Investigating how the palliative care policy was implemented in the Shiseslweni region, Swaziland

Abstract

Background: Palliative care (PC) services in Swaziland were offered without policy guidance until in 2011 when a policy was enacted. This absence resulted in a fragmented approach to palliative care service delivery (Swaziland Ministry of Health, 2011). The absence of a PC policy resulted in the provision of PC services that lacked interdisciplinary collaboration. Aim: To explore the understanding of the palliative care policy and experiences with regard to implementation amongst health care workers in the Shiselweni Region from November 2011 to March 2015. Method: The study used a qualitative method using in-depth interviews with health workers and policy makers. Results: A total of 17 health workers participated in this study. The study showed that there was lack of knowledge about palliative care, confusion as to where palliative care should be offered and by whom and the role of providing medication as part of palliative care. Fascinatingly, the health workers mentioned the importance of different actors, the importance of teamwork and some perceived successes of palliative care implementation. Several challenges were reflected which included availability of medicines, human resources, transport, infrastructure, and lack of coordination of RHMs. Suggested strategies for improving palliative care that were pointed out comprise of training, improving medicine supply, organizational issues and the development of guidelines and standard operating procedures. Conclusion: Concerted action is needed to strengthen the availability of medicines and recruitment of human resources. Successful implementation of palliative care requires that local resources and customs are taken into account and that educational initiatives be undertaken to train health care professionals.