A group of palliative care experts from public, private and NGO sectors met in Pretoria last week for a 3-day Palliative Care Policy Review Workshop hosted by the South African National Department of Health. Participants travelled from across the country to review the National Policy Framework and Strategy on Palliative Care (2017–2022), identify existing gaps, and contribute to the development of a forward-looking strategy for 2026–2030. Representatives from PatchSA were amongst the group and included Chairperson of our board, Dr Samantha Govender, Dr Michelle Meiring, Busi Nkosi, Sue Boucher and Tracy Rawlins.

National Policy Framework and Strategy on Palliative Care (2017 – 2022)

Developed in response the 2014 World Health Assembly (WHA) Resolution 67.19 on Palliative Care, which states the provision of palliative care is a moral imperative of health systems, the National Policy Framework and Strategy on Palliative Care (2017–2022) (NPFSPC) aimed to integrate palliative care into all levels of South Africa’s health system as part of Universal Health Coverage. It sought to ensure equitable access to quality, person-centred care for individuals with life-threatening or life-limiting conditions, including in rural and underserved areas. The policy focused on strengthening governance, embedding palliative care in existing health programmes (such as HIV, TB, cancer, and NCDs), developing the healthcare workforce through training, ensuring access to essential medicines like morphine, and establishing systems for monitoring, evaluation, and research. It envisioned multidisciplinary teams delivering care across all districts, improved quality of life for patients and families, and more efficient use of healthcare resources.

Implementation stalled

Despite its clear goals and roadmap, implementation by 2022 was not attained due to funding and capacity challenges. Significant barriers include inadequate human resource capacity, minimal integration of palliative care training in medical education, restricted access to essential pain relief, and weak health system infrastructure. Additionally, palliative care remains poorly understood by both healthcare providers and the public, and without strong leadership or accountability mechanisms, implementation has stalled despite the clear need for such services.

Prior to the workshop, stakeholders from the NGO sector had sent a letter to Ms Jeanette Hunter, the Deputy Director General: Primary Health Care and to Dr Busisiwe Ndlovu, the Director of NCDs at the NDoH requesting that a dedicated technical writer be hired to write the updated policy, asking for the inclusion of experts for cost analysis to estimate implementation costs and the confirmation of a permanent Deputy Director-General post for palliative care within the NDoH, with an allocated budget.

Gratitude and farewell to Lawrence Mandikiana

The PatchSA delegation with Lawrence from left to right: Sue Boucher, Busi Nkosi, Lawrence Mandikiana, Dr Michelle Meiring, Dr Samantha Govender and Tracy Rawlins

Participants were welcomed to the 3-day workshop by Dr Busisiwe Ndlovu, Director of Non-Communicable Diseases (NCDs) from the National Department of Health (NDoH) who pledged her support for the review process and the successful implementation of the updated policy in due course. After giving a presentation on initiatives towards implementation of the NPFSPC participants also bade a sad farewell to Lawrence Mandikiana, who, as the temporary Deputy Director-General for Palliative Care, has been working tirelessly from within the NDoH. He was thanked sincerely for all that he had done, despite difficult circumstances, to implement policy initiatives and advance the development of palliative care in our country.

The MEC for Health in Gauteng, Ms. Nomantu Nkomo-Ralehoko, also took time to attend the workshop and address the participants on the 2nd day where she commended all on the progress that had been made in the province and gave a sincere commitment to the implementation of the updated policy in Gauteng.

Powerful paediatric advocacy

Under the leadership of Dr Michelle Meiring, an additional paediatric breakaway group was formed to review ways to strengthen advocacy for paediatric palliative care throughout the policy and strategic framework document and included suggestions for:

  • A call centre with a register of doctors and specialists in paediatric palliative care to field questions and ensure better use of scarce resources.
  •  A paediatric focused palliative care pathway
  • The inclusion of a wider paediatric community of stakeholders such as the Department of Social Development, the South African Paediatric Association, Maternal and Child Health Directorate, and the Department of Basic Education.
  • Monitoring and Evaluation that includes objectives, activities, outcomes and indicators specific to paediatric palliative care
  • The inclusion of the following identified gaps:
    • Perinatal palliative care
    • Transitioning adolescents to adult services
    • Paediatric formulations and use of off licence prescribing
    • Bereavement grants to extend 3 months after the death of a child

Palliative Care Conference in Durban

A reminder that the 2025 Palliative Care Conference will be taking place in Durban from 18 – 21 June where Dr Busisiwe Ndlovu will be a guest speaker at the Opening Ceremony. Registration is open and the full conference programme can be found on the conference website at https://pcconference.co.za/programme/