Partnership with the Kenya Hospices and Palliative Care Association to integrate pain treatment into high-level hospitals
Start of Project:June 2012
Length of Project: Three years
Objective: Improve access to oral morphine for Kenyans with moderate or severe pain
Accurate data on the number of people with moderate or severe pain in Kenya do not exist, but a minimum number can be estimated. The World Health Organization (WHO) estimated that 152,000 people died from HIV and 20,000 people died from cancer in 2010. Assuming that 50% of those who died from HIV and 80% of those who died from cancer experienced moderate or severe pain, 92,000 of those deaths required treatment with opioid analgesics, according to the WHO pain treatment guidelines. This number reflects a minimum need, since it does not include people who died of other conditions with pain, such as trauma or myocardial infarction, and people who suffered with painful conditions but did not die.
The government of Kenya reports opioid consumption to the International Narcotics Control Board on an annual basis. The average reported consumption of opioids from 2009-2011, standardized as morphine-equivalents, was 26.7 kg. Assuming that patients, on average, are treated for the last 3 months of their life with 67.5 mg of morphine per day, 26.7 kg would have provided a full treatment for 4,300 people. The amount of opioids required to treat 92,000 people is 566 kg. Please see our fact sheet on access to pain relief in Kenya for more data.
TABLE 1. SNAPSHOT OF ACCESS TO PAIN RELIEF IN KENYA
In June, 2012, we established a 3-year partnership with Kenya Hospices and Palliative Care Association (KEHPCA) to improve access to oral morphine for the treatment of moderate or severe pain. As part of the agreement, we agreed to hire a consultant to serve as a Coordinator for Access to Pain Relief and Palliative Care. This consultant is a physician, trained in palliative care, and seconded to KEHPCA by the Ministry of Medical Services. She is leading the following efforts.
- Draft a strategic plan: The consultant is working with the Ministry of Medical Services and KEHPCA to create a strategic plan for improving access to essential pain medicines in Kenya. This will form the guidance for improving the quality of pain treatment and will incorporate the elements described below.
- Supply of essential pain medicines: The consultant is working with palliative care programs to monitor stocks and troubleshoot shortage of essential medicines for palliative care. The consultant also works with the Ministries of Health and its partners, including the Kenya Medical Supplies Agency (KEMSA), to improve the procurement and tendering process for essential medicines for palliative care.
- Clinical training: The consultant works with relevant authorities in the Ministry of Health and the Ministry of Education to integrate pain relief into in-service training, supports KEHPCA’s continuing medical education programs, and strengthens palliative care in community health worker training.
- Regulations and policy: The consultant works with the Department of Pharmacy and the legal office of the Ministries of Health to update narcotics legislation to align it with United Nations International Narcotics Control Board recommendations and to ensure that policies are clearly communicated to health workers.
- Treatment guidelines: The consultant works with the Ministries of Health, KEHPCA, and other partners to create a National Palliative Care Policy, ensure that guidelines for HIV and cancer contain up-to-date, evidence-based, and comprehensive coverage of pain relief and palliative care, and to ensure that hospital guidelines include palliative care.
- Technical support: The consultant assists KEHPCA’s Director to organize information, best practices, and collaborations and creates presentations and reports to improve communication among KEHPCA, the Ministries of Health, and other partners working in palliative care.
- Awareness: The consultant liaises with various health ministry departments to assist them with integrating pain relief and palliative care into their service delivery, including HIV, cancer, and the Pharmacy and Poisons Board. The consultant also works with hospital leaders to sensitize them and secure their support for palliative care. The consultant also works to communicate progress and success of the project with the media, on the web, and at conferences.
- Strengthen civil society: The consultant coordinates activities with civil society organizations and non-governmental organizations so that their activities are integrated into health ministry activities and will seek to strengthen linkages among hospitals, hospices, and community health programs.
Update on activities, as of February 2013
In July 2010, the Director of Medical Services issued a circular directing 11 level five and high volume hospitals to work closely with KEHPCA to establish palliative care services in the hospitals. They include:
- Coast Provincial General Hospital
- Embu Provincial General Hospital
- Garissa Level Five Hospital
- Kakamega Provincial General Hospital
- Nakuru Provincial General Hospital
- Nyeri Provincial General Hospital
- Kisii Level Five Hospital
- Machakos Level Five Hospital
- Meru Level Five Hospital
- Thika Level Five Hospital
- New Nyanza Provincial General Hospital
KEHPCA has been working with these sites to provide a temporary supply of morphine powder while KEMSA awaits a procurement, to upgrade the facilities for a palliative care space, and to train clinicians.
KEMSA has initiated an order for morphine powder (22 kgs), expected to arrive in the country in the first half of 2013. KEHPCA will be working with the Ministry of Medical Services (MMS), KEMSA, and other partners to introduce standard guidance on reconstitution, streamline the product distribution, and introduce high-quality, centralized production of oral morphine solution.