Marie Charlotte Bouësseau: Reflecting on a decade of work on palliative care at the World Health Organization.

Marie Charlotte Bouësseau from the World Health Organization retires this week.  The EAPC are pleased to be joining many others in paying tribute to her significant contribution to global palliative care.  Marie Charlotte has truly made a difference to the lives of people around the world requiring palliative care.  She has worked closely with the palliative care community and is known and respected by us all, and we wish her a long and happy retirement.  We are pleased to hear from her today with her reflections of notable progress in development of palliative care over the last decade.

Dr. Marie Charlotte Bouësseau.

After 10 years dedicated to establishing and leading the Ethics and Health team at WHO headquarters, I was asked to coordinate a new initiative on palliative care. This request was related to the preparation of an important new resolution on palliative care (which became the World Health Assembly resolution 67.19), adopted by the World Health Assembly in May 2014. Within the community of people working in palliative care, 2014 is rightly known as the year of a significant step made with this global commitment; truly the WHA resolution was crucial in making a strong call to WHO and its 194 Member States to include palliative care within Universal Health Coverage. It insists on the ethical duty to provide equitable access to good palliative care services to the people who need it, when and where they need it. Even if this is still far from being a reality, it is useful to reflect on the progress that has been made over the past decade. What has been achieved and what has changed for the people with severe health related suffering? How can we encourage more people to join this effort and serve the most vulnerable? Personally, I realise that working on palliative care has been one of my strongest ethical commitments. Despite many barriers, substantial improvements have been made and these should stimulate changes and facilitate the access to good palliative care for all the people who need it.

I believe one of the significant successes has been in enabling collaboration. WHO has a special mandate in convening global partners, creating partnerships between the best experts (people with international expertise and people with ‘on the ground’ experience), policy makers, national health authorities, representatives from civil societies, and all relevant stakeholders with an aim to address and build consensus on priority health issues. This strengthened collaboration among global partners active in the field of palliative care has been a key success factor over the past years and will continue to be crucial in the future.

Countless initiatives to embed and improve palliative care have been taken around the globe over the past years, but what was needed and was pivotal was to clarify the specific responsibilities of governments. To address these responsibilities in a concrete manner, WHO provided technical tools to support countries in developing integrated palliative care services, based on a primary health care approach. What I like to describe as the ‘palliative care house’ is a construction that can be adapted to the local settings, taking into account the specificities of the health systems, the local human and financial resources, and people’s needs and expectations. This construction requires the leadership of local health authorities.

World Health Organization diagram of the ‘house’ of palliative care.

WHO also works with countries on assessing the development of palliative care services and the identification of any gaps.  Such measurement is critical to develop health policies and strategies producing a tangible impact on the quality of care. Around the globe countries are now better prepared to strengthen palliative care, ‘leaving no one behind’.

Looking forward, numerous challenges still need to be addressed. I do believe palliative care is one of the best examples of integrated people-centred care; and converting this approach into a reality represents a revolution for health systems and requires a long-term commitment from many stakeholders. These profound changes can be largely facilitated by the engagement of the community at all stages of the decision-making processes including the equal participation, support by, and end of life literacy of, communities. Hence this can be visualised as the foundation of the palliative care house. A deep reflection around the issue of compassion in action is also becoming more and more relevant to improve the real quality of all health services, and this is essential in the field of palliative care. We should not forget that palliative care is somehow ‘the soul of health services’, and what we do in this field also has an impact on the quality of care in other domains.

The wonderful journey I was privileged to make working with WHO over the past two decades will now continue differently for me; time has come to ‘retire’ –  in other words to find new ways to remain serving the most vulnerable.

Links and resources

About the author

Dr. Marie-Charlotte Bouësseau is Team Lead in the Department of Integrated Health Services at the World Health Organization. After receiving her Doctor of Medicine degree from Paris University, she practiced cardiology in France for several years before undertaking post-graduate studies in epidemiology, social sciences, and philosophy in France and Chile. Since 1995, her activities have been wholly focused on questions of global public health and bioethics. For almost 10 years, she worked in Chile, where she took part in several projects of co-operation and set up a Bioethics Unit in the Ministry of Health. In November 2002 she joined the World Health Organization in Geneva to create the Ethics and Health Unit established by the Director General. She led the activities of this team for six years. Since 2014 to March 2023, she led the WHO activities on integrated palliative care.

This entry was posted in ADVOCACY & POLICY, INTERVIEWS & TRIBUTES, public health palliative care. Bookmark the permalink.

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