From co-creation to practice: a collaborative program strengthening palliative care capacity in primary health care...

Access to palliative care in Ghana remains limited, with services concentrated in urban centers and few healthcare professionals trained in this area. Within a primary health care (PHC) framework, strengthening palliative care capacity at the frontline is essential to achieving equitable access and achieving Universal Health Coverage (UHC). To address this gap, Kwame Nkrumah University of Science and Technology and the University of Toronto co-created a short course in palliative care for primary care providers, grounded in adult learning principles and experiential pedagogy. Between 2023 and 2025, three cohorts completed two in -person palliative care educational modules, each spanning 3-4 days, using a curriculum that combined didactic teaching, case-based learning, role play, reflective exercises, and site visits. Formative program evaluation using a mixed methods approach included daily surveys, three end-of-course questionnaires, and six focus group discussions. Quantitative data were analyzed descriptively, while qualitative feedback underwent thematic analysis. 65 participants were enrolled, predominantly nurses (n = 45, 69.2%), followed by physician assistants (n = 9, 13.8%), midwives (n = 7, 10.8%), and smaller numbers of other allied health professionals (n = 4, 6.2%). The majority were female (n = 35, 53.8%), and most were early to midcareer clinicians (n = 51, 78.5% under age 40). Daily evaluations showed high satisfaction, with over 95% reporting lessons were clear and relevant, and 98% indicating they would recommend the course to others. Focus group feedback highlighted improved confidence in serious illness communication, patient advocacy, and holistic care, alongside requests for longer training duration, more clinical exposure, and ongoing mentorship. Learners expressed readiness to integrate palliative care into their practice, with many reporting concrete plans to establish or expand services in their facilities. Findings are, unfortunately, limited by reliance on short-term, self-reported outcomes, without objective assessment of behavior change or patient-level impact. This formative program evaluation demonstrates that co-created training can strengthen palliative care capacity in resource constrained settings. By prioritizing equity in recruitment and embedding experiential learning, the program fostered readiness among frontline providers to integrate palliative care within primary care settings, contributing to more equitable person-centered care, and advancing UHC.