The APCA Atlas of Palliative Care in Africa 2017 (APCA Atlas) was conceived in January 2016. We felt there was a lack of comprehensive, up-to-date information on palliative care development in Africa. Therefore, we decided on a context-specific African project, context-specific, combining our previous expertise with the in-depth and rich knowledge of our African colleagues in the field. African palliative care professionals have shared with us the important issues in palliative care development in Africa and helped us develop the indicators used in this Atlas. The APCA Atlas adds to the growing body of regional atlas projects led by University of Navarra such as the EAPC Atlas of Palliative Care in Europe, the ALCP Atlas of Palliative Care in Latin America, and the Eastern Mediterranean Atlas of Palliative Care.
The APCA Atlas of Palliative Care in Africa comes at a crucial time where palliative care is growing in African countries, but the growth has been unevenly distributed. Furthermore, this is the first report of its kind to comparatively analyse African countries’ progress in palliative care, and there has been no document providing a comprehensive overview of the palliative care situation in Africa in the past decade. As in previous atlases, the current APCA Atlas covers countries that fall under the umbrella of the regional palliative care association, in this case, the African Palliative Care Association (APCA).
For the present publication, we wanted to improve on the methodology used in the EAPC and ALCP Atlases by initially studying and developing indicators specific to palliative care development in Africa. This consisted of a series of interviews with experts from seven different African countries followed by indicator extractions from those interviews and rating of those indicators by 16 African experts in palliative care. The indicators then went through a rigorous two round Delphi consensus process with 14 international committee members who are experts in palliative care indicators. Finally, the indicators were ranked internally by the project team to arrive at the final set of 19 indicators used to build the current report.
We have also decided on a smaller set of more specific indicators than previous atlases in Europe and Latin America for greater ease in comparative analysis and obtaining only that information which is most pertinent to palliative care development in Africa. The present APCA Atlas provides information on 89% (48/54) of countries on the continent and provides a cross-country comparison of the progress of palliative care in Africa. Information was provided by country key informants in each country, which consisted of leaders of national palliative care associations, members of the Ministry of Health, or experts within each country defined as either the leader of an important hospice or palliative care service or among the few persons working to further palliative care progress within the country.
Therefore, in the current APCA Atlas, we are working with “best estimates” provided by such experts. However, as information is scarce in many countries in Africa, and since methodology must be uniform across all countries included in the study, we believe obtaining information through experts to be the best way to obtain such data within the current constraints. Where available, we have cross-compared data provided by experts with the peer-reviewed literature through a scoping review of palliative care development in Africa from 2005-2016. We have also checked the information with the African Palliative Care Association, as the regional representative body for palliative care on the continent as well as other atlases, such as the Eastern Mediterranean Atlas of Palliative Care, where some African countries were also included.
Following this APCA Atlas, we will continue to work on secondary analyses of the data we have collected for publication in a series of scientific papers and reports. We will focus on disseminating this information to key experts in African countries so that it may be used for advocacy efforts in working with governments and Ministries of Health.
We truly thank all of those who volunteered their time for the project. We thank the key informants, country experts, and international committee members for all of their assistance in making this APCA Atlas a reality as well as their tireless work in building up palliative care in their respective countries.