Initiative
Lebanon has a high burden of cancer. In 2018 alone, 17 294 individuals were diagnosed, and 8 976 individuals died of cancer in the country. The high cancer prevalence, combined with an ageing population, re-emphasizes the increasing need for palliative care services in the country. Palliative care services can improve the quality of life for patients by contributing to better symptom and pain control, reducing length of hospitalization and preventing unnecessary emergency care. However, Lebanon faced major challenges in providing palliative care services within their public hospitals.
To reinforce palliative care services in the country, Lebanon’s Ministry of Public Health, the World Health Organization (WHO) and Rafik Hariri University Hospital collaborated with SANAD, a non-profit organization for home-based hospice care, to conduct palliative care training for healthcare professionals in 2018. The aim was to support the integration of patient-centered palliative care services to improve patient experience and improve patient and caregiver satisfaction.
Context
In 2016, noncommunicable diseases (NCDs) were responsible for approximately 91% of all deaths, while cancer was responsible for 27.2% of all NCD-related premature deaths occurring before the age of 69 years in Lebanon. Despite the high burden, and the associated morbidity, minimal focus was placed on palliative care to alleviate suffering. To bridge this gap, WHO called for the integration of palliative care services at all levels of health care as indicated in the World Health Assembly Resolution 67.10, which emphasizes the need for better integration of services to meet the increasing demand for palliative care.
In the last two decades, Lebanon’s Ministry of Public Health has facilitated improvements in the health system performance by implementing hospital autonomy, introducing accreditation and ensuring access to quality care. Collaborative governance allowed this progress through partnerships with nongovernmental organizations and a holistic approach to health promotion, prevention and care.
Initiative
In an effort to support the development of palliative care services in public hospitals, the Lebanon Ministry of Public Health, WHO and Rafik Hariri University Hospital collaborated with SANAD to provide technical support in developing a hospital-based palliative care service at the Rafik Hariri University Hospital. SANAD conducted a needs assessment and consultations to inform the design of a palliative care training programme, which also provided capacity-building and shadowing of the Rafik Hariri University Hospital palliative care team.
Between April and December 2018, SANAD conducted a total of 89 consultations with the trained palliative care team at Rafik Hariri University Hospital. The team comprised 36 healthcare professionals, including a physician, nursing supervisors, nurses, pharmacists, and social workers. The series of training workshops provided the palliative care team with the knowledge and capacity to provide accessible and affordable high-quality palliative care services in one of the largest government hospitals in Beirut.
Impact
Feedback from the multidisciplinary health workforce about the training has been positive. The patient-centered approach of palliative care has helped improve patient experience and empowered the health workforce, leading to higher patient and caregiver satisfaction. Many health workers reported a positive change in their perception of palliative care.
With WHO’s support, the initiative was extended to Ain Wazein Hospital, where the palliative care team was trained and is now offering palliative care services to patients. SANAD’s training has empowered the palliative care team in this hospital to deliver community-based palliative care services.
Lessons learnt
Sustained commitment of health ministries to address the health gap is essential for the success of the national palliative care agenda. Lebanon’s Ministry of Public Health is proactively finding ways to improve its health system performance by implementing hospital autonomy, introducing accreditation, and ensuring access to quality care. This led the Ministry to explore innovative ways to address palliative care needs in the country and engage key stakeholders in improving services.
Collaboration between government, nongovernmental organizations and a diverse set of stakeholders can help scale-up progress for the initiative. The contribution of various stakeholders from the nongovernment sector played a critical role in the success of the programme as they shared specific knowledge, experience and skills with providers in the public sector. Open collaboration between multisectoral and multidisciplinary experts can provide new perspectives on how to improve palliative care services in the country.
The situation analysis and needs assessment helped in better contextualizing the needs of the local community. To ensure success, however, it is important to select a project site that has sufficient resources and capacity to support a larger number of people in the community.
The success of the SANAD project at Rafik Hariri University Hospital illustrates the feasibility of implementing palliative care services in large public hospitals in Lebanon. This project, its outreach and community-based palliative care services planned for Ain Wazein Hospital demonstrate that hospital-based palliative care can be integrated in different ways: through outpatient clinics, consultation services for hospital inpatients, daycare services, inpatient palliative care units, or palliative care outreach services.
It is important to deliver adequate support to hospital administration and healthcare workers to record satisfactory success while helping to develop palliative care services. Providing incentives such as financial support, appropriate infrastructural support and reasonable time allocations while introducing a new initiative were key requirements for facilitators to initiate and sustain the palliative care services at Rafik Hariri University Hospital.
Related links
Eastern Mediterranean Health Journal special edition on palliative care
Lebanon cancer country profile 2020
Story originated in 2021.