The general lack of palliative care in national health policies, education programmes and health services leads to health systems that are too weak to achieve quality and comprehensive services for their populations. Yet palliative care interventions, based on WHO's public health model and health systems agenda have great potential for strengthening health systems to deliver quality services. APCA is implementing strategies that target all these components and pillars of the health system, as well as the stakeholders within these, including: policy makers, legislators, service providers and educationalists.

Several factors exert an adverse influence on the provision of palliative care services for the majority of people in Africa. Firstly, palliative care is a relatively new discipline on the continent and its development is hampered by the fact that it is not integrated into national health systems. Consider the following status samples of palliative care in 53 African countries:

• Four countries -- Kenya, South Africa, Tanzania, and Uganda -- have palliative care integrated into either their health or their cancer strategic plans. 
• Three countries – Malawi, Zambia and Namibia -- have integrated palliative care in their HIV and AIDS national health policy; Uganda has also integrated palliative care in its national health policy besides its integration in the national health strategic plan.
• Two countries -- Rwanda and Swaziland -- have developed stand-alone national palliative care policies and/or guidelines. Malawi has also developed national palliative care guidelines and is in the process of developing a national policy. Rwanda has also adopted national palliative care standards.
  
• Five countries –Kenya, Malawi, South Africa, Botswana and Uganda -- have palliative care integrated in the curricula of health professionals. These countries have recognised palliative care as an examinable subject. The status of palliative care integration signifies a significant deficit in skills training.
• Three countries – Malawi, Kenya, and Botswana -- have developed and are implementing a palliative care national training package, while Namibia, Tanzania and Uganda are in the process of developing a national training package.

Most palliative care is provided by non-governmental, faith-based or community-based organisations with no inbuilt sustainability mechanisms. These challenges are exacerbated by poor health and social care infrastructures in many African countries as well as the lack of available health financing.  In addition, there is a widespread lack of understanding of what palliative care actually is and its corresponding benefits.  Palliative care is often perceived to be synonymous with end of life care, death and hospice, or as a means of relief for physical pain exclusively.  

APCA encourages governments throughout Africa to make use of the four-pillar enhanced public health model of palliative care provision to support a population- based approach to palliative care development.  This approach focuses on palliative care integration into national health systems to increase service accessibility for patients in need.