FIGURE 7-1 The need for palliative care throughout the course of serious illness.

SOURCE: Reprinted, with permission, from WHO (2002). Copyright 2002 by WHO.

cancer, and to ways in which pain control can be expanded to form the core of expanded palliative care, which is taken up at the end of the chapter.

The earliest developments in palliative care began about 25 years ago. Given the poverty, political turmoil, and myriad other challenges the African continent has had to face, it would be surprising if much effort had gone toward easing the suffering of those dying from cancer and other diseases. Progress has been slow and only a small fraction of those experiencing pain or other symptoms today receive palliative care. The general picture of a few hospices (organized services specifically for people approaching death in a matter of no more than months) and other foci of palliative care (e.g., places that provide care for symptoms at any time of illness, up to and including the end of life), and the more widespread absence of such care, has been generally acknowledged, but little detail has been attached to it. A recent survey by the Observatory on End-of-Life Care provides the first systematic look at palliative care in a large number of African countries.

During 2004–2005, representatives from the International Observatory on End-of-Life Care (“the Observatory”) traveled around Africa meeting with contacts knowledgeable about palliative care (Personal communication, D. Clark, Director, International Observatory on End-of-Life Care, 2005). After surveying 47 countries, they developed a typology of 3 categories that captures the state of palliative care development in each country.