Palliative Care Ticks all the Astana 2018 Boxes

Palliative care was included in the #Astana2018 Declaration as an essential service of Primary Health Care (PHC). It ticks all the 1978 Alma Ata Declaration boxes regarding justice, equity and solidarity, and now meets the global health needs of the 21st century.  It is a recognised element of primary health care (PHC), an essential service under UHC, an engine for at least five goals of the 2030 Agenda for Sustainable Development (SDGs), and is human rights friendly. All the major religions of the world have endorsed it and according to the 194 member states that approved a World Health Assembly Resolution four years ago, it is an ethical obligation of governments and health systems.

The concept of ethical responsibility in WHA 67/19 aligns with Agenda 2030’s ethic of “global citizenship” and the Universal Declaration of Human Rights(UDHR), which recognises the “inherent dignity […] of all members of the human family.” Palliative care supports human dignity by relieving the severe physical, emotional, and spiritual suffering of patients and families facing life-limiting illness. As a bio-psycho-socio-spiritual approach to suffering, it affirms life while regarding dying as a natural process.

By recognizing and specifying palliative care as an essential service under UHC, the 2018 Astana Declaration reflects the incremental progress since Alma Ata 1978, in the global development of palliative care. Although still unavailable to millions who need it, palliative care services are slowly taking root around the world. The dedicated professional, multi-disciplinary teams who constantly struggle for professional recognition and support require more public funding through UHC. In the interim, as governments get organized around this, donor support is required to build capacity and reach all the hidden patients in need, those who are told to “go home because there is nothing more we can do.” Palliative care is the “more” that can always be done.

Uruguay PC

Even in 2018, the vast majority of palliative care is still provided by a shrinking handful of underfunded, understaffed, deeply committed, charitable and faith based organisations. May the 40th Anniversary of Alma Ata and Final Declaration inspire finance ministers and donors to recognize the fundamental value of primary and palliative care, and bring them into the policy limelight where they belong.

Governments that integrate basic palliative care into primary care services are more likely to achieve SDGs # 1, 3, 4, 5, 8, than those that don’t. Palliative care as part of UHC (Target 3.8) is a cost effective and ethical alternative to expensive hospitalisation and futile treatments (where available), which drive working families into the medical poverty trap. Community based palliative care supports household, local, and national economies, reducing health related workplace losses by at least 50%. (When serious illness hits a household, both the patient and at least one family caregiver leave the formal or informal economy). Community based palliative care teams that relieve this largely female, largely unpaid, caregiver workforce of the essential task of supporting disabled and dying loved ones, promote gender equality, education, and decent work.

Palliative care integrated into primary healthcare ticks all the global health boxes: clinical, social, economic, legal, spiritual and ethical. Now that it is included in the 2018 Astana Declaration, governments can partner with local, national, and regional palliative care associations to strengthen their health systems, train providers, implement internationally approved standards and guidelines, improve access to internationally controlled essential medicines, achieve the SDGs, and best of all relieve severe health related suffering #SHS.

For more information on what the International Association for Hospice and Palliative Care is doing to advance palliative care worldwide, and to support us by joining, please see