Empowering Nations to Advance Palliative Care Through WHO's Actionable Indicators

The ATLANTES Global Observatory, in collaboration with WHO, piloted a DIY framework using 14 indicators to assess and enhance palliative care systems in Benin, Morocco, and Uruguay. The initiative highlighted gaps, strengths, and actionable strategies to improve access, training, and policy integration, fostering global health equity.

The ATLANTES Global Observatory of Palliative Care at the University of Navarra, in collaboration with the World Health Organization (WHO), spearheaded an innovative initiative to evaluate and enhance palliative care systems in three pilot countries: Benin, Morocco, and Uruguay. Published in the Journal of Pain and Symptom Management, the project addressed the urgent need for palliative care, which affects over 56.8 million individuals globally each year, most of whom live in low- and middle-income countries. Recognized as an ethical and essential health service by the World Health Assembly, palliative care was integrated into WHO's Universal Health Coverage agenda through a structured framework called the "House of Palliative Care." This model uses 14 indicators across six dimensions—health policies, research, education, medicines, community empowerment, and healthcare services. The project adopted a “do-it-yourself” (DIY) methodology, empowering countries to self-assess their systems, identify gaps, and develop strategic plans for improvement without external dependency.

Benin: A Promising Start in Africa's Palliative Care Journey

Benin was the first country in the WHO Africa Region to pilot this approach, with workshops held in February 2023 in Cotonou. The workshops brought together 36 stakeholders, including representatives from the Ministry of Health, NGOs, universities, and healthcare providers. This marked an important step toward integrating palliative care into national health systems. The assessment revealed several strengths, such as a validated five-year national plan for palliative care and the presence of advocates for patients’ rights. However, significant gaps were identified, including the absence of a national policy on advance care planning, limited access to essential medicines, and the lack of specialized training in palliative care for healthcare professionals. The findings highlighted a need to strengthen education, as no medical or paramedical schools in Benin currently offer training in palliative care. Despite these challenges, the country has 11 specialist palliative care teams and significant potential for expanding pediatric palliative care programs. The SWOT analysis identified opportunities for community engagement, yet funding limitations and resistance to change emerged as barriers to progress.

Morocco: Bridging Policy and Practice in Palliative Care

In July 2023, Morocco became the second pilot country, with workshops held in Rabat. The process involved stakeholders from the Ministry of Health, universities, clinicians, and civil society organizations. Morocco’s relatively advanced healthcare infrastructure supported the inclusion of palliative care in national health policies and guidelines for noncommunicable diseases. However, the workshops revealed persistent gaps, such as the absence of a national guideline for advance care planning and limited training for healthcare professionals. Out of the country’s 18 medical schools, only three offered formal palliative care education, and the specialty was yet to be officially recognized for doctors. Access to essential medicines remained a challenge, with limited availability of oral morphine, an important component of pain management. Nonetheless, the country demonstrated significant strengths, including 26 specialized palliative care teams and a robust framework for defending patients’ rights. Morocco’s pilot underscored the need for a comprehensive strategy to ensure equitable access to services, expand training programs, and enhance monitoring mechanisms.

Uruguay: Advancing Established Systems for Greater Equity

Uruguay, the final pilot country, conducted workshops in Montevideo in September 2023. With a well-established palliative care system, the country offered insights into optimizing existing frameworks. Over 60 participants, including representatives from the Ministry of Health, universities, and the Uruguayan Society of Medicine and Palliative Care, contributed to the assessment. Uruguay has had a National Palliative Care Plan since 2013, which facilitated the integration of services into the healthcare system. The country’s opioid consumption rates were among the highest in the region, reflecting improved access to pain management. However, regional disparities in service availability and limited training for healthcare professionals presented challenges. While two out of three medical schools included compulsory palliative care modules, formal specialization in the field remained unavailable. Uruguay’s 79 specialized palliative care teams achieved a 69.7% coverage rate, but the assessment highlighted the need for equitable distribution of services and expanded training programs. The SWOT analysis identified opportunities to update data collection methods and strengthen national planning, with potential threats including resource constraints and growing demand for services.

Transforming Global Health Through Evidence-Based Action

The pilot projects in Benin, Morocco, and Uruguay demonstrated the feasibility and effectiveness of WHO’s DIY approach for palliative care assessment. By engaging local stakeholders and using practical tools, the initiative empowered countries to conduct self-assessments and develop tailored action plans. SWOT analyses across the three countries revealed common strengths, such as strong government commitment and active civil society engagement, alongside weaknesses like insufficient funding, limited training opportunities, and gaps in service accessibility. Opportunities included increasing stakeholder collaboration and scaling up successful models, while threats ranged from resistance to change to limited resources. This methodology fostered community participation, trust-building, and knowledge exchange, creating a replicable model for other regions.

The ATLANTES initiative underscores the importance of contextual adaptation and continuous assessment in advancing palliative care globally. By aligning healthcare policies with WHO indicators, the project provided valuable insights for addressing disparities and strengthening healthcare systems. The findings highlight the transformative potential of evidence-based approaches in reducing global health inequities and ensuring access to essential services for those in need. With its focus on collaboration, innovation, and inclusivity, this initiative offers a pathway for integrating palliative care into healthcare systems worldwide, ultimately improving the quality of life for millions.