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Joseph J, Sankar H, Benny G, Nambiar D. Who are the vulnerable, and how do we reach them? Perspectives of health system actors and community leaders in Kerala, India. BMC Public Health 2023; 23:748. [PMID: 37095483 PMCID: PMC10123577 DOI: 10.1186/s12889-023-15632-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Among the core principles of the 2030 agenda of Sustainable Development Goals (SDGs) is the call to Leave no One behind (LNOB), a principle that gained resonance as the world contended with the COVID-19 pandemic. The south Indian state of Kerala received acclaim globally for its efforts in managing COVID-19 pandemic. Less attention has been paid, however, to how inclusive this management was, as well as if and how those "left behind" in testing, care, treatment, and vaccination efforts were identified and catered to. Filling this gap was the aim of our study. METHODS We conducted In-depth interviews with 80 participants from four districts of Kerala from July to October 2021. Participants included elected local self-government members, medical and public health staff, as well as community leaders. Following written informed consent procedures, each interviewee was asked questions about whom they considered the most "vulnerable" in their areas. They were also asked if there were any special programmes/schemes to support the access of "vulnerable" groups to general and COVID related health services, as well as other needs. Recordings were transliterated into English and analysed thematically by a team of researchers using ATLAS.ti 9.1 software. RESULTS The age range of participants was between 35 and 60 years. Vulnerability was described differentially by geography and economic context; for e.g., fisherfolk were identified in coastal areas while migrant labourers were considered as vulnerable in semi-urban areas. In the context of COVID-19, some participants reflected that everyone was vulnerable. In most cases, vulnerable groups were already beneficiaries of various government schemes within and beyond the health sector. During COVID, the government prioritized access to COVID-19 testing and vaccination among marginalized population groups like palliative care patients, the elderly, migrant labourers, as well as Scheduled Caste and Scheduled Tribes communities. Livelihood support like food kits, community kitchen, and patient transportation were provided by the LSGs to support these groups. This involved coordination between health and other departments, which may be formalised, streamlined and optimised in the future. CONCLUSION Health system actors and local self-government members were aware of vulnerable populations prioritized under various schemes but did not describe vulnerable groups beyond this. Emphasis was placed on the broad range of services made available to these "left behind" groups through interdepartmental and multi-stakeholder collaboration. Further study (currently underway) may offer insights into how these communities - identified as vulnerable - perceive themselves, and whether/how they receive, and experience schemes designed for them. At the program level, inclusive and innovative identification and recruitment mechanisms need to be devised to identify populations who are currently left behind but may still be invisible to system actors and leaders.
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Affiliation(s)
- Jaison Joseph
- The George Institute for Global Health, New Delhi, India.
| | - Hari Sankar
- The George Institute for Global Health, New Delhi, India
| | - Gloria Benny
- The George Institute for Global Health, New Delhi, India
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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Frey R, Balmer D. The challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic: An integrative review. Palliat Support Care 2023:1-13. [DOI: 10.1017/s1478951523000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Abstract
Objectives
The growing demand for palliative care has been accelerated due to the COVID-19 pandemic. However, providing community-based palliative care was also more difficult to do safely and faced several challenges. The goal of this integrative review was to identify, describe, and synthesize previous studies on the challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic.
Methods
Searches were carried out on the Ovid MEDLINE, CINAHL, PsycINFO, Social Care Online, PubMed, Embase, and Expanded Academic databases. Journals typically reporting palliative care and community health studies were also searched (Palliative Medicine, Journal of Pain and Symptom Management, and Health & Social Care in the Community). All articles were peer-reviewed and published in English between December 2019 and September 2022.
Results
Database and hand searches identified 1231 articles. After duplicates were removed and the exclusion criteria applied, 27 articles were included in the final review. Themes in the research findings centered on 6 interconnected categories. The challenges imposed by the pandemic (lack of resources, communication difficulties, access to education and training, and interprofessional coordination), as well as the varying levels of success of the health-care responses, impacted the well-being of health professionals and, in turn, the well-being and care of patients and families.
Significance of results
The pandemic has provided the impetus for rethinking flexible and innovative approaches to overcome the challenges of delivering community palliative care. However, existing governmental and organizational policies require revision to improve communication and effective interprofessional collaboration, and additional resources are needed. A blended model of virtual and in-person palliative care delivery may provide the best solution to community palliative care delivery moving forward.
