Dr. Helena Restrepo who is a consultant physician in palliative care at the National Cancer Institute in Bogotá describes the situation of palliative care within the Colombian health care system as follows:

“ it [palliative care] is recognized within the health system; this means that people can access to palliative care. And there are different models for palliative care provision, such as outpatient care, inpatient care and home care programmes [Palliative care] is also emerging in private clinics” ⁴

On the other hand, another palliative care consultant at the Santa Fe Foundation in Bogotá, Dr Jairo Moyano remarks on existing barriers to the appropriate provision of palliative care within the Colombian health care organization:

“With no doubt one of the biggest obstacles for the development of palliative care is that from a political point of view within the national health system, palliative care does not exist. That means that although a legislation that contemplates the provision of palliative care to patients exists in practice there are neither suitable places nor palliative care specialists and no political intention of giving more importance to palliative care. The government has very few palliative care centres.” ⁵

Palliative care is mostly provided by hospital palliative care teams operating as specialized services within pain clinics. In this sense, Dr. Rene Rodriguez, palliative care consultant at the Social Security Institute in Cali, points out:

“It is important to note that here in Colombia most pain clinics are mixed. We care for patients with chronic pain and palliative care patients with cancer pain. I understand that many clinics in Europe are exclusively palliative care clinics; but here in our area most of them are pain and palliative care clinics” ⁶

Most consolidated palliative care teams exist in Bogotá, Cali and Medellin which are the biggest and most populated cities in Colombia. One of the most developed palliative care teams in the country functions at the National Cancer Institute in Bogotá. Another very active palliative care team operates within the private sector at the ‘ Santa Fe’ Foundation, also in Bogotá. In Cali, one of the most recognized palliative care team exists at the Social Security Institute which provides care for free or at very low cost to a large proportion of people leaving outside the capital city. Another important palliative care service in Cali is the one at ‘del Valle’ University Hospital. In Medellín, palliative care is provided in the area of Antioquia.

Dr Moyano outlines some difficulties that may emerge as a result of most palliative care provision being only available in main cities:

“ It is probably worthwhile mentioning that the biggest and most important [palliative care team] is the Palliative Care Unit at the National Cancer Institute; but apart from this one, there are not many more. In fact, this unit receives patients from very distant places in the country, hundreds of kilometres away; and this can give you the idea that there are not as much resources as needed in the place the patient comes from. That is one of the big difficulties” ⁷

Between late 1980s and early 2004, two palliative care organizations existed outside the public hospitals; they provided palliative care at home and inpatient care for underserved social sectors. These organizations were the palliative care programme called ‘La Viga’ in Cali and the ‘Omega’ Foundation in Bogotá. For reasons of financial constraints and structural and functional problems, both organizations have had to close down their palliative care services (in 1997, the programme in La Viga and in 2004, the Omega Foundation)⁸.

Table 1 summarizes palliative care services that currently exist in Colombia.

Table 1: Palliative Care services currently available in Colombia

Issues and priorities

Dr Restrepo summarizes key priorities for the further development of palliative care in Colombia as follows:

“….there are many things that need to be changed simultaneously: on the one hand, medical education and training need to be improved; physical infrastructure as well as logistic and structural strategies to allow team work and the development of palliative care units are needed in health care institutions. On the other hand, at the governmental level, formal policies are needed to guarantee the recognition of palliative care as a medical specialization as well as the availability and accessibility of palliative care to patients”⁵⁷

Other priorities have also been suggested such as:⁵⁸

• education for pharmacists in opioid analgesia and general principles of cancer pain treatment
• drug policies to guarantee the distribution and availability of opioids and other medicines needed in palliative medicine in the countryside and small towns
• education for general practitioners and other specialties on opioid addiction, tolerance, side-effects and dependence
• education on the philosophy of palliative care for medical students