A Review of the Social Justice Concerns Related to the Integration of Palliative Care within the Kenyan Context

摘要

The World Health Organization (WHO) estimates that 40 million people are in need of palliative care worldwide, and of these, 37 million of them live in low- and middle-income countries (LMIC). Moreover, 98% of children who are in need of palliative care globally live in LMIC and almost half of them are living in Africa (WHO, 2015). Current palliative care needs are largely unmet and yet the need for palliative care is increasing due to the prevalence of HIV/AIDS, drugresistant tuberculosis, and increasing rates of cancer, chronic conditions and non-communicable diseases (Sternswärd & Clark, 2004; Blinderman, 2009). Kenya is a key region to examine because it is a lower middle-income country, the burden of disease is high, public funding of palliative care is very limited, and yet with the combined efforts of national associations, dedicated healthcare workers, Non-Governmental Organizations and charities, Kenya is one of only three African countries that is approaching full integration of palliative care – ranked alongside several high-income countries worldwide. Several international health and social justice agencies have highlighted that palliative care is a human right and should be recognized as a fundamental component of healthcare (Gwythner, Brennan & Harding, 2009); on the ground, the practice of this principal remains tenuous. In 2010 Human Rights Watch issued various hard-hitting reports on the state of palliative care in Kenya, highlighting a severe lack of governmental investments in palliative care service, particularly for children, and inadequate access or provision of essential palliative care medications such as morphine (Lohman & Amon, 2015). Since then, the 4 Kenyan Ministry of Health, in partnership with the Kenyan Hospices and Palliative Care Association (KEHPCA), has attempted to improve access to pain and palliative care services. Improvements such as including palliative care in the National Patients’ Rights Charter, issuing detailed plans to integrate palliative care into the Kenyan public health system, publishing National Palliative Care Guidelines, and recent purchases of publicly funded opioid analgesic in the form of oral morphine (Ali, 2016). Although there have been great strides in the establishment of palliative care services in Kenya, there are some overarching influential factors that complicate these efforts. There are also some key social justice concerns highlighted in the literature with regards to how inequity and stigma affect the facility of palliative care in Kenya. Through a comprehensive literature review in conjunction with my experiences from my internship with KEHPCA, I will discuss the hallmarks of palliative care in Kenya, the impacts of globalization, the increasing need for integrated services, the stigma and misconceptions that contribute to inequitable access, and finally explore the paradoxical relationship between social justice and this emerging public health issue.