Zambia
A lower-resource system where the ministry, donor-funded hospices and government hospitals have worked together to apply the WHO public health model for palliative care.
9 domains reviewed · 9 high-confidence · 0 dated estimates · 9 material gaps
WHO region: Africa. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 4 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 14
- Newest source 2024
Lessons from Zambia
- Advocacy, training and supply work inside government hospitals made oral morphine available where it had been absent. Availability did not guarantee use without prescriber confidence.57,184
- Donor-dependent services and even the national association collapsed when funding ended. Long-term public funding is a precondition, not a later step.184,186
- Training abroad is costly for a small workforce. Domestic undergraduate teaching and a postgraduate program open to all professions build capacity at home.186,57
Palliative care
Is morphine available in Zambia?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
A ministry and national association morphine pilot raised availability, but use stayed low. In a multi-country government hospital program, every participating hospital had oral morphine by the end. Advocates reported in 2022 that essential palliative medicines were still not reliably available.184,57,186,187
Has national morphine consumption changed since the 2021 strategic plan?
Help answer it:Search PubMedHow does Zambia regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
A ministry and national association morphine pilot resolved some supply obstacles, which its evaluation does not name. A four-country hospital program found morphine legislation and regulation challenging to manage. No source read names the controlled-medicine law or its requirements.184,57
What do the controlled-medicine laws require for stocking, prescribing and dispensing, and have they changed?
Help answer it:Search PubMedWho can prescribe morphine in Zambia?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
A study at a Lusaka tertiary hospital describes doctors as the morphine prescribers. A 2024 review lists ten African countries where nurses may prescribe morphine, and Zambia is not among them. A four-country hospital program recommended nurse prescribing to widen capacity. No source read states the legal rule.187,63,57
May nurses or clinical officers prescribe morphine, or only doctors?
Help answer it:Search PubMedHow does palliative care reach patients in Zambia?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
The first National Palliative Care Strategic Plan launched in May 2021, and palliative care sits in the National Health Strategic Plan. Faith agencies provide a large share of care, and donor-supported hospices expanded home-based services.186,57,184
How far has the 2021 strategic plan reached below hospital level?
Help answer it:Search PubMedWho pays for palliative care in Zambia?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Donor funding carried much of the early growth, and the national palliative care association stopped operating when that funding ran short. In the hospital program, hospitals paid staffing while the program paid for training.184,186,57
Does the government budget for palliative care or morphine, and do patients pay out of pocket?
Help answer it:Search PubMedHow are palliative care clinicians trained in Zambia?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Specialist training is scarce and often done abroad. Palliative care is in the University of Zambia undergraduate medical curriculum, a master's program in palliative care is open to all health professions, and an Africa-wide ranking placed Zambia among the leaders on education.186,57,188
Has the master's program graduated students, and is palliative care recognized as a specialty?
Help answer it:Search PubMedHow does Zambia prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
Doctors at a Lusaka tertiary hospital report growing comfort with morphine, but fear of addiction and poor pain recognition were more common among non-cancer doctors. Morphine use was mostly limited to cancer and sickle cell disease, and outpatient prescribing was rare outside oncology.187
What controlled medicine rules, prescription monitoring, opioid agonist treatment and naloxone access exist in Zambia?
Help answer it:Search PubMedHow do children get palliative care in Zambia?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
The 2017 Africa palliative care atlas, cited in a review, counted four pediatric palliative care service outlets in Zambia. In a four-country survey that included 21 Zambian anesthetists, mostly in tertiary hospitals, respondents reported good availability of opioids for children, and Lusaka doctors described morphine use mainly for cancer and sickle cell disease.595,596,187
How many children receive palliative care in Zambia, and are pediatric morphine formulations available outside Lusaka?
Help answer it:Search PubMedHospice care in Zambia
How the hospice model works here, who can use it, who pays and who it reaches. Covered 4 of 4.
