Integrating locally-attuned palliative care into health care systems in the Eastern Mediterranean Region

555 Editorial EMHJ – Vol. 28 No. 8 – 2022 Integrating locally-attuned palliative care into health care systems in the Eastern Mediterranean Region Eric Krakauer,1 Hibah Osman,1 Ahmed Mandil2 and Asmus Hammerich2 1Department of Global Health & Social Medicine, Harvard Medical School, Boston, The United States of America. 2World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt. (Correspondence to: Eric Krakauer ekrakauer@hms.harvard.edu) Citation: Krakauer E; Osman H; Mandil A; Hammerich A. Integrating locally-attuned palliative care into health care systems in the Eastern Mediterranean Region. East Mediterr Health J. 2022;28(8):555–556. https://doi.org/10.26719/2022.28.8.555 Copyright © World Health Organization (WHO) 2022. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo). At the 2014 World Health Assembly (WHA), the ministers of health of all 194 World Health Organization (WHO) Member States affirmed that palliative care, the prevention and alleviation of pain and suffering of any kind associated with serious illness, “is an ethical responsibility of health systems” (1). The Assembly acknowledged “the urgent need to include palliation across the continuum of care, especially at the primary care level,” and emphasized that “inadequate integration of palliative care into health and social care systems is a major contributing factor to the lack of equitable access to such care.” This WHA Resolution (WHA 67.19) (1) differs from other resolutions regarding specific diseases, interventions, populations, or other aspects of health care. It differs not only because palliative care is essential to the care of adults and children affected by serious illness or humanitarian crisis of any type, but also because the Resolution draws attention to the essence of medicine and nursing, the prevention and relief of human suffering. It does so by amplifying the too-often unheard call of the suffering, the poorest, sickest, and most vulnerable. The Resolution is a powerful call to action. But what actions must be taken? WHO acknowledges that the specific types and severity of suffering vary by geopolitical situation, socioeconomic condition, and culture (2). People in low- and middle-income countries often endure less healthy social conditions and have less access to disease prevention, diagnosis, and treatment facilities and resources, than people in high-income countries. Palliative care should never be considered a substitute for disease prevention and treatment or critical care, and palliative care providers have a responsibility to advocate for these interventions wherever they are not yet accessible. However, palliative care should respond to current local needs. If psycho-social or spiritual suffering, for example, is different in two populations, the palliative response also should differ. How, then, should each of the world’s regions and countries go about integrating palliative care into their health care systems? Intra-regional and local differences in culture and socioeconomics may be as great as those between regions, but there are cultural and socio-economic commonalities within regions or sub-regions, and these commonalities are the basis for the current special edition of the Eastern Mediterranean Health Journal on palliative care. The concept of the special edition of the journal was initiated by the “Eastern Mediterranean Palliative Care Expert Network”, first convened in 2019 by WHO/EMRO, to discuss and seek consensus on how best to improve access to culturally sensitive, people-centred palliative care and support integration of palliative care into health care delivery systems throughout the Eastern Mediterranean Region. Membership of the network includes physicians, nurses, and a pharmacist, representing most of the 22 Member States in the Region, which includes most Arab countries, in addition to Afghanistan, Islamic Republic of Iran, and Pakistan. The network aims to interpret and adapt the WHO guidance documents on integrating palliative care into health care systems (2,3-6) to the region’s cultures and countries. Recognizing the enormous diversity within the region, the network is helping to create model policies, curricula, and implementation models relevant to the region and easily amenable to further adaptation by individual countries. This special edition of the journal addresses crucial aspects of palliative care implementation. For example, Miguel, Eduardo, Danny, Nasim, Slim, Marie-Charlotte, and Carlos