brightdata/a.json at main · karaposu/brightdata · GitHub

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While efforts are underway to…\" />\n<meta property=og:image content=\"https://ars.els-cdn.com/content/image/1-s2.0-S2213538319X00028-cov150h.gif\" />\n<meta name=\"citation_title\" content=\"Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey\" />\n<meta property=og:title content=\"Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey\" />\n<meta name=\"citation_publication_date\" content=\"2019/06/01\" />\n<meta name=\"citation_online_date\" content=\"2019/02/20\" />\n<meta name=\"robots\" content=\"INDEX,FOLLOW,NOARCHIVE,NOCACHE,NOODP,NOYDIR\" />\n      <title>Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey - ScienceDirect</title>\n      <link rel=\"canonical\" href=\"https://www.sciencedirect.com/science/article/abs/pii/S2213538318300237\" />\n      <meta name=\"tdm-reservation\" content=\"1\">\n      <meta name=\"tdm-policy\" content=\"https://www.elsevier.com/tdm/tdmrep-policy.json\">\n      <meta property=\"og:type\" content=\"article\" />\n      <meta name=\"viewport\" content=\"initial-scale=1\" />\n      <meta name=\"SDTech\" content=\"Proudly brought to you by the SD Technology team\" />\n      <script type=\"acff22b8cea305d027733f03-text/javascript\">(function newRelicBrowserProSPA() {\n  ;\n  window.NREUM || (NREUM = {});\n  NREUM.init = {\n    privacy: {\n      cookies_enabled: false\n    },\n    ajax: {\n      deny_list: [\"bam-cell.nr-data.net\"]\n    }\n  };\n  ;\n  NREUM.loader_config = {\n    accountID: \"2128461\",\n    trustKey: \"2038175\",\n    agentID: \"1118783207\",\n    licenseKey: \"7ac4127487\",\n    applicationID: \"814814845\"\n  };\n  ;\n  NREUM.info = {\n    beacon: \"bam.nr-data.net\",\n    errorBeacon: \"bam.nr-data.net\",\n    licenseKey: \"7ac4127487\",\n    applicationID: \"814814845\",\n    sa: 1\n  };\n  ; /*! 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{\n                  try {\n                    t.emit(\"internal-error\", [e]);\n                  } catch (e) {}\n                }\n              };\n              for (var s = 0; s < G; s++) r.addEventListener(V[s], this.listener, (0, C.m$)(!1));\n            }\n            function l(e, t, r) {\n              this.cbTime += e, t ? this.onloadCalled = !0 : this.called += 1, this.called !== this.totalCbs || !this.onloadCalled && \"function\" == typeof r.onload || \"function\" != typeof this.end || this.end(r);\n            }\n            function f(e, t) {\n              var r = \"\" + M(e) + !!t;\n              this.xhrGuids && !this.xhrGuids[r] && (this.xhrGuids[r] = !0, this.totalCbs += 1);\n            }\n            function h(e, t) {\n              var r = \"\" + M(e) + !!t;\n              this.xhrGuids && this.xhrGuids[r] && (delete this.xhrGuids[r], this.totalCbs -= 1);\n            }\n            function p() {\n              this.endTime = (0, g.z)();\n            }\n      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e[0].toString()), \"string\" == typeof t && 0 !== t.length) {\n                t && (this.parsedOrigin = (0, U.e)(t), this.sameOrigin = this.parsedOrigin.sameOrigin);\n                var n = o.generateTracePayload(this.parsedOrigin);\n                if (n && (n.newrelicHeader || n.traceContextParentHeader)) if (e[0] && e[0].headers) s(e[0].headers, n) && (this.dt = n);else {\n                  var i = {};\n                  for (var a in r) i[a] = r[a];\n                  i.headers = new Headers(r.headers || {}), s(i.headers, n) && (this.dt = n), e.length > 1 ? e[1] = i : e.push(i);\n                }\n              }\n              function s(e, t) {\n                var r = !1;\n                return t.newrelicHeader && (e.set(\"newrelic\", t.newrelicHeader), r = !0), t.traceContextParentHeader && (e.set(\"traceparent\", t.traceContextParentHeader), t.traceContextStateHeader && e.set(\"tracestate\", t.traceContextStateHeader), r = !0), r;\n              }\n            }\n            function A(e, t) {\n              this.params = {}, this.metrics = {}, this.startTime = (0, g.z)(), this.dt = t, e.length >= 1 && (this.target = e[0]), e.length >= 2 && (this.opts = e[1]);\n              var r,\n                n = this.opts || {},\n                i = this.target;\n              \"string\" == typeof i ? r = i : \"object\" == typeof i && i instanceof W ? r = i.url : u._A?.URL && \"object\" == typeof i && i instanceof URL && (r = i.href), T(this, r);\n              var o = (\"\" + (i && i instanceof W && i.method || n.method || \"GET\")).toUpperCase();\n              this.params.method = o, this.txSize = B(n.body) || 0;\n            }\n            function x(e, t) {\n              var n;\n              this.endTime = (0, g.z)(), this.params || (this.params = {}), this.params.status = t ? t.status : 0, \"string\" == typeof this.rxSize && this.rxSize.length > 0 && (n = +this.rxSize);\n              var o = {\n                txSize: this.txSize,\n                