Promoting primary palliative care in Western Kenya using Project ECHO®.

Currently less than 2% of Kenyans with severe symptoms receive palliative care (PC). Moreover, PC services are concentrated in urban settings and most rural healthcare providers have limited PC expertise. Project ECHO® Palliative Care for Western Kenya was developed as part of a hub-and-spoke model for improving primary PC in rural Kenya. The programme is based at Moi University and Moi Teaching and Referral Hospital, a public, tertiary care facility with a catchment of 25 million Kenyans, the majority of whom live in rural settings. Self-reported assessments by primary care providers found the Project ECHO® Palliative Care for Western Kenya programme improved PC knowledge and clinical skills, increased professional confidence and decreased professional isolation. The training sessions led to an increase in collaborative care management between primary care providers and PC specialists outside of the educational sessions. While a positive finding, it does present challenges to an already small cadre of PC specialists in Western Kenya. A monthly education programme is a useful tool for expanding primary PC services, but optimal clinical care will require increasing the number of speciality PC providers. Effective PC will be most effective when primary and speciality PC are developed in a coordinated fashion.