What does hospice care look like in Zambia?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Zambia has hospices that work alongside other palliative care organisations. In 2009-11, eight hospices and palliative care organisations took part in a national initiative that helped them expand services, secure fuel for transport and support home carers.184
Which Zambian hospices are inpatient units, and are they run by churches, NGOs or government?
Help answer it:Search PubMedWho can get hospice care in Zambia?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
In a 2000 to 2001 Lusaka study, an NGO-run inpatient hospice took terminally ill patients referred from surrounding low-income compounds, mostly people with advanced HIV before antiretroviral therapy was available. Referrals came from an HIV clinic and community services, and no formal entry criteria were described.363
What admission criteria do Zambian hospices use now that HIV is treatable and cancer is a larger share of need?
Help answer it:Search PubMedWho pays for hospice care in Zambia?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
In 2009-11 a national advocacy initiative part-funded eight Zambian hospices and palliative care organisations, which allowed them to expand services and pay for drugs, fuel and home carer support. The evaluators concluded that palliative care must be integrated into the public health system and secure long-term funding to thrive.184
What funds Zambian hospices now that the 2009-11 initiative has ended?
Help answer it:Search PubMedHow many people reach hospice in Zambia?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
One Lusaka hospice had 20 adult beds and recorded 288 admissions and 6,685 bed nights over one year in 2000 to 2001, serving patients from several compounds. In 2009 to 2011 an advocacy program part-funded eight hospices and palliative care organisations, which let them expand services and support home carers.363,184
How many Zambians use hospice care today, and how well is it reached outside Lusaka?
Help answer it:Search PubMedWhat fills the gap in Zambia
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Volunteers and compassionate communities
Community volunteers attached to health facilities in Ndola provide home-based palliative care and reported lack of resources, training, coordination and transport. In a rural program, youth anti-AIDS club members were trained as adjunct caregivers who helped with chores and personal care, though clients wanted material help they could not give.422,423
Subnational evidence- Community health workers and home-based care
Civil society community home-based care programs grew from mutual support among settlement residents to care for people dying of AIDS, and later shifted toward chronic care, while reduced donor funding now threatens this capacity. In Lusaka, home-based care organisations looked after at least half of TB patients. At a rural mission hospital, living in a village with volunteer home-based care was not linked to better HIV treatment outcomes.424,425,426
Mixed scope
Sources cited here
- 184Logie DE, Harding R.
An evaluation of a public health advocacy strategy to enhance palliative care provision in Zambia. BMJ Supportive and Palliative Care 2012;2(3):264-269. Ministry and association morphine pilot raised availability while use stayed low; part-funded hospices expanded services 2009 to 2011. Abstract read.
- 57Grant L, Downing J, Luyirika E, Murphy M, Namukwaya L, Kiyange F, et al.
Integrating palliative care into national health systems in Africa: a multi-country intervention study. Journal of Global Health 2017;7(1):010419. DOI 10.7189/jogh.07.010419. Twelve-hospital intervention across Kenya, Rwanda, Uganda and Zambia, 2012 to 2014, including three Rwandan hospitals. Reports hospital oral morphine consumption, patients identified for palliative care, Rwanda's strict sequential referral from village to national level, and a national morphine procurement and prescribing training initiative directed at doctors and pharmacists.
- 186Rosa WE, Ahmed E, Chaila MJ, et al.
Can You Hear Us Now? Equity in Global Advocacy for Palliative Care. Journal of Pain and Symptom Management 2022;64(4):e217-e226. First National Palliative Care Strategic Plan launched May 2021; national association inactive for lack of funding; training often outsourced abroad; University of Zambia master's curriculum. Full text read.
- 187Robertson E, Bambala A, Kalungia AC, et al.
Prescribers' experiences of, and attitudes to, use of morphine for palliative care at a tertiary hospital in Zambia. Hospital Practice 2020;48(2):86-91. Single-site study: morphine largely restricted to cancer and sickle cell disease. Abstract read.
- 63Bastos F, Garralda E, Montero A, Rhee JY, Arias-Casais N, Luyirika E, et al.