rxSize: 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B(e.response) : \"text\" === r || \"\" === r || void 0 === r ? B(e.responseText) : void 0;\n              }(t, e.lastSize);\n              if (r && (e.metrics.rxSize = r), e.sameOrigin) {\n                var n = t.getResponseHeader(\"X-NewRelic-App-Data\");\n                n && (e.params.cat = n.split(\", \").pop());\n              }\n              e.loadCaptureCalled = !0;\n            }\n            t.on(\"new-xhr\", a), t.on(\"open-xhr-start\", s), t.on(\"open-xhr-end\", c), t.on(\"send-xhr-start\", d), t.on(\"xhr-cb-time\", l), t.on(\"xhr-load-added\", f), t.on(\"xhr-load-removed\", h), t.on(\"xhr-resolved\", p), t.on(\"addEventListener-end\", m), t.on(\"removeEventListener-end\", v), t.on(\"fn-end\", y), t.on(\"fetch-before-start\", w), t.on(\"fetch-start\", A), t.on(\"fn-start\", b), t.on(\"fetch-done\", x);\n          }(e, this.ee, this.handler, this.dt), this.importAggregator());\n        }\n      }\n      var K = i(3614);\n      const {\n        BST_RESOURCE: Y,\n        RESOURCE: J,\n        START: ee,\n        END: te,\n        FEATURE_NAME: re,\n        FN_END: ne,\n        FN_START: ie,\n        PUSH_STATE: oe\n      } = K;\n      var ae = i(7836);\n      const {\n        FEATURE_NAME: se,\n        START: ce,\n        END: ue,\n        BODY: de,\n        CB_END: le,\n        JS_TIME: fe,\n        FETCH: he,\n        FN_START: pe,\n        CB_START: ge,\n        FN_END: me\n      } = ae;\n      var ve = i(4649);\n      class be extends h {\n        static featureName = ve.t;\n        constructor(e, t) {\n          let r = !(arguments.length > 2 && void 0 !== arguments[2]) || arguments[2];\n          super(e, t, ve.t, r), this.importAggregator();\n        }\n      }\n      new class extends t {\n        constructor(t) {\n          let r = arguments.length > 1 && void 0 !== arguments[1] ? arguments[1] : (0, _.ky)(16);\n          super(), u._A ? (this.agentIdentifier = r, this.sharedAggregator = new y({\n            agentIdentifier: this.agentIdentifier\n          }), this.features = {}, this.desiredFeatures = new Set(t.features || []), this.desiredFeatures.add(m), Object.assign(this, (0, s.j)(this.agentIdentifier, t, t.loaderType || \"agent\")), this.start()) : (0, e.Z)(\"Failed to initial the agent. Could not determine the runtime environment.\");\n        }\n        get config() {\n          return {\n            info: (0, n.C5)(this.agentIdentifier),\n            init: (0, n.P_)(this.agentIdentifier),\n            loader_config: (0, n.DL)(this.agentIdentifier),\n            runtime: (0, n.OP)(this.agentIdentifier)\n          };\n        }\n        start() {\n          const t = \"features\";\n          try {\n            const n = a(this.agentIdentifier),\n              i = [...this.desiredFeatures];\n            i.sort((e, t) => r.p[e.featureName] - r.p[t.featureName]), i.forEach(t => {\n              if (n[t.featureName] || t.featureName === r.D.pageViewEvent) {\n                const i = function (e) {\n                  switch (e) {\n                    case r.D.ajax:\n                      return [r.D.jserrors];\n                    case r.D.sessionTrace:\n                      return [r.D.ajax, r.D.pageViewEvent];\n                    case r.D.sessionReplay:\n                      return [r.D.sessionTrace];\n                    case r.D.pageViewTiming:\n                      return [r.D.pageViewEvent];\n                    default:\n                      return [];\n                  }\n                }(t.featureName);\n                i.every(e => n[e]) || (0, e.Z)(\"\".concat(t.featureName, \" is enabled but one or more dependent features has been disabled (\").concat((0, D.P)(i), \"). 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Box 32379, Lusaka, Zambia\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"University of Zambia\"},{\"#name\":\"address-line\",\"_\":\"P.O. Box 32379\"},{\"#name\":\"city\",\"_\":\"Lusaka\"},{\"#name\":\"country\",\"_\":\"Zambia\"}]}]},{\"#name\":\"correspondence\",\"$\":{\"id\":\"cor0005\"},\"$$\":[{\"#name\":\"label\",\"_\":\"⁎\"},{\"#name\":\"text\",\"_\":\"Corresponding author at: Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 2009 Old Clinic Building, Chapel Hill, BC 27599.