Open Society Foundations Strategy for Palliative Care Development in Eastern Europe

1. Open Society Foundations Strategy for Palliative Care Development in Eastern Europe Dr. Kathleen M. Foley April 15, 2011

2. Open Society FoundationsInternational Palliative Care Initiative • International Program funded from1998 based in the Public Health Program • Started with $500,000/year to Public Health Programs in Soros Foundations in CEE & FSU • Provides matching funds to National Foundations for palliative care initiatives • Current funding budget of 3 million dollars/year for global efforts

3. OSF Public Health Program International Palliative Care Initiative in CEE and FSU Mission: to serve as a catalyst to create palliative care as an essential aspect of health care policy and health care systems and to build capacity for palliative care services, education, and advocacy within the region.

4. OSF Rationale to Fund Palliative Care OSF rationale to support this palliative care initiative reflects its commitment to dying persons as a vulnerable population and to a perspective that model programs and services can be powerful forces of social change.

5. Palliative Care in Eastern Europe and Central AsiaHistorical Perspective • 1998 Poznan Declaration • 1999 ECEPT organized • 1999 EAPC Geneva Conference • IPCI supported a 2 day meeting

6. IPCI’s Strategy Meeting Geneva 1999 • Four activities took place • EAPC Congress • Small Group Meetings • ECEPT Organizational Meeting • OSF sponsored a two-day strategy conference

7. Lithuania Macedonia Moldova Mongolia Poland Romania Russia Slovakia Slovenia Tajikistan Ukraine Uzbekistan Countries Participating

8. Albania Azerbaijan Belarus Bosnia Bulgaria Croatia Czech Republic Estonia Georgia Hungary Kyrgyzstan Latvia Countries Participating

9. Institutions Represented • Medical Schools • Hospitals • Palliative Care Programs • Hospice Programs • Home Care Organizations

10. Institutions Represented • Private Foundations • Medical Academies • Medical Research Centers • Children’s Hospitals • Health Ministry

11. Four Objectives to Advance Palliative Care • Public Education • Professional Education • Drug Availability • Policy

12. IPCI’S Thematic Areas for Funding • Education & training • Capacity building • Policy reform • Advocacy

13. WHO Public Health Model POLICY O U T C O M E S C O N T E X T Drug Availability Education Implementation

15. World Health Organization

16. Drug Availability • to assure that necessary opioid medications are available for pain management at home as well as in in-patient facilities • to revise regulatory laws and restrictions governing the manufacturer, importation, and dispensing

17. Policy • Drug Availability • Pain & Policy Studies Group (PPSG) • Core support to provide technical assistance to countries to review and revise the laws and regulations governing opioid availability • Support to organize and direct national and regional drug advocacy workshops • Serve as an global resource on international drug policy

18. Policy:Drug Regulatory Reform • In progress in six countries • Bulgaria Lithuania • Croatia Poland • Hungary Romania • Developing national strategies to reduce barriers to opioid availability • To support the inclusion of essential palliative care drugs in government prescription programs

19. Drug Availability OSI Collaboration with WHO-EURO and WHO Collaborating Center For Pain and Policy Studies at the University of Wisconsin David Joranson, MSSW

20. WHO Workshop, Budapest 2002

21. Policy • To integrate palliative care into: • national health care laws • policies • regulations • standards • So that palliative care may be available for patients: • at home • in hospices • in elderly/nursing homes • in hospitals

22. Policy Hungarian Experience IPCI sponsored Policy Conference resulted in Hungarian Health Insurance Fund sponsoring a pilot program to develop six model palliative care programs Palliative care has been included in the National Cancer Control Program The MOH has committed to develop palliative care services in all regions in the country

23. Policy Romanian Project • Prescribing severely restricted • Complicated forms and authorizations • Dose and time limits • For cancer, not for HIV/AIDS Lancet 2006; 367:2110-2117

24. Policy Health Budget Monitoring • Romania • Grant: develop budgetary cost projections for palliative care in different settings and advocate to government ministries and stakeholders to finance palliative care services in the House of Insurance and MOH budgets • Result: a new government insurance contract for palliative care in home settings for cancer and HIV patients

25. Activities • provide technical assistance and expertise in the development of national health care policies, standards, and guidelines • network w/funders to encourage palliative are in their funding • collaborate with WHO-Geneva & Euro on improvement and expansion of cancer control programs & include palliative care • collaborate with WHO-Geneva & Euro to sponsor three opioid availability workshops in the region

