Challenges in accessing Palliative Care from the perspective of Universal Health Coverage

This article was exclusively written for The European Sting by Ms. Raíssa Thamires Fernandes de Oliveira, and Ms. Maria Helena Medeiros de Albuquerque, Brazilian and Northeastern, live in Caicó, in the state Rio Grande do Norte, Brazil, where they are attending the 2nd year of Medicine in the Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte . They are affiliated with 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.

In the last decade there has been much debate about Universal Health Coverage (UHC), a concept that involves the broad offer of essential health services to the population and the fight against inequities. Given its importance, the United Nations member countries have signed the commitment to reach the UHC by 2030, as part of the Sustainable Development Goals (SDGs). Discussing the issue implies, therefore, in a political debate, given that full access to health is still a reality for few.

One of the strategies for improvement and adherence to the UHC in the various social scenarios consists of investing in primary health care, as a pathway to takes an integral look at individual and collective needs, through the organization of services and actions, which range from health promotion and prevention of diseases to diagnosis, treatment and rehabilitation.

The demographic transition is already a reality in many countries, where it’s observed that population aging and, consequently, the increase of chronic diseases, transmissible or not, become more prevalent. Thus, there is an urgent need to strengthen and expand access to Palliative Care (PC) from the UHC perspective, given that it promotes quality of life to patients and their families, in the face of limiting health conditions in the course of life. Through prevention and relief of suffering, PC is designed to meet the broad concept of health defined by the World Health Organization, which embraces the physical, psychosocial and spiritual dimensions of the individual. Therefore, Palliative Care is integrated as a crucial part of health services, in order to compose the levels of care, with emphasis on primary care as an interface of contact with the individual and its social network. 

Although palliativism is an interdisciplinary field of active and integral care, it is still far from the reality and understanding of many populations, considering that it emerges, culturally, as an alternative “when there is nothing else to be done” and all that can be done is “just palliative“. This culture is reinforced by the low government incentive in the insertion of PC’s longitudinally in the healthcare networks, corroborating the lack of structure in the care centers and low qualification of professionals in the area. As a result, health demands continue to be met mostly under a curative perspective.

Moreover, vulnerabilities influence the way certain populations face and deal with the disease, as well as favor difficulties in access to health. To include the PC in the universal coverage also goes through the need to overcome inequities that intersect issues of gender, color and ethnicity, and presents itself as a way of looking at communities in socioeconomic vulnerability, whose suffering is drawn in the face of inequality.

It is still a challenge to promote the inclusion and practice of Palliative Care in the UHC. For that, it is necessary to resignify the health care under the perspective of a broader care, capable of hosting the pains and demands of each individual. So, when the cure no longer solves, may the amorousness prevail.

References

1. COBO, Viviane de Almeida; DAL FABBRO, Amaury Lelis; PARREIRA, Ana Carolina Serafim Prata  e  PARDI, Fernanda. Palliative Care in Primary Health Care: perspective of health professionals. Bol. – Acad. Paul. Psicol. [online]. 2019, vol.39, n.97 [citado  2020-12-22], pp. 225-235.
2. KNAUL, Felicia Marie et al. Alleviating the access abyss in palliative care and pain relief – an imperative of universal health coverage: the Lancet Commission report. The Lancet, v. 391, n. 10128, p. 1391-1454, 2018.
3. PAIM, P. Palliative Care: the importance of care, comfort and control of symptoms. Available at: https://www.crmpr.org.br/Cuidados-Paliativos-a-importancia-do-cuidado-do-conforto-e-do-controle-dos-sintomas-13-51826.shtml. Accessed on: Dec 22st, 2020.
4. World Health Organization (WHO). Universal Health Coverage (UHC). Available at: https://www.who.int/world-health-day/world-health-day-2019/fact-sheets/details/universal-health-coverage-(uhc). Accessed on: Dec 21st, 2020.

About the authors

Raíssa Thamires Fernandes de Oliveira, 19 years old, Brazilian and Northeastern, lives in Caicó, in the state Rio Grande do Norte, where she’s attending the 2nd year of Medicine in the Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte (EMCM/UFRN) and serves as Local Officer on Medical Education Director at the IFMSA Brazil UFRN Caicó committee. Currently, she develops the project “Dying: the Human thing”, with the objective of building a space to approach death, thanatology, anthropology and palliative care as a human and necessary part in graduation.

Maria Helena Medeiros de Albuquerque, 20 years old, Brazilian and Northeastern, lives in Caicó, in the state of Rio Grande do Norte, where she’s attending her 2nd year of Medicine at The Multicampi School of Medical Sciences of the Federal University of Rio Grande do Norte (EMCM/UFRN) and serves as Local Officer on Human Rights and Peace Director at the IFMSA Brazil UFRN Caicó committee. Currently, she collaborates with the development of projects “Dying: a human thing”, “Esperanza” and “Nazaré”, aiming at the construction of spaces for longitudinal discussions focused on vulnerable populations’s health.