Inequality of access to palliative care and symptom relief is one of the greatest disparities in
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global health care (1). Currently, there is avoidable suffering on a massive scale due to lack of access to palliative care and symptom relief in low- and middle-income countries (LMICs) (1). Yet basic palliative care that can prevent or relieve most suffering due to serious or life-threatening health conditions can be taught easily to generalist clinicians, can be provided in the community and requires only simple, inexpensive medicines and equipment. For these reasons, the World Health Assembly (WHA) resolved that palliative care is "an ethical responsibility of health systems"(2). Further, most patients who need palliative care are at home and prefer to remain there. Thus, it is imperative that palliative care be provided in the community as part of primary care. This document was written to assist ministries of health and health care planners, implementers and managers to integrate palliative care and symptom control into primary health care (PHC).
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This publication aims to provide examples of better palliative care practices for older people to help those involved
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in planning and supporting care-oriented services most appropriately and effectively. Examples have been identifi ed from literature searches and from an international call for examples through various organizations, including the European Association of Palliative Care and the European Union Geriatric Medicine Society. Some examples consider how to improve aspects within the whole health system; specifi c smaller examples consider how to improve palliative care education, support in the community, in hospitals or for specifi c groups of people, such as people in nursing homes and people with dementia and their families. Some examples await rigorous evaluation of effectiveness, and more research is needed in this fi eld, especially the cost–effectiveness and generalizability of these initiatives.
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Consolidated Guidelines
Geneva, 2016
The End TB Strategy
WHO, in partnership with the International Society for Prosthetics and Orthotics (ISPO)
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and the United States Agency for International Development (USAID), has published global standards for prosthetics and orthotics. Its aim is to ensure that prosthetics and orthotics services are people-centred and responsive to every individual’s personal and environmental needs. The standards advocate for the integration of prosthetics and orthotics services into health services, under universal health coverage. Implementation of these standards will support countries to fulfil their obligations under the Convention on the Rights of Persons with Disabilities and towards the Sustainable Development Goals, in particular Goal 3: Ensure healthy lives and promote well-being for all at all ages.
The standards provide guidance on the development of national policies, plans and programmes for prosthetics and orthotics services of the highest standard. The standards are divided into two documents: the standards and an implementation manual. Both documents cover four areas of the health system:
policy (governance, financing and information);
products (prostheses and orthoses);
personnel (workforce);
and provision of services.
The Standards have been developed through consultation with experts from around the globe via a steering group, development group and external review group.
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mhGAP is based on evidence-based technical guidelines (4) and provides a set of tools and
training packages to extend service provision. The mhGAP Intervention Guide (mhGAP-IG)
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for MNS disorders in non-specialized health settings (8) is a clinical decision-making tool
for assessing and managing priority MNS conditions (depression, psychoses, epilepsy, child
and adolescent mental and behavioural disorders, dementia, disorders due to substance
use, self-harm and suicide).
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The ICOPE guidance for person-centred assessment and pathways in primary care (ICOPE Handbook) h
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elps community health and care workers put the recommendations outlined in the ICOPE Guidelines into practice. The Handbook assists with setting person-centred goals, screening for loss in a range of domains of intrinsic capacity and assessing health and social care needs to develop a personalised care plan. The care plan may include multiple interventions to manage declines in intrinsic capacity, provide social care and support, support self-management and support caregivers. The domains of intrinsic capacity include cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss and depressive symptoms.
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Submission by the WHO Collaborating Centre on training and policy on opioid availability
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and WHO collaborating Centre for community participation in palliative care and long term care To the Indian Nursing Council for consideration to be included in the Undergraduate Nursing education curriculum
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This report provides an overview of the operations and activities of the WHO Country Office in Ukraine
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in 2023. Despite the acute health impacts of the war in Ukraine, the Country Office continued its work according to its core mandate. WHO supported the Government of Ukraine in managing the health emergency and pursued existing priorities set out in WHO’s Thirteenth General Programme of Work 2019–2023, the European Programme of Work 2020–2025, and the Biennial Collaborative Agreement 2022–2023 signed with the Government of Ukraine. The report presents the achievements of the WHO Country Office in Ukraine in 2023 in the context of the war’s impact on the lives, health, and well-being of Ukrainians.
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Tuberculosis (TB) is, and should be, a curable disease; however, each year significant numbers of patients acquire or develop drug-resistant TB, which has a much lower cure rate. Patients with drug-resistant TB have a high prevalence of sympto
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ms; hence, staff caring for these patients should have some familiarity with palliative care, so that general palliative care principles are available to all patients. The timely identification, and addressing, of adverse events occurring during the treatment course is considered as general palliative care for those receiving curative treatment. This publication summarizes the general palliative care approach, which is recommended for use in settings and services that occasionally treat palliative care patients, but do not provide palliative care as the main focus of their work. The review focuses on 18 high TB priority countries of the WHO European Region.
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It provides insight into WHO’s work that aims to improve the health of the people of the United Republic of Tanzania in collaboration with key stakeholders.
Good practice examples from India
The WHO document "Integrating the prevention and control of noncommunicable diseases in HIV/AIDS, tuberculosis,
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and sexual and reproductive health programmes: implementation guidance" provides a framework for integrating noncommunicable diseases (NCDs) into existing health programs for HIV/AIDS, tuberculosis (TB), and sexual and reproductive health (SRH). It emphasizes the importance of a people-centered approach to enhance healthcare accessibility and efficiency, especially in low-resource settings. The document outlines strategies for strengthening policy, financing, capacity building, and health system infrastructure. It offers actionable steps, tools, and case studies to support countries in reducing the burden of NCDs through integrated, holistic care within primary health services.
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Regional Network for Equity in Health in east and southern Africa (EQUINET): Disussion Paper 109
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This report describes the evolution of mainland Tanzania’s EHB; the motivations for developing the EHBs, the methods used to develop, define and cost them; how it is being disseminated, communicated, and used; and the facilitators (and barriers) to its development, uptake or use. Findings presented in this report are from three stages of analysis: literature review, key informant perspectives and a national consultative meeting.
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This report presents an overview of the transition process in Azerbaijan, some sustainability aspects and challenges stemming from donor withdrawal from TB-related activities, along with recommenda
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tions on how to overcome transition-related difficulties and ensure sustainability.
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An international field study by African and German theologicans and health workers.