\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"Division of Global Women's Health\"},{\"#name\":\"organization\",\"_\":\"Department of Obstetrics and Gynecology\"},{\"#name\":\"organization\",\"_\":\"University of North Carolina at Chapel Hill\"},{\"#name\":\"address-line\",\"_\":\"2009 Old Clinic Building\"},{\"#name\":\"city\",\"_\":\"Chapel Hill\"},{\"#name\":\"postal-code\",\"_\":\"BC 27599\"}]}]}]}],\"floats\":[],\"footnotes\":[],\"affiliations\":{\"aff0005\":{\"#name\":\"affiliation\",\"$\":{\"id\":\"aff0005\",\"affiliation-id\":\"S2213538318300237-9ba875003292395367964a3e1c1a929e\"},\"$$\":[{\"#name\":\"label\",\"_\":\"a\"},{\"#name\":\"textfn\",\"_\":\"Centre for Infectious Disease Research in Zambia (CIDRZ), P.O. Box 34681, Lusaka, Zambia\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"Centre for Infectious Disease Research in Zambia (CIDRZ)\"},{\"#name\":\"address-line\",\"_\":\"P.O. Box 34681\"},{\"#name\":\"city\",\"_\":\"Lusaka\"},{\"#name\":\"country\",\"_\":\"Zambia\"}]}]},\"aff0010\":{\"#name\":\"affiliation\",\"$\":{\"id\":\"aff0010\",\"affiliation-id\":\"S2213538318300237-387eda8bbf09f950b58e553806ba6d3e\"},\"$$\":[{\"#name\":\"label\",\"_\":\"b\"},{\"#name\":\"textfn\",\"_\":\"Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, 3009 Old Clinic Building CB #7570, Chapel Hill, NC, 27599-7570, USA\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"Division of Global Women’s Health\"},{\"#name\":\"organization\",\"_\":\"Department of Obstetrics and Gynecology\"},{\"#name\":\"organization\",\"_\":\"University of North Carolina at Chapel Hill School of Medicine\"},{\"#name\":\"address-line\",\"_\":\"3009 Old Clinic Building CB #7570\"},{\"#name\":\"city\",\"_\":\"Chapel Hill\"},{\"#name\":\"state\",\"_\":\"NC\"},{\"#name\":\"postal-code\",\"_\":\"27599-7570\"},{\"#name\":\"country\",\"_\":\"USA\"}]}]},\"aff0015\":{\"#name\":\"affiliation\",\"$\":{\"id\":\"aff0015\",\"affiliation-id\":\"S2213538318300237-ebb45fab9bca315640439e0a3f63f83a\"},\"$$\":[{\"#name\":\"label\",\"_\":\"c\"},{\"#name\":\"textfn\",\"_\":\"Cancer Diseases Hospital, Lusaka, Zambia\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"Cancer Diseases Hospital\"},{\"#name\":\"city\",\"_\":\"Lusaka\"},{\"#name\":\"country\",\"_\":\"Zambia\"}]}]},\"aff0020\":{\"#name\":\"affiliation\",\"$\":{\"id\":\"aff0020\",\"affiliation-id\":\"S2213538318300237-75e3d91d63d2b06f08bb55997ed085e6\"},\"$$\":[{\"#name\":\"label\",\"_\":\"d\"},{\"#name\":\"textfn\",\"_\":\"University of Zambia, P.O. Box 32379, Lusaka, Zambia\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"University of Zambia\"},{\"#name\":\"address-line\",\"_\":\"P.O. Box 32379\"},{\"#name\":\"city\",\"_\":\"Lusaka\"},{\"#name\":\"country\",\"_\":\"Zambia\"}]}]}},\"correspondences\":{\"cor0005\":{\"#name\":\"correspondence\",\"$\":{\"id\":\"cor0005\"},\"$$\":[{\"#name\":\"label\",\"_\":\"⁎\"},{\"#name\":\"text\",\"_\":\"Corresponding author at: Division of Global Women's Health, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, 2009 Old Clinic Building, Chapel Hill, BC 27599.\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"Division of Global Women's Health\"},{\"#name\":\"organization\",\"_\":\"Department of Obstetrics and Gynecology\"},{\"#name\":\"organization\",\"_\":\"University of North Carolina at Chapel Hill\"},{\"#name\":\"address-line\",\"_\":\"2009 Old Clinic Building\"},{\"#name\":\"city\",\"_\":\"Chapel Hill\"},{\"#name\":\"postal-code\",\"_\":\"BC 27599\"}]}]}},\"attachments\":[],\"scopusAuthorIds\":{},\"articles\":{}},\"authorMetadata\":[],\"banner\":{\"expanded\":false},\"biographies\":{},\"body\":{},\"chapters\":{\"toc\":[],\"isLoading\":false},\"changeViewLinks\":{\"showFullTextLink\":true,\"showAbstractLink\":false},\"citingArticles\":{\"hitCount\":4,\"viewMoreUrl\":\"http://www.scopus.com/scopus/inward/citedby.url?partnerID=10&rel=3.0.0&eid=2-s2.0-85062260346&md5=bcd05a3ce165aedd72b77164f349b7cb\",\"articles\":[{\"articleTitle\":\"A scoping review on the availability and utilization of essential opioid analgesics in Sub-Saharan Africa\",\"authors\":\"Yao J.S., Kibu O.D., Foretia D.A.\",\"doi\":\"10.1016/j.amjsurg.2023.03.013\",\"externalArticle\":false,\"issn\":\"00029610\",\"openAccess\":0,\"page\":\"409-421\",\"pii\":\"S0002961023001095\",\"publicationDate\":\"2023-10-01\",\"publicationTitle\":\"American Journal of Surgery\",\"publicationYear\":\"2023\",\"scopusArticleUrl\":\"http://www.scopus.com/scopus/inward/record.url?partnerID=10&rel=3.0.0&view=basic&eid=2-s2.0-85151572888&md5=5381c647e56789d11499cf1cce93f5f\",\"scopusEid\":\"2-s2.0-85151572888\",\"snippets\":[\"For example, a 2017 study demonstrated that non-opioid analgesics such as paracetamol (acetaminophen) and ibuprofen were more commonly and appropriately identified by HCPs as pain medications over opioids.94 In addition, a survey of nine provincial hospitals in Zambia showed that acetaminophen was available at all institutions, but codeine was never available at 64% of facilities (n = 7) and fentanyl, methadone, and oxycodone were never available at 90% of facilities (n = 10).55 Non-essential opioids such as tramadol and pentazocine were more frequently used for pain management over essential opioids in one Nigerian teaching hospital.49\"],\"thirdParty\":false,\"volume\":\"Volume 226\",\"abstract\":{\"$$\":[{\"$$\":[{\"$\":{\"id\":\"sectitle0010\"},\"#name\":\"section-title\",\"_\":\"Abstract\"},{\"$$\":[{\"$\":{\"id\":\"sectitle0015\"},\"#name\":\"section-title\",\"_\":\"Background\"},{\"$\":{\"view\":\"all\",\"id\":\"abspara0010\"},\"#name\":\"simple-para\",\"_\":\"Management of acute, post-operative, and chronic pain requires access to and availability of opioids. While often oversupplied in high-income countries, significant shortages exist in low- and middle-income countries. We conducted a scoping review on availability and usage of opioids in Sub-Saharan Africa (SSA).