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.

There are no established palliative care services in Ghana. In the absence of formal structures, individuals in Ghana have begun to incorporate palliative care principles into home based care projects with AIDS and cancer patients.³

Terry Magee, director of education at Myland Hall Education Centre (St Helena Hospice, UK) has been involved in education initiatives in Ghana for the last two years. She notes:

T here are a number of initiatives that are a mixture of outreach and social and health support for people who are living in communities - rural communities mostly - who have HIV; and Aids and there are services developing within the hospitals in Kumasi and Accra, to try to produce more information and more awareness for patients about issues like pain and symptom control and family support.

As yet, there isn’t a hospice as such, but the idea of hospice is very much alive in the practice. This time we did a series of story telling workshops with the students where we talked to them about what exquisite holistic care was all about, and we outlined the principles of hospice care, and we asked them to tell us stories of where they felt that was happening in their own practice, and how they were making that happen, and we heard some wonderful examples - it‘s not got a label ‘hospice’ over it, but it’s hospice care nonetheless. Some lovely stories of where the care was delivered to a person, or the actions taken by healthcare professional, or a social care professional had resulted in some very, very fine holistic care and good quality of life in dying people, and some very fine examples of very appropriate after death care and support.