Uterine torsion in pregnancy: Case presentation and review of literature

Objectives : Palliative care is a fundamental human right, but many people have no access. This study aimed to increase access to palliative care in 10 publicly funded former provincial and level 5 hospitals in Kenya. Design : Progress was tracked for seven years, between 2011 and 2017. Data collected using annual hospital submissions to the Ministry of Health, surveys with more than 600 people undergoing training and interviews with 125 key informants. Quantitative data were analysed using t-tests at the 95% level of confidence. Qualitative data were analysed using narrative theme analysis. Setting : Kenya Interventions : The interventions included creating national guidelines, requiring hospitals to offer palliative care, training professionals, setting up clinical placement sites, supervision visits, and engaging community volunteers, traditional leaders and the media to raise awareness. Main outcome measures: Number of people accessing palliative care in 10 former provincial and level 5 hospitals. Results: Combining national and hospital-based initiatives increased access to palliative care. Within two years, the number of people receiving palliative care in provincial hospitals doubled. The number of people helped decreased after national support was reduced but was still five times higher than baseline (5408 in 2017 compared to 854 in 2011, 533% increase). Conclusion: Resource-poor countries can increase access to palliative care. Success factors in Kenya were; government support, national coordination and empowering local hospitals and communities. Palliative care can be provided in all levels of care even in limited resource setting. Integration is sustained since services are incorporated into existing facilities and budgets.