Final Evaluation Report for the INTEGRATE PALLIATIVE CARE PROJECT This project was supported by the Tropical Health & Education Trust (THET) as part of the Health Partnership Scheme, which is funded by the UK Department for International Development (DFID)” Integrate Evaluation Report Format Page 1 of 180 September 2015 Glossary ..................................................................................................................................................... 8 1 Introduction ...................................................................................................................................... 10 1.1 Background ............................................................................................................................. 10 1.1.1 Palliative Care ................................................................................................................. 10 1.1.2 Context ............................................................................................................................. 10 1.1.3 Need for Palliative Care in Africa ................................................................................. 10 1.1.4 Models of Palliative Care in Africa ............................................................................... 11 1.1.5 Barriers to the delivery of Palliative Care in SSA ...................................................... 11 1.2 Integration of Palliative Care in Health Systems ............................................................... 12 1.2.1 Public Health Approach to Palliative Care .................................................................. 12 1.2.2 WHA resolution on Palliative Care Integration ........................................................... 13 1.3 The Integrate Palliative Care Project ................................................................................... 14 1.3.1 Project Goal ..................................................................................................................... 14 1.3.2 Project Pillars .................................................................................................................. 15 1.3.3 Project Indicators ............................................................................................................ 18 1.4 The Integrate Project Evaluation .......................................................................................... 19 1.4.1 Evaluation Process......................................................................................................... 19 1.4.2 Evaluation Team ............................................................................................................. 19 1.4.3 Data Sources Used ........................................................................................................ 21 1.4.4 Evaluation Objectives .................................................................................................... 21 2 Countries of Operation................................................................................................................... 23 2.1.1 Health System in Kenya ................................................................................................ 23 2.1.2 Palliative Care in Kenya ................................................................................................ 25 2.2 Rwanda .................................................................................................................................... 25 2.2.1 Health System in Rwanda ............................................................................................. 25 2.2.2 Palliative Care in Rwanda ............................................................................................. 26 2.3 Uganda ..................................................................................................................................... 27 2.3.1 Health System in Uganda ............................................................................................. 27 2.3.2 Palliative Care in Uganda .............................................................................................. 28 2.4 Zambia ..................................................................................................................................... 29 2.4.1 Health System in Zambia .............................................................................................. 29 2.4.2 Palliative Care in Zambia .............................................................................................. 30 2.5 Selection and baseline description of the 12 centres ....................................................... 31 2.5.1 National Referral Centres .............................................................................................. 31 2.5.2 Regional Referral Centres ............................................................................................. 33 Integrate Evaluation Report Format Page 2 of 180 September 2015 2.5.3 District hospitals .............................................................................................................. 35 3 Integrated Palliative Care Service Models Implemented ......................................................... 38 3.1 Overview .................................................................................................................................. 38 3.2 Integrated Palliative Care Organisational Components ................................................... 38 A: Senior Hospital Leadership ...................................................................................................... 39 B: Palliative Care Leadership and Planning ............................................................................... 39 C: Palliative Care Service Co-ordination .................................................................................... 39 D: Palliative Care Service Delivery .............................................................................................. 40 3.3 Palliative Care Coordination and Service Delivery Processes ........................................ 40 3.4 Format of this Section ............................................................................................................ 41 3.5 National Referral Hospitals ................................................................................................... 42 3.5.1 Kenya: Moi Teaching and Referral Hospital (MTRH) ............................................... 42 3.5.2 Zambia: University Teaching Hospital (UTH) ............................................................. 46 3.5.3 Rwanda: Centre Hospitalier Universitaire Kigali (CHUK) ......................................... 50 3.6 Regional Referral Hospitals .................................................................................................. 54 3.6.1 Kenya: Nyeri County Teaching and Referral Hospital (NCTRH) ............................ 54 3.6.2 Uganda: Gulu Regional Hospital (GRRH) .................................................................. 58 3.6.3 Uganda: Kabale Regional Hospital .............................................................................. 63 3.6.4 Zambia: Ndola Central Hospital (NCH) ....................................................................... 66 3.7 District Hospitals ..................................................................................................................... 70 3.7.1 Kenya: Homa Bay County Teaching and Referral Hospital ..................................... 70 3.7.2 Uganda: Gombe General Hospital ............................................................................... 75 3.7.3 Zambia: Mazabuka General Hospital .......................................................................... 80 3.7.4 Rwanda: Kibagabaga Hospital ..................................................................................... 84 3.7.5 Rwanda: Rwanangama Hospital .................................................................................. 88 4 Project Delivery Pillars ................................................................................................................... 93 4.1 Advocacy ................................................................................................................................. 93 4.1.1 Ministry of Health Advocacy ......................................................................................... 93 4.1.2 Community Advocacy .................................................................................................... 95 4.1.3 Internal (Hospital) Advocacy ......................................................................................... 96 4.1.4 Educational Institution Advocacy ................................................................................. 96 4.1.5 Issues Identified Going Forward .................................................................................. 99 4.2 Training .................................................................................................................................. 100 4.2.1 Basic Training ............................................................................................................... 101 4.2.2 ToT Training .................................................................................................................. 103 Integrate Evaluation Report Format Page 3 of 180 September 2015 4.2.3 Specialist Training .......................................................................................................