Original Research - Special Collection: Pain Management and Palliative Care

Palliative care in a rural subdistrict in South Africa: A 4-year critical review

Agnes Hamilton-Baillie, Louis S. Jenkins, Margie Munnings, Ernestine Bruinders, Annemarie Bekker
African Journal of Primary Health Care & Family Medicine | Vol 16, No 1 | a4047 | DOI: https://doi.org/10.4102/phcfm.v16i1.4047 | © 2024 Agnes Hamilton-Baillie, Louis S. Jenkins, Margie Munnings, Ernestine Bruinders, Annemarie Bekker | This work is licensed under CC Attribution 4.0
Submitted: 18 February 2023 | Published: 21 January 2024

About the author(s)

Agnes Hamilton-Baillie, Faculty of Improving Global Health, Thames Valley and Wessex Leadership Academy, Winchester, United Kingdom
Louis S. Jenkins, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; and Department of Primary Health Care Directorate, Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and Department of Family and Emergency Medicine, George Hospital, Western Cape Department of Health, George, South Africa
Margie Munnings, Department of Family and Emergency Medicine, George Hospital, Western Cape Department of Health, George, South Africa
Ernestine Bruinders, Department of Physiotherapy, George Hospital, Western Cape Department of Health, George, South Africa
Annemarie Bekker, Department of Family and Emergency Medicine, George Hospital, Western Cape Department of Health, George, South Africa

Abstract

Background: Palliative care (PC) is a priority in South Africa, focussing on integrating PC into primary health care. Few examples exist showing how this is done. In 2018, a rural PC project was implemented, which subsequently evolved into an integrated service between the hospital and the community.

Aim: The aim was to review the PC project over 4 years.

Setting: The setting was the George subdistrict of the Garden Route district in South Africa. Community-based services were offered to all patients with PC needs by three non-governmental organisations who deliver home community-based care via community health workers. They were supplemented by primary health care clinics, an intermediate care facility and two hospitals.

Methods: This was a retrospective descriptive study. Inpatient ward round data and patient referrals between 2018 and 2022 were analysed using descriptive statistics. Variables included patient demographics, diagnosis, home visits and place of death.

Results: A total of 819 patients were referred. Inpatients were reviewed on weekly ward rounds by a multidisciplinary team. The most common diagnosis was cancer (57%). Home visits enabled patient follow-ups, of which 152 were recorded.

Conclusion: The programme has become sustainable and integrated in the public healthcare system. Contributing factors included dedicated staff, using simple tools and continuous training. The findings may be useful to PC programmes in similar contexts elsewhere.

Contribution: This work adds new knowledge to the field of PC in an underresourced rural healthcare environment in sub-Saharan Africa, by describing how system-wide integration of a new service was navigated to become sustainable.


Keywords

palliative care; rural model; integrated; review; South Africa.

Sustainable Development Goal

Goal 3: Good health and well-being

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