The following organisations feature prominently in Ethiopia:

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).⁹ 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

The World Health Organisation (WHO)¹⁰

The WHO is currently involved in a community health approach to palliative care for HIV/AIDS and cancer patients in Africa. This joint project - involving the five countries of Botswana, Ethiopia, Tanzania, Uganda and Zimbabwe - seeks to improve the quality of life of HIV/AIDS and cancer patients in sub-Saharan Africa by developing comprehensive palliative care programmes with a community health approach. The project contains four major elements: team building, situation analysis, needs assessment and action plans.

WHO acknowledged the formidable difficulties confronting Ethiopia:

Ethiopia, the largest country, was identified as having the greatest number of unmet needs and requiring the most support to improve its situation.¹¹

The Diana, Princess of Wales Memorial Fund¹²

The Diana Fund has formed the view that palliative care plays a vital role in the management of life-limiting illness. In particular, palliative care is ideally suited to home based care; it makes use of affordable drugs and it empowers the family to care for their members more effectively.

In 2001, the Diana Fund launched a palliative care initiative which focussed on nine countries in sub-Saharan Africa ( Ethiopia, Kenya, Malawi, Rwanda, South Africa, Tanzania, Uganda, Zambia and Zimbabwe) and committed an initial £5 million over 5 years. The Fund does not implement palliative care programmes; rather, it supports locally-based partners who are already implementing programmes or who wish to incorporate palliative care into existing home based care services.

President’s Emergency Plan for AIDS Relief (PEPFAR)¹³

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 Uganda is one of 12 in Africa – to develop integrated care and treatment programmes (Table 5). 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

Countries of Africa involved in PEPFAR, Diana Fund and WHO projects