The Palliative Care Challenge Facing Universal Healthcare in South Africa

The Palliative Care Challenge Facing Universal Healthcare in South Africa

In the first episode of a HASA-sponsored limited series of podcasts that examine the critical issues in universal healthcare, Dr Lungi Nyathi speaks about the state of palliative care in South Africa. The release below captures some of the interview highlights.

The sad reality is that most South Africans with advanced illnesses will spend their last months of life in pain and anguish because they cannot access palliative care.

Only a few organisations in the country offer this specialised care to patients with serious, complex, and advanced illnesses.

But there is good news: According to Dr Lungi Nyathi, the CEO of value-based care provider Alignd, which offers a palliative care service, the number of South Africans with access to palliative care is growing.

Nyathi was speaking on the Advancing Healthcare Podcast, sponsored by the Hospital Association of South Africa. She provided an overview of the state of palliative care in the country and discussed what was likely to happen, particularly with the upcoming healthcare reforms.

“So palliative care has not quite existed optimally in South Africa,” explained Nyathi in the podcast. “Most palliative care has been hospice care, and most hospices in South Africa have been run as NGOs, who have looked after those indigent patients with the funds they have. And palliative care has been poorly funded in the private sector too”.  She also mentioned that schemes were shown to spend over R20 billion in the last year of life, but not all this spending provided value to all stakeholders.

She added that several challenges have prevented the uptake of palliative care in South Africa. The biggest of these is the shortage of healthcare providers trained to provide palliative care. There are less than 100 palliative care-trained doctors in South Africa, and there is also af palliatively  dire shortage otrained nurses.

The quality and accessibility of palliative care in the public sector varies depending on the province.

“Very few provinces have a structured palliative care offering for public sector patients. Some refer to hospices or step-down facilities, but those aren’t many, and they’re few and far between. In the Western Cape, they are looking at training community health care workers and nurses to provide some elements of palliative care in the community.”

Another problem, explains Nyathi, is that most South Africans don’t know what palliative care is and that it is available. Typically, when they are no longer in curative care that the system can provide, they die in an acute hospital or high-care or ICU. If beds are needed, patients are sent home.

“Most families just look after their loved one themselves,” said Nyathi. “They’ll find the assistive nursing care if they need it. They’ll get meds if they can, but most of the time, patients die in pain, a lot of pain.”

Palliative care is easier to access in the private healthcare sector, and its availability to members continues to grow.

Five large medical aid schemes, which care for 4 million South Africans, use Alignd’s offering. Another 3 million have access through an advanced illness benefit provided by their administrator. Alignd offers palliative care multi-disciplinary approach, where several professionals come together to provide care and support for the family through a multi and a defined scheme-funded programme.

“To provide palliative care, you often can’t just rely on the palliative care doctor alone to meet all the needs of a family; you need a nurse, you need a social worker, and the religious or spiritual leader of a family also needs to be involved,” explained Nyathi. “And we had to intentionally design a platform where all of them can talk in one space because one would have assumed that it is easy to get all the players to speak to each other, but all are running their practices.”

Providing this care also requires considering the many different faiths and cultures within South Africa.

Palliative care providers working through Alignd found that many patients wanted to return to their rural homes. This required finding healthcare providers willing to travel to these areas for care. These professionals must then navigate the families’ and patients’ cultures and wishes in their care.

“Sometimes you’re allowed in the room, sometimes you’re not allowed in the room, doctors have to speak, sitting next to a patient or not sitting next to a patient. If it’s a male patient or a female patient, families do different things,” said Nyathi.

However, while too few South Africans can access palliative care, Nyathi believes this could change one day. The eventual introduction of universal healthcare could be a driver because Alignd has a defined and costed programme prototype.

Many hurdles need to be crossed to bring palliative care to all South Africans, and one of these is growing the pool of healthcare professionals trained in the discipline. However, those who work within palliative care daily see its true value to the patient and those loved ones around them.

Six weeks following the death of a patient, the usual procedure at Alignd is to ask the family about their experiences of using palliative care.

“The vast majority of them are extremely grateful, even if they enrolled very late in their illness journey,” Nyathi said on the podcast.

“Just to have someone explain what’s going on, explain the journey and pull it all together. So, for most of them, it was very beneficial and were in less pain and felt emotionally supported.”

The full episode and details of upcoming episodes are available at https://hasa.co.za/hasa-podcasts/

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