The following organisations feature prominently in palliative care in Kenya:

Kenya Hospice and Palliative Care Association:

This national association was formed in October 2004 to provide palliative care countrywide by developing more hospices with a standard quality of care. A second objective is to supply smaller hospices with drugs that can be bought in bulk in Nairobi. It is anticipated that all existing hospices will be members, as well as other organizations providing elements of palliative care in related fields.

Hospice Care Kenya ( UK)²⁹

This UK based charity supports hospices in Kenya by providing funds for various projects. Significantly, Hospice Care Kenya (UK) sponsors a doctor rotation programme by paying the salaries of local doctors who work at Kenyan Hospices for three months. After this placement doctors should be able to provide palliative care and train others in palliative care in whichever part of the country they are working. Four doctors successfully completed this rotation in the year 2002-2003.

President’s Emergency Plan for AIDS Relief (PEPFAR)³⁰

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 Kenya 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

Table 3 Countries of Africa involved in PEPFAR, Diana Fund and WHO projects

The Diana, Princess of Wales Memorial Fund³¹

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 focused 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.

The Diana Fund has supported palliative care development in Kenya by awarding the following grants:

• to Maua Methodist hospital - a three year project to establish a system for caring for the very sick, including access to morphine. £123,962
• To Nairobi Hospice – a three year palliative care training programme that will target health professionals: £60,000

UK Forum for Hospice and Palliative Care Worldwide³²

 This NGO, formed in 2001 to support the development of palliative care in resource poor countries, falls under the umbrella of Help the Hospices (UK). It has supported palliative care development in Kenya by means of the following grant:

• Meru Hospice – support for Dr Bactrin Killingo to study for a diploma in palliative care: £1,500

African Palliative Care Association (APCA) :

The African Palliative Care Association was formally inaugurated at a conference in Arusha in June 2004. The concept was born in 2002 in Cape Town, South Africa at a meeting to look at issues of palliative care education in Africa. The desire to link knowledge, resources and networks throughout Africa provided the motivation to form the association.Steering committee members were drawn from: Kenya (Zipporah-Merdin Ali), South Africa (Kath Defilippi), Tanzania (Jacobson) Uganda ( Anne Merriman) and Zimbabwe (Sambulo Mkwananzi).³³ 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

Foundation for Hospices in Sub-Saharan Africa

This US-based organisation was established in November 1999 to support the efforts of hospice workers in Africa. An international consultation was held in 2000 to devise a strategy for hospice and palliative care development in the Sub-Saharan region. Recommendations for funding were approved and supported by standards for African programmes seeking assistance. These standards were developed from those adopted by the Hospice Association of South Africa. During 2004, FHSSA became part of the US based National Hospice and Palliative Care Organisation.

Through FHSSA Nairobi Hospice has a twinning arrangement with VITAS San Antonio, Texas, USA. This partnership was the first between hospices in Kenya and America. The VITAS San Antonio program is part of the VITAS Innovative Healthcare Corporation. One of San Antonio’s nurses is a native of Kenya, and was instrumental in spearheading the twinning efforts with Hospice Nairobi.³⁴ Meru Hospice is twinned with Hospice Care Incorporated in Wisconsin, USA.