26. Activities • Provide technical assistance in the integration of palliative care into existing professional education programs in CEE & FSU • Support the development of HIV resource training centers in Russia & Ukraine • Support the translation and dissemination of palliative care education materials

27. SEVEN PROGRAM AREAS 1.Resource Training Centers 2. Regional Education Programs 3. National Education Programs 4. Regional Meetings of Policy Makers

28. SEVEN PROGRAM AREAS 5.Palliative Care Scholarships 6. Palliative Care Travel Grants 7. Translation of Existing Educational Materials

29. Transitions in End of Life Care Mapping hospice and palliative care programs and services in CEE & FSU Published by Open University Press in their “Facing Death Series” Distributed to health care policy makers www.eolc-observatory.net

30. www.eolc-observatory.net

33. EAPC, EAPC-E, ECEPT, IAHPC • EAPC--to support the participation of individuals from CEE & FSU to attend annual conferences • EAPC-E--established a palliative care coordination center in Stockholm • ECEPT--to support the development of palliative care in the region • IAHPC--website for education and twinning

34. Translations • WHO Cancer Pain Relief and Palliative Care:Albanian, Serbo-Croatian, Mongolian, Polish, Ukrainian • WHO, Cancer Pain Relief with a Guide to Opioid Availability:Macedonian, Mongolian, Ukrainian • WHO Symptom Relief in Terminal Illness:Albanian, Georgian, Mongolian, Serbo-Croatian, Ukrainian • Palliative Medicine:Romanian • Symptom Management in Advanced Cancer: Serbo-Croatian • Principles of Care:Mongolian • A guide to the development of children’s palliative care:Romanian

35. Albania Macedonia Azerbaijan Moldova Bosnia Mongolia Bulgaria Poland Croatia Romania Latvia Russia Lithuania Translation Grants WHO Cancer Pain and Palliative Care For Children Russian Croatian

36. EAPC-Palermo Albania Moldova EAPC-Berlin Bosnia Mongolia EAPC-Lyon Czech Republic Poland EAPC-Hague Croatia Romania Montreal Congress Hungary Russia Geriatric Congress Lithuania Slovenia Travel Grants

37. Croatia Hungary Latvia Moldova Mongolia Romania Palliative Care Scholarships Dr. AndaJansone from Children’s Hospital in Riga, Latvia spent one-month training at the Warsaw Hospice for Children and then returned home to develop the first home hospice program for children in Latvia.

38. Resource Training Centers • Croatia—Dr. Jusic • Hungary (2)—Dr. Simko & Dr. Muszbek • Poland (2)—Dr. Dangel & Dr. Luczak • Romania—Dr. Mosoiu • Slovenia—Dr. Ravnik

39. Croatia Hungary Albania Poland Bulgaria Croatia Romania Georgia Slovenia Hungary Moldova (AIDS) Mongolia Russia Slovenia National Education Programs Regional Education Programs

40. Network Palliative Care Experts in CEE & FSU • ACS University • NHPCO • WHO – Geneva • WHO – Euro • Help the Hospices • IHAPCO • EAPC-E • IASP • ESMO • UICC • Pain and Policy Program, WHO Collaborating Center, University of Wisconsin, Madison

41. Current Initiatives • Campaign to Stop Torture in Health Care • Armenia ,Kyrgistan. Ukraine Georgia • Leadership Development Initiative; leaders from Czech Republic, Moldova, Hungary, Slovenia • Nursing Educational Initiative in Czech Republic, Romania, Hungary, Russia, and Bulgaria • WHO Policy Workshops for Tajikistan ,Krygistan • EAPC Survey of Palliative Care Needs in CEE/FSU

42. Leadership Development Initiative • Intended to advance palliative care globally by supporting the development of critical leadership skills in the next generation of physician leaders in resource-limited countries • Two cohorts of trainees of 5 years

43. Leadership Development Initiative Africa Kenya Nigeria South Africa Tanzania Uganda Botswana Eastern Europe Czech Republic Hungary Moldova Slovenia Latin America Argentina Brazil Asia India Vietnam Middle East Jordan

44. Levels 4, 3 + 2: capacity building (n=41; 18%)

45. Regional variations *A service here is defined as a service type: number of services courtesy of EAPC Task Force