\"}],\"$\":{\"view\":\"all\",\"role\":\"background\",\"id\":\"abssec0010\"},\"#name\":\"abstract-sec\"},{\"$$\":[{\"$\":{\"id\":\"sectitle0020\"},\"#name\":\"section-title\",\"_\":\"Methods\"},{\"$\":{\"view\":\"all\",\"id\":\"abspara0015\"},\"#name\":\"simple-para\",\"_\":\"The five-stage approach of Arksey and O'Malley (2005) was used. MEDLINE via PubMed, EMBASE, and SCOPUS were search and results categorized into themes: 1) Local/regional availability and supply, 2) Consumption patterns, 3) Legislation and policy, 4) Costs and financing, 5) Knowledge and cultural beliefs, and 6) Education and training.\"}],\"$\":{\"view\":\"all\",\"id\":\"abssec0015\"},\"#name\":\"abstract-sec\"},{\"$$\":[{\"$\":{\"id\":\"sectitle0025\"},\"#name\":\"section-title\",\"_\":\"Results\"},{\"$\":{\"view\":\"all\",\"id\":\"abspara0020\"},\"#name\":\"simple-para\",\"_\":\"6923 studies were identified from which 69 (1%) met inclusion criteria. Five key findings were: 1) Significant shortages exist, especially in rural areas, 2) Non-opioid analgesics commonly used as first-line acute pain management, 3) Barriers to market entry and bureaucratic processes prevent local production, 4) Significant knowledge gaps/myths exist amongst healthcare practitioners on opioid use, and 5) Continuous education and short courses will be critical.\"}],\"$\":{\"view\":\"all\",\"role\":\"results\",\"id\":\"abssec0020\"},\"#name\":\"abstract-sec\"},{\"$$\":[{\"$\":{\"id\":\"sectitle0030\"},\"#name\":\"section-title\",\"_\":\"Conclusions\"},{\"$\":{\"view\":\"all\",\"id\":\"abspara0025\"},\"#name\":\"simple-para\",\"_\":\"Major challenges significantly limit availability and utilization of essential opioids in SSA. Reforms needed to upscale training and education, increase uptake by professionals, and increase market entry.\"}],\"$\":{\"view\":\"all\",\"role\":\"conclusion\",\"id\":\"abssec0025\"},\"#name\":\"abstract-sec\"}],\"$\":{\"view\":\"all\",\"id\":\"abs0010\",\"lang\":\"en\",\"class\":\"author\"},\"#name\":\"abstract\"},{\"$$\":[{\"$\":{\"id\":\"sectitle0035\"},\"#name\":\"section-title\",\"_\":\"Highlights\"},{\"$$\":[{\"$$\":[{\"$$\":[{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"p0015\"},\"#name\":\"para\",\"_\":\"Essential opioid analgesics are often overprescribed and abused in many high-income countries.\"}],\"$\":{\"id\":\"u0015\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"p0020\"},\"#name\":\"para\",\"_\":\"Significant shortages exist in sub-Saharan Africa (SSA) especially in rural communities.\"}],\"$\":{\"id\":\"u0020\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"p0030\"},\"#name\":\"para\",\"_\":\"In SSA, there is considerable stigma against palliative care and opioids, exacerbating barriers to accessing opioids.\"}],\"$\":{\"id\":\"u0030\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"p0035\"},\"#name\":\"para\",\"_\":\"Significant knowledge gaps exist in opioid prescribing and administration among healthcare practitioners.\"}],\"$\":{\"id\":\"u0035\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"p0040\"},\"#name\":\"para\",\"_\":\"Reforms are needed to upscale local manufacturing of opioids, to increase training and to reduce barriers to market entry.\"}],\"$\":{\"id\":\"u0040\"},\"#name\":\"list-item\"}],\"$\":{\"id\":\"ulist0010\"},\"#name\":\"list\"}],\"$\":{\"view\":\"all\",\"id\":\"abspara0030\"},\"#name\":\"simple-para\"}],\"$\":{\"view\":\"all\",\"id\":\"abssec0030\"},\"#name\":\"abstract-sec\"}],\"$\":{\"view\":\"all\",\"id\":\"abs0015\",\"lang\":\"en\",\"class\":\"author-highlights\"},\"#name\":\"abstract\"}],\"$\":{\"xmlns:ce\":true,\"xmlns:dm\":true,\"xmlns:sb\":true},\"#name\":\"abstracts\"}},{\"articleTitle\":\"Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review\",\"authors\":\"Ooms G.I., van Oirschot J., Reed T.\",\"doi\":\"10.1016/j.drugpo.2023.104078\",\"externalArticle\":false,\"issn\":\"09553959\",\"openAccess\":1,\"pii\":\"S0955395923001263\",\"publicationDate\":\"2023-08-01\",\"publicationTitle\":\"International Journal of Drug Policy\",\"publicationYear\":\"2023\",\"scopusArticleUrl\":\"http://www.scopus.com/scopus/inward/record.url?partnerID=10&rel=3.0.0&view=basic&eid=2-s2.0-85163350905&md5=86b179fc49ef3259a9198bce6ac388e7\",\"scopusEid\":\"2-s2.0-85163350905\",\"snippets\":[\"Only one government facility in Nigeria and Cameroon stocked oral morphine in 2018 (Nchako et al., 2018), and 50% of nurses in Eritrea indicated that lack of opioids was a barrier to access (Kahsay & Pitkäjärvi, 2019). Stockouts were a problem in Zambia, where 45% of surveyed hospitals indicated that morphine had been stocked out for at least 90 days (Frett Utter et al., 2019). In Zimbabwe 22% of surveyed healthcare workers (HCWs) indicated opioids had been stocked out in the last three months (Tapera & Nyakabau, 2020).