Primary Care: a way to provide Palliative Care in Universal Health Coverage

This article was exclusively written for The European Sting by Ms. Celina Maria de Carvalho Guimarães and Maria Brenda Clemente Lima, two 21 years old second year medical student at Universidade de Pernambuco, Recife. They are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writers and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The World Health Organization (WHO) says that the Palliative Care (PC) is an approach to promote a better quality of life for the patient and their family. It not only involves physical health, but also includes the psychosocial and the spiritual life. It is important to endorse that this system embraces all ages, requires multiprofessional support and has been considered as an essential part of the health process that cannot be neglected. In Brazil, the PC has been applied since the end of the 90’s and in 2017 it reached the 3B level in Development of Palliative Care, which means that it has an important level of PC services but there are some lacks on its coverage and initiatives, like training and education.

Universal Health Coverage (UHC) is a WHO’S definition about the health services’ availability for all individuals and communities without the need of a substantial amount of financial resources. It should involve every level of care: promotion, prevention, treatment and rehabilitation, including the PC. Despite that, the efficient PC’s coverage is not a reality for major countries. According to PC 2017 Mapping Levels, only 14% of the global population has access to the highest level of Palliative Care Provision and those are concentrated in European countries. This data expresses there is a relevant gap within this area and different strategies are required to insert PC more effectively in UHC.

To understand what are the best strategies for achieving this goal, it’s important to say that the UHC itself isn’t a reality for major countries, and PC, as a part of that, it’s far from being included in an expressive approach. Despite that, the benefits of CP are very expressive for every level of the health system. For the patients, researches have shown how posite are the effects of early PC on the treatment of several illnesses, and that there will be an increasing demand for that, exemplified by chronic and non communicable diseases combined to population aging.

In this thought, a way to ensure PC in UHC is to offer it in Primary Care. This is fundamental because it is the society’s closest access to the health services, especially to ones with low mobility, and it may also promote attendance decentralization, which can improve the service quality. To ensure that, it’s relevant to create and apply public politics related to PC, as it occured through a 2018 resolution in Brazilian Unified Health System, which guides PC inclusion in public care.

Some advantages to enforce PC in Primary Care are to assure a singular terapeutic project to the patients, based on their characteristics and needs. If it were combined to prepared health care teams near to their residences, the attention could be facilitated by becoming the home a place of assistance.

Therefore, one way to ensure PC in the UHC is finding a space for it in Primary Care, making sure that the population has this service available close to them.

References

BRASIL. Resolução nº 41, de 31 de outubro de 2018. Dispõe sobre as diretrizes para a organização dos cuidados paliativos, à luz dos cuidados continuados integrados, no âmbito Sistema Único de Saúde (SUS). Diário Oficial da União: seção 1, Brasília, DF, 23 nov. 2018. Available from: https://portalarquivos2.saude.gov.br/images/pdf/2018/novembro/23/RESOLUCAO-N41.pdf. Access on : 22 dez. 2020.

CLARK, D. et al. Mapping levels of palliative care development in 198 countries: the situation in 2017. Journal of Pain and Symptom Management, v. 59, n. 4, p. 794- 807.e4, abr. 2020.

GOMES, A. L. Z. et al. Cuidados paliativos. Estudos Avançados, v. 30, n. 88, p. 155–166, dez. 2016.

MARCUCCI, F. C. I. et al. Identification and characteristics of patients with palliative care needs in Brazilian primary care. BMC Palliative Care, v. 15, 1 jun. 2016.

Universal health coverage (Uhc). Available from: <https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)&gt;. Access on: 23 dez. 2020.

About the author

Celina Maria de Carvalho Guimarães is a Brazilian 21 years old second year medical student at Universidade de Pernambuco, Recife. She is a member of IFMSA Brazil (International Federation of Medical Students’ Associations – Brazil).

Maria Brenda Clemente Lima is a Brazilian 21 years old third year medical student at Universidade de Pernambuco, Recife.