Palliative care in the Eastern Mediterranean: comparative analysis using specific indicators

Background Monitoring the development of palliative care (PC) illustrates the capacity of health systems to respond to the needs of people experiencing serious health-related suffering. Aim To analyse comparatively the situation of PC in the countries of the Easter Mediterranean region using context-specific indicators. Method An online questionnaire with 15 context-specific PC indicators investigating service provision, use of medicines, policy, education, and vitality was designed. Authors Institution 1 nominated in-country experts to complete the survey. Data were analysed using a comparative description of indicators per domain and a multivariate analysis. Results In-country experts were identified in 17/22 countries. 12/17 contributed to the survey. In total, 117 specialized PC services were identified. Specialized services per population ranges from 0.09 per 100,000 inhabitants in Lebanon and Saudi Arabia, Qatar and Kuwait; to zero services in the Occupied Palestinian Territories. On average, opioid consumption was 2.40 mg/capita/year. National PC strategies were reported in nine countries. In six countries, PC is officially accredited either as a specialty or sub-specialty, and PC mandatory courses are implemented in 36% of medical schools and 46% of nursing schools. National PC associations were documented in six countries. A higher pattern of development was identified in Jordan, Kuwait, Saudi Arabia, Oman, Lebanon, Qatar. Conclusions Despite a higher development in the Arabian Peninsula, the region is characterised by a very low provision of specialized PC services and opioid consumption. Policy improvements represent an opportunity to improve access to PC. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01047-7.

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Information from this survey will be used to prepare a technical report and a further survey on the current status of palliative care progress in the region. By continuing with the survey, you agree to take part in this study.
You can exit the survey at any time and your responses will be saved once you have finished each section. Please rate the indicators to the best of your knowledge. You can also download the questionnaire in a pdf format, so that you can read the questions before you complete it or by using the pdf form and returning it to us via e-mail if you prefer.
You will be formally acknowledged in the acknowledgement section of the technical report. If you do not wish to be publicly acknowledged please tick the box below. INDICATOR 1: Existence of a current national palliative care plan, programme, policy or strategy Concept: National plan or programme refers to regulatory and official publications that are applicable to the whole country (these could be in the form of laws or other official documents). These publications are usually endorsed by the national health authority and contain norms and standards for the development of palliative care, Regulations relating to its service provision and in some cases guidelines for palliative care research. It should: (I) be of national scope; (II) be designed to integrate palliative care in health care services; (III) have an allocated budget; and (IV) have an assigned focal point at national level.

INDICATOR 3: Inclusion of palliative care services in the basic package of health services
Concept: Basic package of health services are a set of services identified by countries which stipulates what should be available and provided at primary health care level in the country. Based on global and regional UHC commitments, one of those services included in the basic package of health services should be palliative care. This indicator aims at assessing only the inclusion of palliative care in the list of services provided at primary care level but not its implementation. The inclusion of the specific palliative care term in the list is compulsory in order to answer "yes" to this indicator.

Have palliative care services been included in the basic package of health services? Please select.
Yes, for all patients, with any diseases Yes, but only for patients with oncological diseases No I do not know

INDICATOR 4: Allocation of funds for palliative care in the national health budget by the Ministry of Health or equivalent Government Agency
Concept: Ministry of Health or equivalent government agency has reserved some type of funding in the annual national health budget for palliative care provision.
How is palliative care funded in your country? Please select all applicable options. For the purpose of this questionnaire we are interested in the total number of palliative care services operating in your country. These include, but are not limited to: (I) free standing hospices with or without inpatient beds, (II) hospices that are a part of public or NGO hospitals, (III) home care teams, (IV) palliative care support teams in hospitals, (V) palliative care inpatient and outpatient facilities, (VI) pediatric palliative care hospices and services. Our focus is on services that are providing specialized / specialist palliative care as their primary mission. We also note that a palliative care service provider organization may have more than one local service in operation. Please therefore report information on the number of palliative care services in your country, recognizing that this is likely to be greater than the number of provider organizations. Importantly, Palliative Care services may be unequally distributed in the country causing accessibility problems and overall big in-country differences between regions, cities, rural and urban areas, etcetera. We want to measure to what extent the different modalities of provision of palliative care services across the country extend geographically.
What was the total number of palliative care services operating in your country in 2020?
Is the above figure your personal estimate?  Children's palliative care services are available through a variety of palliative care providers and types of services.
Children's palliative care services are available through a variety of palliative care providers and types of services on an continuos basis.

INDICATOR 8: Availability of centres of excellence for palliative clinical care, education and research
Concept: A center of excellence for palliative care is a program within a healthcare institution which is assembled to supply an exceptionally high concentration of expertise and related resources centered on palliative care. It delivers associated care in a comprehensive, interdisciplinary fashion to afford the best patient outcomes possible. Palliative care is delivered in a unique and focused manner to patients. Besides the center has significant research component and the staff members receive clinical capacity building to ensure that they understand and can relate to patients (adapted from Elrod and Fortenberry, 2017 Step 1 of the ladder (e.g. paracetamol, aspirin) Step 2 of the ladder (e.g. codeine, tramadol) Step 3 of the ladder (e.g. morphine, fentanyl)

Please tell us to what extent patients in need of palliative care in your country have access to each step of the ladder. Select access.
Education domain

PALLIATIVE CARE DEVELOPMENT STATUS IN THE EMRO REGION UPDATE 2020
INDICATOR 10: Existence of a process of official specialisation in Palliative Medicine for physicians, recognised by the competent authority Concept: Official specialisation in palliative medicine refers to any formal process (or schedule of training/education) that provides official certification and accredits a higher level of competence to the physician working in the area of palliative medicine.
In case you have a specialization, please estimate the number of certified palliative care professionals.
Existence of an official process for the specialization in palliative medicine for physicians, accredited by the national responsible authority (as specialty, sub-specialty, special area of competence or other advanced accreditation diploma)? Please select.
Yes, special area of competence or other advanced accreditation diploma.
No, but a process of specialisation is in progress.
No, but a specialisation done abroad is officially recognized in the country.
No, but basic training courses are available in the country No, but informal process of training is available in the country No, there is no established, in progress, or, recognised specialisation process or diplomas to certify competency Don't know

INDICATOR 11: Education for pre-qualification doctors/nurses
Concept: This indicator explores palliative care undergraduate education and training in the country.
What is the total number of medical schools in the country?
Number of medical schools that offer a mandatory course or subject specifically dedicated to palliative care as part of their curricula.
Number of medical schools that offer mandatory palliative care education in combination with other related disciplines (e.g. a mandatory course of oncology and palliative care).
Number of medical schools that teach mandatory palliative care transversally, integrated into the curricula.
Number of medical schools that teach palliative care optionally.

Please fill in the next questions about medical schools
What is the total number of nursing schools in the country?
Number of nursing schools that offer a mandatory course or subject specifically dedicated to palliative care as part of their curricula.
Numer of nursing schools that offer mandatory palliative care education in combination with other related disciplines (e.g. a mandatory course of oncology and palliative care). What is the level of public awareness of palliative care in your country?
There is no type of social awareness for palliative care Most people don't care about palliative care Some sectors of the society recognize the importance of palliative care A significant proportion of the society agrees with the importance of palliative care The public awareness of palliative care is generalised in the society