Health promoting palliative care interventions in African low-income countries: a scoping review

Palliative care (PC) has advanced rapidly since 2005, when the World Health Assembly posited it as an urgent humanitarian need. Over the same period, the principles of the Ottawa Charter for Health Promotion have been promoted to implement sustainable PC. It is not known whether the Ottawa Charter principles have been integrated into existing PC efforts in low-income African countries. The purpose of this scoping review is to determine the state of knowledge on the consequences of health promoting PC (HPPC) interventions in African low-income countries.

We searched for literature published in English, French and Spanish between 2005 and 2022 in CINAHL, PubMed and PsycINFO. The inclusion criteria for studies were (1) conducted in African low-income countries and (2) evaluated the consequences of an HPPC intervention. Using Covidence, two reviewers independently carried out a two-step review process (title/abstract and full text) and data extraction.

A total of 2259 articles were screened and 12 were included. Of the 22 low-income countries in Africa, 3 countries-Malawi, Uganda and Rwanda-were represented in the selected studies. The majority of studies were cross-sectional, had limited numbers of participants and were conducted in English-speaking countries. We found that volunteers and caregivers played a key role in HPPC. Interventions sought to strengthen community action by reinforcing the skills and knowledge of community health workers (usually unpaid volunteers). Only two studies were related to building health promoting policy. Changes in professional education, training and culture were addressed in a few studies.

There is a need to increase the capacity of low-income African countries, especially French-speaking countries, to sustain HPPC interventions and to conduct and publish research on this topic. Decision-makers looking to implement HPPC measures in Africa or elsewhere may find the practical outcomes of this review helpful.