Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013

Details for Mechanism ID: 12125
Country/Region: Malawi
Year: 2010
Main Partner: African Palliative Care Association
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $200,000

Malawi has over 1 million people infected with HIV, and an estimated 25,000 living with cancer. For many of these people, curative treatment is unavailable, rendering them in need of palliative care, as a vital intervention to improve their quality of life. To this end, Malawi established the Palliative Care Association of Malawi (PACAM) in 2005 to work with health policy makers and service providers to scale-up palliative care in Malawi.

This project is a buy-in to a regional award to the African Palliative Care Association (APCA) with the Regional HIV/AIDS Program (RHAP) of the United States Agency for International Development (USAID), through the President's Emergency Plan for AIDS Relief (PEPFAR), for the scale-up of palliative care provision across several countries in Southern, Central and East Africa. In this project, APCA will continue to provide technical support to PACAM to strengthen local capacity in the provision of comprehensive palliative care services to people living with HIV/AIDS and their families.

The overall objective is to scale up palliative care services in Malawi through a partnership between APCA and PACAM by: 1) Strengthening the human and institutional capacity of PACAM to effectively coordinate palliative care development in Malawi; 2) Promoting linkages and sharing of knowledge between and among palliative care providers within Malawi; 3) Promoting, through advocacy, the availability of the essential drugs required for provision of palliative care in Malawi; and Coordinating and facilitating palliative care training and mentorship for NGOs, FBOs and government facilities to enhance the integration and provision of comprehensive palliative care within existing services.

The project will continue to build on the work that began in January 2008 with PEPFAR funding through PACT Malawi to PACAM/APCA. In the past two years with technical support from APCA, PACAM has strengthened its capacity to deliver comprehensive and holistic palliative care services, and provided technical support for palliative care in Malawi. Key health professionals at the Ministry of Health, NGOs, and CHAM have been trained to provide palliative care services; a strong working relationship has been established with the MOH; and a 5-day introductory palliative care course for health professionals accredited by the Ministry of Health has been developed.

To date twelve health professionals in Malawi (4 nurses, 2 doctors and 6 clinical officers) have received postgraduate qualifications in palliative care. 578 health professionals from district and CHAM hospitals have received an introduction to palliative care through a 5-day training. The 5-day training was delivered by those with postgraduate qualifications. As this project moves forward a mapping exercise will be carried out to establish the exact number of trained health professionals across the country to establish

which districts and facilities are adequately covered by trained palliative care staff and how they are using the knowledge they have acquired to support the ongoing development of palliative care in Malawi. Once this is established then it will be evident where the need for new trainings will be and can be planned accordingly.

Despite these successes, several challenges remain around legislation and policy; availability of opioids for pain relief; integration of palliative care into home based care services; and continued organizational development and technical support for PACAM to strengthen its role as a national coordinating and facilitating body. In July 2009 key MOH policy makers from Malawi visited Uganda to study the practice of scaling up morphine availability nationwide. The expected outcome of this visit was to support the development of opioid roll out in Malawi. With a national advocacy strategy in place this project will continue to advocate for improved drug availability and promote palliative care across Malawi.

The project will support Goals 3 and 4 of the Partnership Framework which seek to mitigate the economic and psychosocial effects of HIV and AIDS and improve the quality of life for PLHIV, OVC and other affected individuals and households; and to provide targeted, discrete systems strengthening in human resources, and procurement and supply chain management, respectively.

Budget Summary PFIP Year 1 Funding - $0 PFIP Year 2 Funding - $200,000

Funding for Care: Adult Care and Support (HBHC): $200,000

200,000 - Year 2

PEPFAR funds to APCA will support interventions that strengthen the human and institutional capacity of PACAM to effectively coordinate palliative care development in Malawi; promote linkages and sharing of knowledge between and among palliative care providers; promote the availability of essential drugs required for palliative care; and facilitate palliative care training.

