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.

In Zimbabwe, palliative care is considered to be given by the following organisations (Table 1):

Bekezela Community Home Based Care. The service was founded in 1994. Around 140 patients were cared for during 2003 and about 200 patients have registered in 2004 (to March 21).⁴ 

Dananai Home Based Care (Murambinda). The organisation was founded in 1992 as a home based care organisation. Focusing on HIV/AIDS patients, it has since extended its service to include education, palliative care and care for orphans. Around 740 patients are registered with the organisation.⁵ 

Family AIDS Caring Trust (FACT). Founded in 1987, FACT was Zimbabwe’s first AIDS service. Today, FACT undertakes peer education and training; facilitates community responses to AIDS sufferers and orphans; and mobilises local resources and volunteers.⁶

Island Hospice. This non government organisation (NGO) has centres in Harare (established 1979), Bulawayo (1981), and Mutare (1985), and incorporates six autonomous branches throughout the country.⁷ Services range from a full palliative home care service - including palliative nursing support, counselling and volunteer services - to simple nursing care. In 2002, 287 patients were registered with Island Hospice, Harare(excluding patients seen at Chitungwiza and in the community based projects). During 2003, Island Hospice Bulawayo cared for 160 patients,⁸ and Island Hospice Mutare cared for 368.⁹

Lubancho House was established in 1989 and focuses on home based care (primarily AIDS patients), children and youth (primarily orphans) and community mobilisation. Around 2,500 patients are currently registered (March 2004). Patients are seen weekly by a member of staff and three times per week by a community volunteer.¹⁰

Mashambanzou Care Trust. Mashambanzou hospice offers a wide range of services, including: a drop-in centre; pre- and post-test counselling; a terminal care centre (for 22 patients); home based care; and bereavement support and counselling. Referrals come via Harare clinics, other care organisations or word of mouth. In 2000, four home based care teams visited 8,350 patients; 40% were male, 60% female. Thirty two per cent were new patients. In the same year, 1,506 orphans received assistance.¹¹

The Mildmay Centre Harare Children’s Hospital is designed to care for children affected by HIV/AIDS. Based at Harare Hospital, children are referred from other health centres, from doctors, or from Mildmay’s outreach centre in Kuwadzana (a high density area). At present, 250 children aged from birth to 16 years are registered with the project. The day care centre can accommodate 15 children.¹²

 Morgenster Mission Hospital has a developing service which began in March 2003 and cares for up to 150 patients.¹³