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Thelly ASS, Rose MJ, Rana S. Epilogue: Reflections from Stakeholders of a Facilitated Community Partnership Developed to Provide Palliative Care to a Vulnerable Population in Kerala. Indian J Palliat Care 2023; 29:94-99. [PMID: 36846278 PMCID: PMC9944653 DOI: 10.25259/ijpc_81_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/15/2022] [Indexed: 11/04/2022] Open
Abstract
Introduction In mid-March 2020, the Kerala government implemented additional preventive measures to the steps already taken to reduce the transmission of COVID-19. Strategies were taken by a non-governmental palliative care organisation (Pallium India) with Coastal Students Cultural Forum - a coastal area-based collective of young educated people in the coastal region to address the medical needs of people living in this community. The facilitated partnership lasted 6 months (July-December 2020) and addressed the palliative care needs of the community in the selected coastal regions during the first wave of the pandemic. Volunteers sensitised by the NGO identified more than 209 patients. The current article highlights the reflective narratives of key players in this facilitated community partnership. Materials and Method The current article is dedicated to highlighting the reflective narratives of key players in this facilitate community partnership to the readers of this journal. The palliative care team's overall experience was collected from selected key participants to understand the program's impact, identify areas of improvement, and discuss possible solutions if there were any challenges. The contents below are their statements on the experience of the entire program. Conclusion Palliative care delivery programmes must be configured to respond to local needs and customs, be community-based and integrated with local health and social care and have accessible referral pathways between and across services. They must also be responsive to changing individual and population needs and shifts in local and national health structures.
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Affiliation(s)
- Anu Savio Savio Thelly
- Department of Palliative Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - M. Jima Rose
- Coastal Students Cultural Forum, Thiruvananthapuram, Kerala, India
| | - Smriti Rana
- Pallium India Trust, Aisha Memorial Hospital Building, Thiruvananthapuram, Kerala, India
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Rosa WE, Ahmed E, Chaila MJ, Chansa A, Cordoba MA, Dowla R, Gafer N, Khan F, Namisango E, Rodriguez L, Knaul FM, Pettus KI. Can You Hear Us Now? Equity in Global Advocacy for Palliative Care. J Pain Symptom Manage 2022; 64:e217-e226. [PMID: 35850443 PMCID: PMC9482940 DOI: 10.1016/j.jpainsymman.2022.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 07/08/2022] [Indexed: 10/17/2022]
Abstract
Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences (W.E.R.), Memorial Sloan Kettering Cancer Center, New York, New York, USA; Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA.
| | - Ebtesam Ahmed
- Department of Clinical Health Professions (E.A.), St. John's University College of Pharmacy and Health Sciences, Queens, New York, USA; MJHS Institute for Innovation in Palliative Care (E.A.), New York, New York, USA
| | | | - Abidan Chansa
- National Palliative Care Program (A.C.), Ministry of Health, Lusaka, Zambia
| | - Maria Adelaida Cordoba
- Pediatric Palliative Section (M.A.C.), Fundación Hospital Pediátrico de La Misericordia, Bogotá, Colombia; Department of Pediatrics (M.A.C.), Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rumana Dowla
- Palliative Medicine Cancer Care Centre (R.D.), United Hospital, Dhaka, Bangladesh
| | - Nahla Gafer
- Integrated Palliative and Oncology Unit (N.G.), Khartoum Oncology Hospital, Khartoum, Sudan
| | - Farzana Khan
- Fasiuddin Khan Research Foundation (F.K.), Uttara, Dhaka, Bangladesh; Global Health Academy (F.K.), University of Edinburgh, Scotland, United Kingdom
| | - Eve Namisango
- African Palliative Care Association (E.N.), Kampala, Uganda; Department of Palliative Care and Rehabilitation (E.N.), Cicely Saunders Institute, King's College, London, United Kingdom
| | - Luisa Rodriguez
- Department of Anesthesia (L.R.), Pain and Palliative Medicine, Universidad de La Sabana, Chia, Colombia; Asociación Colombiana de Cuidados Paliativos (L.R.), Bogotá, Colombia
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami (W.E.R. and F.M.K.), Coral Gables, Florida, USA; Department of Public Health Sciences (F.M.K.), University of Miami Miller School of Medicine, Miami, Florida, USA; Tómatelo a Pecho, Mexico City (F.M.K.), Mexico; Fundación Mexicana para la Salud (F.M.K.), Mexico City, Mexico
| | - Katherine I Pettus
- International Association for Hospice and Palliative Care (K.I.P.), Houston, Texas, USA
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