Substance Abuse
the palliative care services have started focusing more on ensuring support to patients who no longer require acute care but who cannot yet be supported through home-based care. These services includes a number of areas critical to ensuring treatment adherence, such as ensuring adequate food supply, safe water supplies, information, and community support.
On the other hand, some countries are seeing pal- liative care moving down in the priority list. Particularly in situations where financial resources are constrained, there is a lot of pressure (both within the country and from donors) to put funding to work on the ‘highest impact’ interventions. Palliative care, while a neces- sary component, is not as immediately or financially impactful, and has not been subjected to the same degree of cost-effectiveness research. Therefore many national programmes find themselves in a position where resources are being concentrated on individual interventions such prevention, diagnosis, and treatment initiation and adherence – rather than on developing one overall approach.
Zambia, for example, has recently reduced the proportion of its Global Fund grant financing allocated to palliative care because the country anticipates that by increasing funding for treatment and adherence support,
the number of people who are chronically ill and who require home-based care will eventually decrease. Nonetheless, the need for palliative care will
continue to exist. Despite advances in education and treatment, there are still many people who seek out treatment too late in the progression of their disease, and who will need a coordinated system of care which includes not only medical interventions but also psy- chosocial support in dying.
While the Global Fund finances all programmes or interventions which can be proven to be scientifically sound and technically feasible, it does not prescribe which approach countries should take, relying instead on local expertise to design strategies and priorities appropriate to the local context, epidemic, and culture. This is the cornerstone of the Global Fund model, or what is known as country ownership.
As countries evolve from an emergency response to a more sustained and sustainable management of the fight against the three diseases, so too will their approach to providing health care to those affected by HIV, TB, and malaria.
If you would be interested in receiving the Global Fund’s electronic newsletter, please visit the website at
www.theglobalfund.org to register.
July 2012
Africa Health 47 Africa Health 15
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