Mobile Teams in Kazakhstan: Improving Cancer Patients’ Access to Palliative Care

Abstract

Because of the vastness of territory (roughly equal to the size of Western Europe) and scattered population (less than 19 million people or approximately seven people per square kilometer), access to hospice and palliative care for cancer patients in Kazakhstan has remained an issue for a long time. None of the existing hospices, opened between 1999 and 2006 in six major cities: Almaty, Pavlodar, Karaganda, Kostanai, Ust-Kamenogorsk, and Semei, have had permanent visiting services, making it impossible for cancer patients, especially residing in rural areas of the country, to get palliative care at the end of their lives. Besides, the vast majority of people suffering from life-threatening diseases prefer to spend their last days in the comfort of their own homes. Primary health-care facilities still have little to offer to this category of patients, except for prescription of painkillers and rare home visits of a residential oncologist or a general practitioner, due to the lack of time, personnel, and confidence in palliative care delivery.

Several nongovernmental organizations, based in Karaganda (Credo), Almaty (Together Against Cancer), Taraz (Amazonka), and Pavlodar (Solyaris Hospice), became pioneers of the in-home palliative care, creating independent teams in 2011–2013. Supported by the Open Society Foundation and local sponsors, each of them followed their own model, but only two of them gained sustainability. Their experience has become a valuable source of methodological and practical information for future development of in-home palliative care for cancer patients.

An important step, addressing the growing demand for end-of-life care for cancer patients who were no longer receiving specialized care in oncology centers, was the decision of the Ministry of Health to establish mobile teams, providing multidisciplinary home-based palliative care in all 14 provinces and three cities of Kazakhstan. The budget for this project was allocated through the Complex Plan to Combat Cancer for 2018–2022, put into effect by the Decree of the Government of the Republic of Kazakhstan #395 On Adoption of Complex Plan to Combat Oncological Diseases in the Republic of Kazakhstan for 2018–2022 dated 30.12.2019. https://online.zakon.kz/document/?doc_id=35255787.

Considerable effort will be required to properly implement the task of providing quality end-of-life services to all cancer patients in need, regardless of their place of residence, including building capacity and knowledge in palliative care providers, gaining sustainability in financing and continuity of care. Nonetheless, mobile teams have every prospect to close the need for palliative care for cancer patients.