From Rio Grande to Astana: The dream of palliative care as part of Universal Health Coverage must include primary care

In a recent post, Katherine Pettus, Sébastien Moine and Gulnara Kunirova explained why the Declaration of Astana’s decisive inclusion of palliative care as an essential service supports integration of our discipline into universal health coverage.  

In this post, we hear from Santiago Rodríguez Corrêa, a family physician, and Carla Mazuko, a nurse, with Estar ao Seu Lado – Cuidados Paliativos na Atenção Primária’, a project to promote palliative care in primary care and the community, in Rio Grande in the south of Brazil.

Santiago Rodríguez Corrêa and Carla Mazuko

The message in the title of this post is strong and clear. And that was the message conveyed at the Global Conference on Primary Care held in Astana, Kazakhstan, on 25 and 26 October 2018. More than just words, the message contains the key to reach the final objective to provide palliative care for all. But how can we do it given the many challenges facing primary care across the world?

During the last 40 years since Alma-Ata, solutions have not kept pace with the ever-increasing number of new challenges. And this is certainly true in the case of primary care and palliative care. The low funding of primary care, differences in relationship to its provision across the world, low degrees of awareness about what palliative care is, and the many doubts around the subject are just some of the many challenges.. Furthermore, many situations related to palliative care in primary care need to be studied but from the point of view of primary care.

Dr Santiago Corrêa (extreme right) is pictured with members of the International Association for Hospice and Palliative Care (IAHPC) delegation in Astana: (Left to right) Dr Sébastien Moine, Ms Gulnara Kunirova and Dr Katherine Pettus.

Yet, despite all the obstacles, there has been a fantastic step forward when we consider that palliative care is now included in the new Declaration of Astana. This huge achievement is down to the enormous advocacy efforts of many colleagues. Now is the time to keep moving forward and offering this approach to the biggest stakeholders: the person needing palliative care in primary care and their family members. To do that, we must plan and implement short-, middle- and long-term goals in accordance with the ideas proposed in the Declaration of Astana.

Brazil is making progress in palliative care. In particular, the process to build a National Policy, which started last year, is now complete and recently one important step was taken to finally achieve its implementation. However, as the Declaration of Astana supports the achievement of universal coverage of health for all it should be specifically focused on primary care.

Now that we have the basis for a strong policy that primary care should include palliative care we must develop ways to integrate primary care services into specialist services. We must enable wider and fairer access to appropriate specialist services for everyone in Brazil who has complex needs, and to create a greater care environment for all.

The city of Rio Grande celebrates its first ‘Palliative Care Municipal Week’.

Here in the Rio Grande, in the south of Brazil, we have continued our efforts to improve the skills of primary care professionals with courses for physicians and nurses. You can read about some of our past initiatives here. This year, the city celebrated its first ‘Palliative Care Municipal Week’ with seminars on topical subjects including: ‘Palliative care and the Catholic Church’, ‘Integrative practices’ and a major discussion about the legacy of Cicely Saunders.

We used the image of tied ribbons around the heart (pictured above) as the symbol for the week to highlight the dream of Universal Health Coverage by 2030. This symbolises our own dreams to unite Rio Grande to Astana and the hope that the new Astana Declaration will guide us to a future based on equity, compassion and universal health coverage for all – because ‘everyone matters’.

Links and resources

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