\"],\"thirdParty\":false,\"volume\":\"Volume 118\",\"abstract\":{\"$$\":[{\"$$\":[{\"$\":{\"id\":\"cesectitle0001\"},\"#name\":\"section-title\",\"_\":\"Highlights\"},{\"$$\":[{\"$$\":[{\"$$\":[{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"para0001\"},\"#name\":\"para\",\"_\":\"Lack of knowledge of the public and health workers on controlled medicines.\"}],\"$\":{\"id\":\"celistitem0001\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"para0002\"},\"#name\":\"para\",\"_\":\"Low availability, stockouts and unaffordability of the medicines were common.\"}],\"$\":{\"id\":\"celistitem0002\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"para0003\"},\"#name\":\"para\",\"_\":\"Lacking quantification systems and cumbersome procurement processes hamper access.\"}],\"$\":{\"id\":\"celistitem0003\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"para0004\"},\"#name\":\"para\",\"_\":\"Strict national laws lead to overly restrictive prescription practices.\"}],\"$\":{\"id\":\"celistitem0004\"},\"#name\":\"list-item\"},{\"$$\":[{\"#name\":\"label\",\"_\":\"•\"},{\"$\":{\"view\":\"all\",\"id\":\"para0005\"},\"#name\":\"para\",\"_\":\"Important to tackle barriers in Sub-Saharan Africa for this class of drugs together.\"}],\"$\":{\"id\":\"celistitem0005\"},\"#name\":\"list-item\"}],\"$\":{\"id\":\"celist0001\"},\"#name\":\"list\"}],\"$\":{\"view\":\"all\",\"id\":\"spara007\"},\"#name\":\"simple-para\"}],\"$\":{\"view\":\"all\",\"id\":\"abss0001\"},\"#name\":\"abstract-sec\"}],\"$\":{\"view\":\"all\",\"id\":\"abs0001\",\"class\":\"author-highlights\"},\"#name\":\"abstract\"},{\"$$\":[{\"$\":{\"id\":\"cesectitle0002\"},\"#name\":\"section-title\",\"_\":\"Abstract\"},{\"$$\":[{\"$\":{\"id\":\"cesectitle0003\"},\"#name\":\"section-title\",\"_\":\"Background\"},{\"$\":{\"view\":\"all\",\"id\":\"spara008\"},\"#name\":\"simple-para\",\"_\":\"Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization's Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA.\"}],\"$\":{\"view\":\"all\",\"role\":\"background\",\"id\":\"abss0002\"},\"#name\":\"abstract-sec\"},{\"$$\":[{\"$\":{\"id\":\"cesectitle0004\"},\"#name\":\"section-title\",\"_\":\"Methods\"},{\"$\":{\"view\":\"all\",\"id\":\"spara009\"},\"#name\":\"simple-para\",\"_\":\"A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework.\"}],\"$\":{\"view\":\"all\",\"role\":\"materials-methods\",\"id\":\"abss0003\"},\"#name\":\"abstract-sec\"},{\"$$\":[{\"$\":{\"id\":\"cesectitle0005\"},\"#name\":\"section-title\",\"_\":\"Results\"},{\"$\":{\"view\":\"all\",\"id\":\"spara010\"},\"#name\":\"simple-para\",\"_\":\"The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices.\"}],\"$\":{\"view\":\"all\",\"role\":\"results\",\"id\":\"abss0004\"},\"#name\":\"abstract-sec\"},{\"$$\":[{\"$\":{\"id\":\"cesectitle0006\"},\"#name\":\"section-title\",\"_\":\"Conclusion\"},{\"$\":{\"view\":\"all\",\"id\":\"spara011\"},\"#name\":\"simple-para\",\"_\":\"This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.\"}],\"$\":{\"view\":\"all\",\"role\":\"conclusion\",\"id\":\"abss0005\"},\"#name\":\"abstract-sec\"}],\"$\":{\"view\":\"all\",\"id\":\"abs0002\",\"class\":\"author\"},\"#name\":\"abstract\"}],\"$\":{\"xmlns:ce\":true,\"xmlns:dm\":true,\"xmlns:sb\":true},\"#name\":\"abstracts\"}},{\"articleTitle\":\"Can You Hear Us Now? Equity in Global Advocacy for Palliative Care\",\"authors\":\"Rosa W.E., Ahmed E., Pettus K.I.\",\"doi\":\"10.1016/j.jpainsymman.2022.07.004\",\"externalArticle\":false,\"issn\":\"08853924\",\"openAccess\":0,\"page\":\"e217-e226\",\"pii\":\"S0885392422008223\",\"publicationDate\":\"2022-10-01\",\"publicationTitle\":\"Journal of Pain and Symptom Management\",\"publicationYear\":\"2022\",\"scopusArticleUrl\":\"http://www.scopus.com/scopus/inward/record.url?partnerID=10&rel=3.0.0&view=basic&eid=2-s2.0-85138003835&md5=326f69bcf5d2195199bae6e19a83134e\",\"scopusEid\":\"2-s2.0-85138003835\",\"snippets\":[\"Zambia's Ministry of Health launched the country's first National Palliative Care Strategic Plan (2021–2026) on May 26, 2021, which will support further development and integration of palliative care in the country.34 Despite this important advancement, there is a dearth of palliative care specialty education, teachers, curricula, and centers of excellence, as well as inconsistent access to short-term training programs in Zambia.35 There are only three individuals with masters-level palliative care education at the time of this writing – one physician, one nurse, and one social worker.\"],\"thirdParty\":false,\"volume\":\"Volume 64\",\"abstract\":{\"$$\":[{\"$$\":[{\"$\":{\"id\":\"cesectitle0001\"},\"#name\":\"section-title\",\"_\":\"Abstract\"},{\"$$\":[{\"$\":{\"view\":\"all\",\"id\":\"spara004\"},\"#name\":\"simple-para\",\"_\":\"Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice & Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.