More Nurses Needed to Prescribe Morphine

By Esther Nakkazi

Twenty-nine students graduated with a Diploma in Clinical Palliative Care from the Institute of Hospice and Palliative Care in Africa (IHPCA) at Hospice Africa Uganda on Friday 20th May. The graduates who are either registered nurses or clinical officers can legally prescribe oral liquid morphine for pain relief. 

To date the IHPCA has trained 160 palliative care practitioners in prescribing liquid morphine. Whilst palliative care exists in 80% of the districts in Uganda this is “a drop in the ocean” compared with the demand for palliative care in the country.

Uganda is the first country in the world to make legislation that allows trained nurses and clinical officers to prescribe oral liquid morphine, a cornerstone medication used in Palliative Care. This supplements the few number of doctors, who in most countries are the only registered prescribers of such medications.

Dr. Elioda Tumwesigye the Minister of Health said there is an ''urgent need' to scale up and pledged to support the scaling up of palliative care training in Uganda.

“Despite major achievements, especially the work of Hospice Africa Uganda over the last 23 years, a lot more needs to be done to meet all of the palliative care needs in the country,” Dr. Tumwesigye said at the graduation and spoke of his own personal experience with cancer, having lost both parents to the disease. He revealed his mother was on the Hospice Africa Uganda programme in Mbarara.

Dr Eddie Mwebesa, the acting Chief Executive Director of HAU reiterated the huge need for Palliative care in Africa and in Uganda.

Dr. Tumwesigye said he will support to widen the reach of palliative care and to see if the Government, through the Ministry of Health, will consider stepping in to offer scholarships for palliative care courses, or at least to subsidize student fees at Public training Institutions.

He also said he would work to ensure that all the three academic programmes run at the IHPCA - the Bachelor of Science Degree, the Diploma in Palliative Care and the Diploma in Clinical Palliative Care - are included in the Ministry of Public Service scheme of service.

This has been the most serious challenge faced by graduates from these courses because it means they have no channel for promotion or career progression in public service.

Prof. Stanley Acuda Wilson the Institute principal said the IHPCA is playing a vital role in training and educating doctors, nurses and healthcare workers in palliative care in Uganda and Sub Saharan Africa.

The Institute was recognized by the National Council for Higher Education as a tertiary institution in 2009 and granted a provisional license to confer degrees and diplomas in affiliation with Makerere University. It was also granted the degree awarding Institution status in 2014 with a provisional license to award its own degrees and diplomas.

HAU founder Professor Anne Merriman said “despite the achievements by Hospice Africa Uganda in provision of palliative care services with meagre resources, there are a number of challenges which require government help in order to increase accessibility of palliative care in Uganda and fulfill HAU’s vision of palliative care reaching all in need in Uganda and Africa”.

All over the world, including Uganda, the need for palliative care is significant and growing because of the high prevalence of cancer, HIV/AIDS and increasing prevalence of non-communicable diseases.

Hospice Africa Uganda is the country’s pioneer Hospice founded by Prof. Anne Merriman in 1993. According to Worldwide Hospice and Palliative care Alliance in 2016, 40 million people worldwide need palliative care.

18 million die each year in severe pain and distress due to lack of access to palliative care and pain relieving medications. 78% of these live in middle and low income countries and 6% are children. 42% of countries in the world do not have any palliative care services.

Since its inception HAU has cared for over 26 000 people at its three sites in Uganda, (Kampala, Mbarara and Hoima), and it currently cares for over 4,600 patients annually.