President’s Emergency Plan for AIDS Relief (PEPFAR)

During his state of the Union address in 2003, President Bush announced his PEPFAR initiative; this groundbreaking intervention encompasses HIV/AIDS activities in more than 75 countries and focuses on 15 countries worldwide – of which Cote d’Ivoire is one of 12 in Africa – to develop integrated care and treatment programmes (Table 3). Over the next 5 years, PEPFAR is donating a total of US $15billion, of which 15% is earmarked funding for palliative care. This has dramatically changed the palliative care landscape in Africa, as bids for new initiatives are attracting the funding for implementation. Four main areas are targeted:

• prevention of HIV transmission
• treatment of AIDS and associated conditions
• palliative care for HIV infected individuals
• care for AIDS orphans and other vulnerable children

Centres for Disease Control (CDC)

The US funded Centres for Disease Control provide technical support to the Ministry of Health to develop a strategy to combat the HIV/AIDS epidemic. It also acts as the conduit for funds from the President’s Emergency Plan For AIDS Relief (PEPFAR) to several government departments involved in the prevention and treatment of AIDS.

African Palliative Care Association (APCA)

This international association was formed after a meeting of Hospice and Palliative Care trainers in Cape Town that led to the Cape Town Declaration. The first APCA steering committee meeting was held in Uganda from 19-20 February 2003. Steering committee members were drawn from: Kenya (Zipporah-Merdin Ali), South Africa (Kath Defilippi), Tanzania (Jacobson) Uganda (Anne Merriman) and Zimbabwe (Sambulo Mkwananzi).⁶ In summary, APCA aims to:

• promote study, knowledge, training and research in palliative care
• foster networks and links at all levels of palliative care
• address ethical issues
• establish an international communication network
• sponsor publications
• disseminate achievements
• promote access to resources

Objectives include:

• promotion of standards
• advocating for palliative care at governmental level
• securing the availability of drugs
• encouraging the development of national associations within Africa
• promotion of training programmes
• devising standard guidelines
• advocacy

Table 3 Countries of Africa involved in PEPFAR, the Diana, Princess of Wales Memorial Fund and WHO projects