\"}],\"$\":{\"view\":\"all\",\"id\":\"abss0001\"},\"#name\":\"abstract-sec\"}],\"$\":{\"view\":\"all\",\"id\":\"abs0001\",\"class\":\"author\"},\"#name\":\"abstract\"}],\"$\":{\"xmlns:ce\":true,\"xmlns:dm\":true,\"xmlns:sb\":true},\"#name\":\"abstracts\"}},{\"articleTitle\":\"Comprehensive scoping review of palliative care development in Africa: recent advances and persistent gaps\",\"authors\":\"Bastos F.V., Garralda E., Tripodoro V.A.\",\"doi\":\"10.3389/frhs.2024.1425353\",\"externalArticle\":true,\"openAccess\":0,\"publicationDate\":\"2024\",\"publicationTitle\":\"Frontiers in Health Services\",\"publicationYear\":\"2024\",\"scopusArticleUrl\":\"http://www.scopus.com/scopus/inward/record.url?partnerID=10&rel=3.0.0&view=basic&eid=2-s2.0-85212671292&md5=be65e7849417d5bd7daf57a41571353d\",\"scopusEid\":\"2-s2.0-85212671292\",\"thirdParty\":false,\"volume\":\"Volume 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class=\\\"key-dates-help\\\"><h3 class=\\\"u-margin-s-bottom u-h4\\\">Publication milestones</h3><p class=\\\"u-margin-m-bottom\\\">The dates displayed for an article provide information on when various publication milestones were reached at the journal that has published the article. Where applicable, activities on preceding journals at which the article was previously under consideration are not shown (for instance submission, revisions, rejection).</p><p class=\\\"u-margin-xs-bottom\\\">The publication milestones include:</p><ul class=\\\"key-dates-help-list u-margin-m-bottom u-padding-s-left\\\"><li><span class=\\\"u-text-italic\\\">Received</span>: The date the article was originally submitted to the journal.</li><li><span class=\\\"u-text-italic\\\">Revised</span>: The date the most recent revision of the article was submitted to the journal. Dates corresponding to intermediate revisions are not shown.</li><li><span class=\\\"u-text-italic\\\">Accepted</span>: The date the article was accepted for publication in the journal.</li><li><span class=\\\"u-text-italic\\\">Available online</span>: The date a version of the article was made available online in the journal.</li><li><span class=\\\"u-text-italic\\\">Version of Record</span>: The date the finalized version of the article was made available in the journal.</li></ul><p>More information on publishing policies can be found on the <a class=\\\"anchor anchor-secondary u-display-inline anchor-underline\\\" href=\\\"https://www.elsevier.com/about/policies-and-standards/publishing-ethics\\\" target=\\\"_blank\\\"><span class=\\\"anchor-text-container\\\"><span class=\\\"anchor-text\\\">Publishing Ethics Policies</span></span></a> page. View our <a class=\\\"anchor anchor-secondary u-display-inline anchor-underline\\\" href=\\\"https://www.elsevier.com/researcher/author/submit-your-paper\\\" target=\\\"_blank\\\"><span class=\\\"anchor-text-container\\\"><span class=\\\"anchor-text\\\">Publishing with Elsevier: step-by-step</span></span></a> page to learn more about the publishing process. For any questions on your own submission or other questions related to publishing an article, <a class=\\\"anchor anchor-secondary u-display-inline anchor-underline\\\" href=\\\"https://service.elsevier.com/app/phone/supporthub/publishing\\\" target=\\\"_blank\\\"><span class=\\\"anchor-text-container\\\"><span class=\\\"anchor-text\\\">contact our Researcher support team.</span></span></a></p></div>\",\"title\":\"What do these dates mean?\"}},\"glossary\":{},\"issueNavigation\":{\"previous\":{},\"next\":{}},\"linkingHubLinks\":{},\"metrics\":{\"metricGroup\":{\"citations\":[],\"captures\":[],\"mentions\":[],\"socialMedia\":[]},\"isLoading\":false,\"error\":false,\"hasMetrics\":false},\"preview\":{\"content\":[{\"#name\":\"introduction\",\"$$\":[{\"#name\":\"section\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"sec0005\",\"role\":\"introduction\",\"view\":\"all\"},\"$$\":[{\"#name\":\"label\",\"_\":\"1\"},{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0045\"},\"_\":\"Introduction\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0020\",\"view\":\"all\"},\"_\":\"Palliative care emphasizes improving quality of life through medical, psychological, and spiritual services. These approaches are applicable to many diseases including cancer and HIV/AIDS [1,2]. Globally, palliative care models are associated with positive outcomes including reduced symptom burden, increased quality of life, and improved psychosocial wellbeing [[3], [4], [5], [6]]. Unfortunately, the global need for services far exceeds availability, this is especially true throughout sub-Saharan Africa. While efforts to increase palliative care services across Africa have led to improvements in care in the last 12 years, the majority of African countries (52%) lack organized palliative care services [7].