Positioning palliative oncology in health care in Caribbean and Sub-Saharan African countries: Leveraging social and economic opportunities.

Each year, millions of people around the world experience serious health-related suffering from life-threatening and life-limiting illnesses and require palliative care. Palliative care is a human right to adequate and timely interventions for the well-being of patients with serious illnesses and their families. The World Health Assembly incorporated palliative care as a component of universal health care, reinforcing the World Health Organization's mandate to support governments in integrating the service into primary health care. Yet, fewer than half of the countries across the globe have realized this integration. Low- and middle-income countries lag in the provision of palliative care and pain relief for children and adults and have disproportionately higher mortality rates among people who experience serious health-related suffering. Our objective is to create awareness of barriers to positioning palliative oncology in healthcare and to propose affirmative measures to improve the services for children and adults in Caribbean and Sub-Saharan African countries. Four critical barriers influencing the positioning of palliative care in healthcare systems are presented: the exclusion of palliative care in universal health care schemes, restrictions to oncological end-of-life care, insufficient deliberate distinctions in services for children and adults, and limited access to medications and the absence of medication policies and regulations. We present three measures, with examples, of how to address barriers to integrating palliative oncology in healthcare systems: an approach to capacity building for pediatric palliative care in African countries, ensuring more equity in delivering primary care services; repositioning culturally sensitive psychosocial oncology care in Sub-Saharan African countries and the Caribbean, focusing on the habilitative opportunities that exist and bridging cost-effective efforts within health systems; and a matrix of domains and dimensions supports the construction of financial structures for the sustainable resilience of health care systems. Finally, we present recommendations for advocacy and to generate support for implementing the proposed measures to transform palliative services for children and adults. This paper supports the development of policies and interventions to close gaps in delivering healthcare to people affected by cancer. Further research may stem from this work, focusing on palliative care for critical conditions from other illnesses.