Activity 1: Strengthen the human and institutional capacity of PACAM to effectively coordinate palliative care development in Malawi.

APCA supported PACAM to develop a clear strategic plan for 2009-2011. Through the implementation of the strategic plan and continued support to finalize and implement its fundraising strategy, APCA will assist PACAM to assess their sustainability and explore avenues through which this can be achieved. APCA will also support PACAM to assess and strengthen the organizational development needs of its member organizations, such as hospices; as well as work with PACAM to strengthen the monitoring and evaluation (M&E) of services. This will allow high quality data to be collected, analyzed and used for information and reporting on every PACAM activities by the PACAM secretariat and the wider stakeholders where relevant as well as forming a national palliative care a dataset for Malawi. As the M&E work develops and grows an M&E officer will be recruited to manage the dataset.

Activity 2: Promote linkages and sharing of knowledge between and among palliative care providers within Malawi.

PACAM will be supported to continue to promote linkages and sharing of knowledge between and among palliative care providers within Malawi through sharing of information and knowledge between and among palliative care providers within the country. Key activities will include collaboration with MOH to introduce palliative care into home-based care networks. APCA/PACAM will train all district home based care coordinators in palliative care. This training will be accredited by MoH so home based care coordinators will be certified as home-based palliative care trainers. Using the palliative care manual for volunteers APCA and PACAM will support MOH to train community volunteers in all 3 regions in Malawi. It is important to train community volunteers in palliative care to equip them with skills to deliver quality

palliative care. APCA will also establish a national taskforce team. A national taskforce team is essential to build links between the association, Government, MOH and other key players in palliative care.

Activity 3: Promote, through advocacy, the availability of the essential drugs required for provision of palliative care in Malawi.

APCA/PACAM will support ongoing advocacy training for in-country policy change that will facilitate the greater availability of pain relief drugs and the integration of palliative care services within the national HIV/AIDS framework. APCA/PACAM will also provide opioid guidelines orientation to prescribers using the opioid guidelines book currently being developed by APCA and PACAM. The handbook will act as a guide for morphine use to ensure morphine becomes widely used and phobias surrounding its use are eased amongst health professionals. APCA in collaboration with PACAM and MOH will develop a curricula and a training manual for prescribers and we will support MOH to provide prescribers' training. The training will help prescribers to understand the importance of morphine use for patients with severe pain and will focus on morphine storage, records keeping and reporting systems. It is expected that after the training prescribers will have reduced their fears regarding prescribing morphine to patients. APCA will also conduct district consultations to advocate for the inclusion of palliative care in district implementation plans; as well as strengthen referral networks for services.

Activity 4: Coordinate and facilitate palliative care education, training, standards and mentorship

In collaboration with MoH and with support from APCA, PACAM has finalized the development of a 5-day introductory palliative care course for health professionals and the training manual for this course has been finalized and piloted with great success. The course is recognized and accredited by the Ministry of Health. In view of this APCA, PACAM and the Ministry of Health will train trainers to deliver this course. PACAM has also been accredited by Medical Council of Malawi to provide Continuous Professional Development (CPD) for clinicians as a result of the impact of its work. APCA will train 10 master trainers. On completion of the 2-week training the participants will be accredited as MoH palliative care trainers. These Trainers of trainers will then train 30 Home based care workers and volunteers, including training of men as care givers using manuals developed by APCA. APCA has also developed palliative care standards for enhancing quality of care of patients with life-threatening illnesses and their families. The standards will be piloted in 3 sites that are involved in care provision. The results will allow the standards to be incorporated into the national palliative care standards and guidelines for Malawi.

Activity 5: Policy review to allow nurses prescribe opioids At present only doctors are able to prescribe opioids in Malawi. APCA and PACAM will enter into discussions with MOH and key stakeholders to advocate for policy change to allow nurses to prescribe


Cross Cutting Budget Categories and Known Amounts Total: $200,000
Human Resources for Health $200,000