The conception of the Nankya model of palliative care development in Africa

There is a great need for palliative care in Uganda. The framework for the development of such services has been the World Health Organization's (WHO) public health strategy for palliative care, including policy, drug availability, education and implementation. In this model and in much of the literature it is accepted that education has a part to play in the development of palliative care; yet, there is a lack of evaluative literature or an understanding as to the steps required alongside education to develop palliative care services. An evaluation was undertaken of an HIV/AIDS palliative care education strategy in rural Uganda. It aimed to determine the effectiveness of the education strategy and to explore what had taken place in order for any change in practice to be seen. The impact of the programme was seen in different areas and a grounded theory approach was used to look at the emerging themes from the evaluation. Throughout the process it was possible to identify key milestones and changes that had to occur within the district where the training was taking place, in order to help develop palliative care services. To achieve these milestones and make the changes it was necessary not only to provide palliative care training, but also to advocate for palliative care at the district and national levels and work with other stakeholders in the area. Out of this, a model for the development of palliative care in the rural African context has emerged called the 'Nankya model of palliative care development'. Further work needs to be done on validating the model although it appears that the Nankya model is congruent with the WHO's public health approach to palliative care and it is anticipated that it will help stakeholders to understand the process of developing palliative care in the rural setting.