\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0025\",\"view\":\"all\"},\"$$\":[{\"#name\":\"__text__\",\"_\":\"In Zambia, there is a generalized HIV/AIDS epidemic, the cervical cancer rate is the 5\"},{\"#name\":\"sup\",\"$\":{\"loc\":\"post\"},\"_\":\"th\"},{\"#name\":\"__text__\",\"_\":\" highest in the world, and breast cancer is routinely diagnosed at advanced stages. Such a setting demands comprehensive palliative care services [8,9]. Although momentum is building, research indicates Zambia’s palliative care infrastructure remains weak [10,11].\"}]},{\"#name\":\"para\",\"$\":{\"id\":\"par0030\",\"view\":\"all\"},\"_\":\"According to the World Health Organization’s Public Health Strategy for expanding palliative care, key elements of national palliative care programs include: policies, drug availability, education, and service implementation [12]. To obtain an overview of the availability of palliative care in Zambia, we completed an analysis of results from a nationwide, structured assessment documenting the availability of breast and cervical cancer screening, treatment, and care services in Zambia, including palliative care. The primary findings from this assessment as well as an overview of the methodology utilized were published in this journal in 2017 [8]. Adding to that publication, we report here our findings specific to palliative care, using the WHO Public Health Strategy as a benchmark.\"}]}]},{\"#name\":\"section\",\"$$\":[{\"#name\":\"section\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"sec0010\",\"role\":\"materials-methods\",\"view\":\"all\"},\"$$\":[{\"#name\":\"label\",\"_\":\"2\"},{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0050\"},\"_\":\"Methods\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0035\",\"view\":\"all\"},\"_\":\"This analysis utilizes data from a facility assessment survey completed at all 9 provincial hospitals as well as the University Teaching Hospital and Cancer Diseases Hospital in Lusaka (N = 11). The survey methods are described in detail in our prior publication of the primary findings [8]. Briefly, facilities were chosen due to their priority listing for service expansion in the Zambian National Cancer Control Strategic Plan. At each facility, we administered an in-person survey to collect\"}]}]},{\"#name\":\"section\",\"$$\":[{\"#name\":\"section\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"sec0015\",\"role\":\"results\",\"view\":\"all\"},\"$$\":[{\"#name\":\"label\",\"_\":\"3\"},{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0055\"},\"_\":\"Results\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0050\",\"view\":\"all\"},\"_\":\"Between August 2014 and January 2015, 11 Zambian hospitals participated in our study. Our survey revealed a national average of 2 healthcare workers per 10,000 population, an estimate devised from the total number of clinical providers (physicians, nurses, midwives, pharmacists, and clinical officers) and population estimates. Eight facilities (72%) reported a demand for palliative care, with 4 (36%) reporting that patients often present seeking palliative care, 1 (9%) reporting that patients\"}]}]},{\"#name\":\"section\",\"$$\":[{\"#name\":\"section\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"sec0020\",\"role\":\"discussion\",\"view\":\"all\"},\"$$\":[{\"#name\":\"label\",\"_\":\"4\"},{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0060\"},\"_\":\"Discussion\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0065\",\"view\":\"all\"},\"_\":\"The results of our health facility assessment reveal major gaps and opportunities for improving the availability of palliative care services across Zambia. As noted, only 36% of facilities reported having a policy governing the provision of palliative care, highlighting the need for national guidance on palliative care development throughout the country. While inpatient palliative care services are accessible at the majority of provincial-level facilities in Zambia, few offer outpatient or\"}]}]},{\"#name\":\"section\",\"$$\":[{\"#name\":\"section\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"sec0025\",\"role\":\"conclusion\",\"view\":\"all\"},\"$$\":[{\"#name\":\"label\",\"_\":\"5\"},{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0065\"},\"_\":\"Conclusion\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0080\",\"view\":\"all\"},\"_\":\"Palliative care is an essential healthcare service. Our findings demonstrate that while inpatient palliative care services are accessible at 72% of provincial-level facilities in Zambia, few facilities offer outpatient or home-based services. Access to palliative care medications is also limited. Implementation of a national framework that outlines guidance for (1) inpatient, outpatient, and home-based services, (2) educational programs, and (3) procurement of palliative care medications will\"}]}]},{\"#name\":\"section\",\"$$\":[{\"#name\":\"section\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"sec0030\",\"view\":\"all\"},\"$$\":[{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0070\"},\"_\":\"Authors' contributions\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0085\",\"view\":\"all\"},\"_\":\"BF and CJC conceived of and designed the study, performed the analyses, and drafted the manuscript. GPP conceived of the study and provided critical input on the manuscript. CHM, KS, AM, JM, SK, and AB participated in the study design, the acquisition of data, and provided critical input on the manuscript. SCM, KK, MM, and KL reviewed and provided critical input on the manuscript. All authors approved the final version of the manuscript for publication.