Where opioids are generally unavailable, the definition of palliative care can be problematic. We have taken the view that where a service is in the process of development from (largely) physical care to a broader form of holistic care that approximates to the WHO definition, it should be included in the review. In resource poor areas, the blending of supportive care with hospice/ palliative care is frequently linked to the development of previously established services, particularly home based care (HBC).

Family Health International (FHI) defines home and community based care (HCBC) as “the provision of care and support that endeavours to meet the nursing and psychosocial needs of persons with chronic illnesses and their family members in their home environment”². While HCBC delivers patient care in the home environment, palliative care is an approach that attends to the needs of patients and families affected by a life threatening illness in a variety of settings including the home, hospice, hospital, clinic and community.

The concept of home-based care is relatively new in Ethiopia and has evolved as a response to the HIV/AIDS epidemic. Three non-governmental humanitarian organisations provide this care: the Medical Missionaries of Mary, Mekdem and Mary Joy.³ According to a WHO (2002) Progress Report on the status of palliative care in Ethiopia, data indicated that most patients prefer to be treated and cared for in health facilities rather than at home.⁴

Addis Ababa was selected as the target area for a palliative care demonstration project by the World Health Organisation Ethiopia Palliative Care Team in 2001.⁵ The WHO (2002) Progress Report for the project reports that no information is available on cancer incidence, prevalence or mortality within Ethiopia. However the three most common cancers referred to the Radiotherapy Centre were cancers of the cervix, breast and head/neck. Most patients were diagnosed at the late stages of the disease. There is no cancer control programme or palliative care programme for advanced disease. The report further estimates that 13% of the population of Addis Ababa are HIV infected although antiretroviral drugs are neither available nor affordable for much of the population.

There is no palliative care component within the HIV/AIDS control programme in Addis Adaba.