ArticleFamily medicine and community health2026
Implementation of primary palliative care interventions across six sub-Saharan African countries: understanding contextual determinants and lessons learnt.
Article in Family medicine and community health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo synthesise five purposively selected service-level primary palliative care interventions in six sub-Saharan African countries to identify the contextual barriers and facilitators and the implementation strategies employed to address them.
settingPrimary palliative care studies that have taken place in sub-Saharan Africa in the last 5 years.
designWe used an implementation-focused formative evaluation design involving semi-structured interviews with every site lead (n=7) supplemented by a review of study-related documentation. Data were analysed using framework analysis underpinned by the relevant constructs of the Consolidated Framework for Implementation Research.
participantsSite leads from each of the five studies were interviewed.
resultsFacilitators to implementing primary palliative care interventions included the following: (1) the relative advantage compared with standard care (ie, person-centred approach, expansion to those with non-cancer conditions), (2) primary care worker champions within sites, (3) broad sustained engagement with policymakers, managers, healthcare workers, patients and families and (4) availability of linked healthcare records. Barriers included the following: (1) inconsistent staffing and training needs for the diverse workforce, (2) fragmented referral pathways, (3) inconsistent national and local policies and (4) physical infrastructural limitations.
conclusionContext-specific facilitators, barriers and recommendations should be considered to bolster the implementation process of future primary palliative care interventions. Advocacy is needed to ensure adequate investments in the design, equipping and staffing of primary healthcare in sub-Saharan Africa to properly support patients and their families.
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