• Shaun Bateman

Recent report shows South Africans have unequal access to services

to relieve suffering at the end of life

A recently-published Inequalities Trends report by the national statistics service of South Africa indicates millions of black South Africans may lack access to public services, which also provide relief from pain and suffering at the end of life.

The Inequalities Trends report shows that 8 out of 10 of black African-headed households usually use public healthcare facilities when a household member gets ill, compared to 10% of white-headed households.

Akhona* from Port Shepstone, Kwazulu – Natal travels nearly 15 kilometers to reach her nearest public hospital to receive Tuberculosis treatment.

She has experienced public service access challenges firsthand, spending R25 for a trip to a public clinic and losing a full workday’s wage in waiting for essential medications and palliative care services due to long cues.

“Access to palliative care is definitely needed in our community, however many people can’t afford to travel to hospitals to collect their medication - resulting in them defaulting and becoming ill," she said.

To address the nationwide public health gap in palliative care services, the Department of Health has developed a National Policy Framework and Strategy on Palliative Care 2017– 2022, which estimates that 45-50% of people who died in the country could have benefitted from palliative care, according to 2014 figures.

Although this palliative care policy and framework is in place, there is no national plan or budget for implementation.

In the meantime, the majority of South Africans that do access palliative care services continue do so through referrals from public clinics to nonprofit hospices.

Rural communities pay the price for dwindling hospice funding

However, in recent years donor funding for NGO hospice services has been dwindling, highlighting an urgent gap in essential care to reach low-income rural communities in need of palliative care services, without catastrophic financial hardship placed upon families.

“We now recognise the need to create equitable access to palliative care for a range of both communicable and non-communicable diseases and it is no longer an option that only certain communities benefit from such care,” writes former Minister of Health, Dr PA Motsoaledi, in the national policy and strategy framework.

Hospices in South Africa support more than 100,000 people of the nearly 2.5 million people living with terminal and life-limiting conditions in South Africa each year, 67% of which are black and access palliative care primarily through community-based settings.

“South Africa has one of the highest burdens of need for palliative care in the world and needs increased public investment and support to hospices and clinics to come close to meeting the need in the country,” said Dr Stephen Connor, Executive Director of the Worldwide Hospice Palliative Care Alliance.

Further, South Africa’s 104 hospices dispersed across the provinces don’t just focus on end-of-life care. They are out in the community providing TB control, family education, diagnosis and infection control, as well as going into clinics to provide basic HIV treatment.

Hospice funding cuts could result in critical gaps in these essential services.

“Suffering from pain caused by life-threatening illness is unnecessary pain, and it is unacceptable in today’s world. Palliative care is a human right, and it should not be denied to anyone who needs it,” said Dr Ewa Skowronska, Chief Executive Officer of the Hospice Palliative Care Association of South Africa.

While the Department of Health has been working to strengthen the public health system over the next five years, a national budget for palliative care for the majority of South Africans dependent on public services, just can’t come soon enough.