A combination of inexpensive opioids with simple analgesics can provide effective pain relief for more than 90% of people with advanced cancer. Unfortunately access to affordable and consistent supplies of opioids remains a major obstacle, particularly in low- and middle- income countries (LMICs). Despite these challenges several LMICs have been able to use innovative approaches to ensure that people have access to this essential medication.
Hospice Africa Uganda, a non-governmental organisation established in 1993, has been working with the Ugandan Ministry of Health (MoH) to increase access to affordable morphine. This joint initiative includes: a clinical community outreach service, family and carer support, training for health care workers, and advocacy efforts to change the national narcotics legislation to allow trained nurses to prescribe oral morphine. National awareness-raising events involving local media and community leaders, highlighting the fact that suffering and pain are not inevitable, have resulted in strong community awareness, involvement and advocacy. A national stakeholders’ team led by the MoH has now been established to ensure access to oral morphine and has led to a steady increase in morphine consumption alongside the development of palliative care services.
In 2006, leaders of the Palliative Care Association in Malawi and representatives from the MoH took part in a Workshop on Palliative Care in Africa. They were inspired by success stories from other countries in their region that had overcome similar obstacles. An advocacy strategy involving media and members of the community, that highlighted the difference that oral morphine can make, was put in place and has since resulted in policy changes that support increased access and availability of opioids.
In Ethiopia, a delegation of health professionals and policy makers also attended the Workshop on Palliative Care in Africa and reviewed the Uganda experience, but arrived at a very different solution. They decided to produce their own affordable oral morphine through a partnership between government and a local pharmaceutical company. The product is now being made available to the national cancer hospital with plans for further roll-out across the country.