The following organisations feature prominently in Nigeria:

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 formed the motivation to form the association.Steering committee members were drawn from: Kenya (Zipporah-Merdin Ali), South Africa ( Kath Defilippi), Tanzania (Mark Jacobson) Uganda ( Anne Merriman) and Zimbabwe (Sambulo Mkwananzi).¹¹

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

Representatives of APCA presented papers at a workshop convened in Ibadan in January 2005 to promote advocacy for palliative care in Nigeria.

President’s Emergency Plan for AIDS Relief (PEPFAR)¹²

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 Nigeria 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

Hospice Africa Uganda

This NGO was founded in 1993 to care for cancer and HIV/AIDS patients and give support to family members.¹³ In the past, most referrals came from hospitals; now, an increasing number originate from community vigilantes (trained carers who identify patients in the community in need of the hospice’s services). Hospice Africa Uganda also incorporates Mobile Hospice Mbarara and Little Hospice Hoima, both established in 1998.¹⁴

In Central and East Africa, Hospice Africa Uganda became the Diana Fund’s partner agency in a 3 year project which attracted funding of £300,000. During this period, Hospice Africa Uganda would:

• provide technical support and advice on the identification of countries with the capacity and political will to initiate palliative care services
• provide guidance and training to such countries
• set up and run a Distance Learning Diploma in Palliative care for African countries
• set up a resource centre of palliative care materials for Africa, at Makindye, Kampala
• improve services within Uganda so that a model can be developed that works for the poorest and that can be duplicated in other African countries.

Anne Merriman comments:

In 2001, the Diana, Princess of Wales, Memorial Fund in London, invited Hospice Africa Uganda to be their technical experts in assisting other African countries to start or strengthen palliative care services using the public health approach and integrating with existing health systems. Working with World Health Organisation, this initiative has brought the Hospice training programmes to several other African countries.¹⁵

As part of this vision Hospice Africa Uganda has assisted PCIN in its efforts to introduce palliative care into Nigeria.

There is no national association in the country. This has been identified as a priority by the participants of the palliative care workshop held in February 2005 in Ibadan.

UK Forum for Hospice and Palliative Care Worldwide¹⁶

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). The following grant has been awarded top Nigeria:

• PCIN - a 2 day regional advocacy workshop involving health professionals, policy-makers and others from the south west of Nigeria: £2,000