Comprehensive scoping review of palliative care development in Africa: recent advances and persistent gaps. Frontiers in Health Services 2024;4:1425353. DOI 10.3389/frhs.2024.1425353. Country tables covering literature from 2017 to 2023: service counts and ratios, countries where nurses may prescribe morphine, and national production of oral morphine solution.
- 188Rhee JY, Garralda E, Namisango E, et al.
An Analysis of Palliative Care Development in Africa: A Ranking Based on Region-Specific Macroindicators. Journal of Pain and Symptom Management 2018;56(2):230-238. Zambia among the leading African countries on education indicators. Abstract read.
- 422Musonda KC, Nyashanu M, Mutale W, et al.
Exploring The Challenges Faced by Informal Home Based Palliative (HBP) Caregivers in Ndola District, Zambia. J Soc Work End Life Palliat Care 2021;17(4):349-363. In-depth interviews with 25 community volunteers attached to health facilities in Ndola District, Zambia, who provide home-based palliative care. Abstract read.
- 595Namisango E, Bhakta N, Wolfe J, et al.
Status of Palliative Oncology Care for Children and Young People in Sub-Saharan Africa: A Perspective Paper on Priorities for New Frontiers. JCO Glob Oncol 2021;7:1395-1405. Perspective review of palliative oncology care for children in sub-Saharan Africa, citing 2017 Atlas counts of pediatric palliative care service outlets by country. Full text read.
- 596Bhettay A, Gray R, Desalu I, et al.
Current pediatric pain practice in Nigeria, South Africa, Uganda, and Zambia: A prospective survey of anesthetists. Paediatr Anaesth 2023;34(7):602-609. Survey of 141 specialist anesthetists in Nigeria, South Africa, Uganda and Zambia (21 from Zambia) on pediatric pain practice and analgesic availability; mostly tertiary hospitals. Abstract read.
- 363Terris-Prestholt F, Kumaranayake L, Ginwalla R, et al.
Integrating tuberculosis and HIV services for people living with HIV: costs of the Zambian ProTEST Initiative. Cost Eff Resour Alloc 2008;6:2. Costing study of an HIV/TB service package in two Lusaka compounds, including one 20-bed adult hospice run by Kara Counselling and Training Trust; data from 2000 to 2001, before public antiretroviral therapy, single hospice. Full text read.
- 423Esu-Williams E, Schenk KD, Geibel S, et al.
'We are no longer called club members but caregivers': Involving youth in HIV and AIDS caregiving in rural Zambia. AIDS Care 2006;18(8):888-94. Program evaluation in rural Zambia training members of youth anti-AIDS clubs as adjunct home caregivers. Run by the Population Council Horizons program. Abstract read.
- 424Aantjes CJ, Simbaya J, Quinlan TK, et al.
From end of life to chronic care: the provision of community home-based care for HIV and the adaptation to new health care demands in Zambia. Prim Health Care Res Dev 2016;17(6):599-610. Mixed-methods study (2011 to 2012) of civil society community home-based care programs for HIV in Zambia and their shift from end-of-life to chronic care. Abstract read.
- 425Bond VA, Tihon V, Muchimba M, et al.
'Kuyendela odwala TB'--visiting TB patients: the widening role of home-based care organisations in the management of tuberculosis patients in Lusaka, Zambia. Int J Tuberc Lung Dis 2005;9(3):282-7. Survey of eight home-based care organisations and one hospice in Lusaka, including 142 TB patients under home-based care, 54 caregivers and 9 managers (1999). Abstract read.
- 426Estopinal CB, van Dijk JH, Sitali S, et al.
Availability of volunteer-led home-based care system and baseline factors as predictors of clinical outcomes in HIV-infected patients in rural Zambia. PLoS One 2012;7(12):e49564. Retrospective cohort of 523 patients on antiretroviral therapy at Macha Mission Hospital, rural Southern Province, Zambia, comparing villages with and without volunteer home-based care teams. Abstract read.