (but no service yet)
• countries with localised provision of hospice-palliative care
• and countries where hospice and palliative care activities are approaching integration with the wider health system

The authors find that around half of the 234 countries included in this review have established one or more hospice-palliative care services. Yet only 35 (15%) countries have achieved a measure of integration with wider mainstream service providers. In 78 (33%) countries, no palliative care activity can be identified.Consequently, despite increasing calls for palliative care to be recognised as a human right, there is a long way to go before palliation is within reach of the global community.

Palliative care activists point to a broad range of challenges, which include issues such as absence of policy and legislation, low public awareness of this relatively young discipline, along with palliative care being seen as a less prestigious discipline and the absence of palliative care modules/ placements in medical curriculum.

The report also highlights that it is important not to assume that countries experiencing challenges are located in a particular category or geographic region, for most of these challenges appear in one form or another throughout the world and in all groups of countries. The relationship between a country’s wealth (GDP per capita) and palliative care development should thefore be approached with caution, since high and low income countries are represented in each of the four groups of countries.