Palliative care services are provided by two organisations in Nigeria, the Palliative Care Initiative ( Ibadan) and Hospice Nigeria ( Lagos) (Table 1).

Table 1 Palliative care provision in Nigeria, 2004

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. Where opioids are unavailable, however, 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.

Palliative care services in Nigeria are undeveloped. There is continuing resistance to some palliative care concepts including opiate use, the multidisciplinary team approach to the management of medical problems and the inclusion of patient and family as the unit of care.

Palliative Care Initiative, Nigeria (PCIN)

Palliative care is being introduced to Nigeria through the Palliative Care Initiative, Nigeria based at the College of Medicine, University of Ibadan. PCIN is a multidisciplinary group of medical specialists who implement the major objectives of training, service and research in this area of medical care. The group was formed in January 2003 and in addition to sensitizing the public on the importance of palliative care, it has sponsored some of its members to attend palliative care courses and conferences in other countries. It operates a pain and palliative care clinic at the University College Hospital, Ibadan. This was commissioned in February 2005 to provide support for patients with chronic pain and cancer patients.² In its current form as a chapter of the International Association for the Study of Pain the group is working towards including palliative care into the curriculum of medical and nursing students, based upon guidelines developed by Hospice Africa Uganda. Funding has been obtained to develop home based palliative care services. A train the trainers programme is expected to produce locally trained palliative care practitioners. Olaitan Soyannwo summarises the current situation:

So what we have in terms of palliative care right now is that we have a lot of individuals, oncologists, surgeons, physicians, you know, just managing patients as best as they can. But the holistic approach, we’ve just introduced that using a small clinic in the radiotherapy clinic and a group of us, two anaesthetists, one oncologist, one nurse, psycho-oncologist, who does counselling, we run a clinic there once a week and then patients on the ward are referred to us, patients with terminal illness, but one major problem is availability of opioids. We don’t have oral morphine in the country: we have injectable opioids – even that one was not available for about four years, and we had to do a lot of advocacy because there was some years back some regulatory problems and opioids were banned with, because they were grouped with narcotics, so although it’s on the National Drug Formulary…we don’t have the oral form, even on the Formulary, so we’re doing a lot of advocacy to get that in now for management of palliative care, for palliative care and management of ill patients.³

She envisages palliative care as a helpful approach in managing the HIV/AIDS epidemic in Nigeria.

We had a group, an international group, like a collaborative from my university, Medical Women’s Association from Lagos and a group from California, which were mainly alumni of university who are interested in cancer pain management. Although we focused on cancer of the breast and cervix which are the two commonest cancers, we want to use the template to do a lot of advocacy for patients with cancer and HIV/AIDS. And the good thing that I think we have in my institution is that we’re already on the national programme in terms of ARV therapy and also prevention of mother to child transmission, so since we are, that is already established, I’m hoping that it will not be too difficult with the support from APCA, this new organisation, to be able to convince them back home that palliative care should be part of this AIDS programme in the country.⁴

PCIN organised a one day workshop on the art and science of palliative care and the management of terminally ill patients in Nigeria on 27 January 2005. Participants included t he Provost and Principal Officers of the College of Medicine, The Chief Medical Director, Chairman, Medical Advisory Committee and Director of Administration of the University College Hospital, Ibadan. Also present were representatives of the Commissioner of Health ( Oyo State), Permanent Secretary, Ministry of Health ( Osun State), retired and serving members of the judiciary, clergy, health professionals, students, the public and the press. There were also representatives of Hospice Nigeria based in Lagos and the Palliative Care Association based in Abeokuta. International guests included Anne Merriman, Founder of Hospice Africa Uganda and Jack Jagwe, a Senior Adviser on Drugs Policy in Uganda.⁵ A primary focus for the workshop was to advocate for palliative care in Nigeria. The main outcomes of the workshop include:

the need to promote a greater awareness of the benefits of palliative medicine in the population at large and among all cadres of professional and traditional healthcare providers. The workshop also recommended a review of the existing restrictions on the availability of oral morphine and other opioids in recognized hospitals and clinics for the relief of severe pain, especially in terminal care situations. It recognizes palliative care as a specialty in itself and the need to train trainers in the field.

The workshop recognizes the leadership roles of the Federal Ministry of Health (FMOH) and the National Agency for Food and Drug Administration and Control (NAFDAC) in these endeavours and urges the Palliative Care Initiative of Nigeria (PCIN) to seek the cooperation of these institutions in these matters.

The workshop strongly recommends the formation of a National Committee or a National Association on Palliative Care to coordinate the activities of satellite groups nationwide, to establish the standards and ethics of terminal care, and to foster relations with similar organizations worldwide.⁶

Hospice Nigeria

This non-governmental organisation in Lagos was registered in 1993 and provides home based care to the terminally ill. It is most often utilised by patients returning home to Nigeria from abroad. The founder, Olusola Fatunmbi ,explains the system:

I had more patients referred to me from London at Lagos Hospitals than within Nigeria, but they knew I had drug problems, and on that basis they promised to see that the patients come with enough oral morphine and some other palliative drugs for their use. And my home care service with my husband and occasionally some of the members of the Trustees, was acquired, was free because we had no funding from anybody, and the counselling, the only thing is that the patients buy their own drugs.⁷

A cancer public awareness campaign has resulted in a few local patients benefiting from the organisation’s help although scarce supplies of oral morphine result in poor pain management.

Several other organisations and individuals may offer some elements of palliative care in clinics and support services for HIV/AIDS patients. Two doctors based at Federal Medical Centre, Abeokuta ( Ogun State) and Zaria have formed a Palliative Care Association and are understood to be promoting palliative care.