Evaluation of a Palliative Care Initiative on the African Continent: Responsibly Improving Access to Pain Treatment
Year of Publication
Martin School of Public Policy and Administration
Master of Public Administration
The African continent today faces a crisis of inadequate palliative care, in spite of the growing level of suffering of its citizens who are faced with debilitating diseases and injuries. Much of this problem stems from deeply ingrained attitudes towards opioids: while the American continent grapples with the effects of opioid overprescribing, physicians trained in Africa are taught that opioids are inappropriate for virtually all scenarios, and therefore they come to fear and avoid their use or simply remain untrained on them altogether. Patients fail to advocate for themselves out of submission to the doctor’s authority, governments remain apathetic to the situation, and as a result thousands of Africans die every year in agonizing and completely preventable pain.
Recognizing this growing problem, American Cancer Society (ACS) has partnered with African governments and hospice organizations to create an initiative known as “Treat the Pain.” The main focus of the program is on in-house production of an oral morphine solution that is cheap to make, simple to administer, and highly effective at treating pain. The program has been implemented in 5 different African countries (Uganda, Kenya, Rwanda, Nigeria, and Swaziland), and several other countries have expressed interest and are currently receiving “technical support” from ACS. Due to a scarcity of high-quality data, attempts at program evaluation have been limited and it is not known whether the initiative is having its intended effect.
This capstone represents a first attempt at utilizing the available information to determine whether countries implementing “Treat the Pain” have indeed increased their consumption of opioids, specifically morphine. Utilizing a United Nations report on opioid consumption, I have attempted to determine whether there is a difference in reported morphine consumption after the date of program implementation when compared to the years before, and also in comparison to countries not participating in the initiative. Using a time series regression and difference-in-differences analysis, I found no statistically significant impact on morphine consumption due to program implementation. Given that there are few instances of the program and that the morphine consumption data is deeply flawed, I recommend continued controlled implementation of the program, and emphasize improved data collection going forward.
Hirschi, J. Spencer, "Evaluation of a Palliative Care Initiative on the African Continent: Responsibly Improving Access to Pain Treatment" (2019). MPA/MPP/MPFM Capstone Projects. 318.
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