describe the macro-indicators for palliative care development (7) and their research to create more accurate and robust indicators for palliative care monitoring in the Eastern Mediterranean Region (8). Zahra and Ali describe strategies used by nurses for palliative care in Iran (9); and Armin, Maryam, Toktam, Maryam, Hossein, Shilan, and Salman present the perceptions about ‘good death’ and use of life-sustaining treatment in the Islamic world (9). There are also reports on the formation of the Eastern Mediterranean Regional Palliative Care Expert Network and the development of relevant strategic tools for the region (8,11,12). We hope that this special edition will inform efforts by the region’s public health policy and decisionmakers and humanitarian responders to implement people-centred palliative care, catalyse further discussion of integration models and tools, and guide clinicians on best palliative 556 Editorial EMHJ – Vol. 28 No. 8 – 2022 References 1. World Health Assembly. World Health Assembly Resolution 67.19: Strengthening of palliative care as a component of compre- hensive care throughout the life course. Geneva: World Health Organization; 2014. https://apps.who.int/gb/ebwha/pdf_files/ WHA67/A67_R19-en.pdf. 2. World Health Organization. Integrating palliative care and symptom relief into primary health care: A WHO guide for planners, implementers, and managers. Geneva: World Health Organization; 2018a https://apps.who.int/iris/handle/10665/274559. 3. World Health Organization. Planning and implementing palliative care services: A guide for programme managers. Geneva: World Health Organization; 2016. http://apps.who.int/iris/bitstream/10665/250584/1/9789241565417-eng.pdf. 4. World Health Organization. Integrating palliative care and symptom relief into paediatrics: a WHO guide for healthcare plan- ners, implementers and managers. Geneva: World Health Organization; 2018b. http://apps.who.int/iris/handle/10665/274561. 5. World Health Organization. Integrating palliative care and symptom relief into the response to humanitarian emer- gencies and crises: a WHO guide. Geneva: World Health Organization; 2018c. http://apps.who.int/iris/bitstream/hand le/10665/274565/9789241514460-eng.pdf. 6. World Health Organization. Why is palliative care an essential function of primary health care? Geneva: World Health Organi- zation; 2018d. http://www.who.int/docs/default-source/primary-health-care-conference/palliative.pdf?sfvrsn=ecab9b11_2. 7. Sánchez-Cárdenas M; Garralda E; Van Steijn D; Pourghazian N; Slama S; Bouesseau M-C; et al. Region-specific macro-indicators for palliative care development in the Eastern Mediterranean Region: a Delphi study. East Mediterr Health J. 2022;28(8):560– 568. https://doi.org/10.26719/emhj.22.036. 8. Sánchez-Cárdenas M; Garralda E; Van Steijn D; Pourghazian N; Slama S; Bouesseau M-C; et al. Development of an atlas of palliative care in the Eastern Mediterranean Region through a stakeholder participative process. East Mediterr Health J. 2022;28(8):614–621. https://doi.org/10.26719/emhj.22.048. 9. Ebadinejad Z; Fakhr-Movahedi A. Palliative care strategies of Iranian nurses for children dying from cancer: a qualitative study. East Mediterr Health J. 2022;28(8):577–583. https://doi.org/10.26719/emhj.22.047. 10. Fereidouni A; Rassouli M; Kianian T; Elahikhah M; Souri H; Azizi S; et al. Factors related to good death in the Eastern Mediterra- nean Region: a systematic review. East Mediterr Health J. 2022;28(08):601–609. https://doi.org/10.26719/emhj.22.069. 11. Pourghazian N; Krakauer E; Slama S; Fadhil I; Osman H. The Eastern Mediterranean Regional Palliative Care Expert Network: Designing a roadmap for palliative care development in the region. East Mediterr Health J. 2022;28(8):610–613. https://doi. org/10.26719/emhj.22.066. 12. Krakauer E; Al-Shammary SA; Duraisamy B; Rassouli M; Rizkallah R; Fadhil S; et al. Palliative care models and innovations in 4 Eastern Mediterranean Region countries: a case-based study. East Mediterr Health J. 2021;28(8):622–628. https://doi. org/10.26719/emhj.22.038. care practices. We encourage colleagues in other regions around the world to organize similar regional palliative care networks, projects, and publications to further integrate palliative care into health care systems to improve the quality of life and reduce suffering. The verb “integrate” literally means to “make whole.” Health care systems are not whole, and fail to adequately heal, unless they include palliative care services that are accessible by all. May the papers in this special edition contribute to the healing.