\"}]}]},{\"#name\":\"section\",\"$$\":[{\"#name\":\"section\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"sec0035\",\"view\":\"all\"},\"$$\":[{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0075\"},\"_\":\"Declarations of interest\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0090\",\"view\":\"all\"},\"_\":\"None.\"}]}]},{\"#name\":\"section\",\"$$\":[{\"#name\":\"acknowledgment\",\"$\":{\"xmlns:ce\":true,\"xmlns:mml\":true,\"xmlns:xs\":true,\"xmlns:xlink\":true,\"xmlns:xocs\":true,\"xmlns:tb\":true,\"xmlns:xsi\":true,\"xmlns:cals\":true,\"xmlns:sb\":true,\"xmlns:sa\":true,\"xmlns:ja\":true,\"xmlns\":true,\"id\":\"ack0005\",\"view\":\"all\"},\"$$\":[{\"#name\":\"section-title\",\"$\":{\"id\":\"sect0080\"},\"_\":\"Acknowledgements\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0095\",\"view\":\"all\"},\"_\":\"Special thanks to all survey respondents from the participating hospitals and provincial health offices who gave generously of their time in responding to our questionnaire.\"},{\"#name\":\"para\",\"$\":{\"id\":\"par0100\",\"view\":\"all\"},\"$$\":[{\"#name\":\"__text__\",\"_\":\"The nationwide facility assessment survey was funded by the \"},{\"#name\":\"grant-sponsor\",\"$\":{\"id\":\"gs0005\",\"type\":\"simple\",\"role\":\"http://www.elsevier.com/xml/linking-roles/grant-sponsor\"},\"_\":\"Susan G. Komen Foundation\"},{\"#name\":\"__text__\",\"_\":\" Award GSP14UNC006. Additional investigator support was provided through a Fulbright-Fogarty Fellowship Award, the \"},{\"#name\":\"grant-sponsor\",\"$\":{\"id\":\"gs0010\",\"sponsor-id\":\"https://doi.org/10.13039/100000054\",\"type\":\"simple\",\"role\":\"http://www.elsevier.com/xml/linking-roles/grant-sponsor\"},\"_\":\"National Cancer Institute\"},{\"#name\":\"__text__\",\"_\":\" Award 1D43CA153784, and the \"},{\"#name\":\"grant-sponsor\",\"$\":{\"id\":\"gs0015\",\"sponsor-id\":\"https://doi.org/10.13039/100000061\",\"type\":\"simple\",\"role\":\"http://www.elsevier.com/xml/linking-roles/grant-sponsor\"},\"_\":\"Fogarty International Center\"},{\"#name\":\"__text__\",\"_\":\" Award R25TW009340 to the UNC Hopkins\"}]}]}]}],\"floats\":[],\"footnotes\":[],\"attachments\":[]},\"rawtext\":\"\",\"recommendations\":{\"articles\":[{\"pii\":\"S0002961015003712\",\"doi\":\"10.1016/j.amjsurg.2015.05.017\",\"journalTitle\":\"The American Journal of Surgery\",\"publicationYear\":\"2016\",\"publicationDate\":\"2016-01-01\",\"volumeSupText\":\"Volume 211, Issue 1\",\"articleNumber\":\"\",\"pageRange\":\"294-299\",\"trace-token\":\"AAAAQFbeX_QqnTSZE0v6ZtwkfuVjPgpOFltaW1j1-AP73TA_Qvpd7NS-Ijg2r5ynvUjWT86dA3iNHKsj7DOHRax666G0jbYbbgzwAaspKHUU51qnZf60DA\",\"authors\":{\"content\":[{\"#name\":\"author-group\",\"$\":{\"id\":\"augrp0010\"},\"$$\":[{\"#name\":\"author\",\"$\":{\"id\":\"au1\"},\"$$\":[{\"#name\":\"given-name\",\"_\":\"Asha G.\"},{\"#name\":\"surname\",\"_\":\"Bale\"},{\"#name\":\"degrees\",\"_\":\"M.D., F.A.C.S.\"},{\"#name\":\"cross-ref\",\"$\":{\"refid\":\"aff1\",\"id\":\"crosref0010\"},\"$$\":[{\"#name\":\"sup\",\"$\":{\"loc\":\"post\"},\"_\":\"a\"}]},{\"#name\":\"cross-ref\",\"$\":{\"refid\":\"cor1\",\"id\":\"crosref0015\"},\"$$\":[{\"#name\":\"sup\",\"$\":{\"loc\":\"post\"},\"_\":\"∗\"}]},{\"#name\":\"e-address\",\"$\":{\"type\":\"email\",\"id\":\"eadd0010\"},\"_\":\"Abale@palisadesmedical.org\"}]},{\"#name\":\"author\",\"$\":{\"id\":\"au2\"},\"$$\":[{\"#name\":\"given-name\",\"_\":\"Ziad C.\"},{\"#name\":\"surname\",\"_\":\"Sifri\"},{\"#name\":\"degrees\",\"_\":\"M.D., F.A.C.S.\"},{\"#name\":\"cross-ref\",\"$\":{\"refid\":\"aff2\",\"id\":\"crosref0020\"},\"$$\":[{\"#name\":\"sup\",\"$\":{\"loc\":\"post\"},\"_\":\"b\"}]},{\"#name\":\"cross-ref\",\"$\":{\"refid\":\"fn1\",\"id\":\"crosref0025\"},\"$$\":[{\"#name\":\"sup\",\"$\":{\"loc\":\"post\"},\"_\":\"1\"}]}]},{\"#name\":\"affiliation\",\"$\":{\"id\":\"aff1\"},\"$$\":[{\"#name\":\"label\",\"_\":\"a\"},{\"#name\":\"textfn\",\"_\":\"Department of Surgery, Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, USA\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"Department of Surgery\"},{\"#name\":\"organization\",\"_\":\"Palisades Medical Center\"},{\"#name\":\"organization\",\"_\":\"7600 River Road\"},{\"#name\":\"city\",\"_\":\"North Bergen\"},{\"#name\":\"state\",\"_\":\"NJ\"},{\"#name\":\"postal-code\",\"_\":\"07047\"},{\"#name\":\"country\",\"_\":\"USA\"}]}]},{\"#name\":\"affiliation\",\"$\":{\"id\":\"aff2\"},\"$$\":[{\"#name\":\"label\",\"_\":\"b\"},{\"#name\":\"textfn\",\"_\":\"Department of Surgery, Rutgers University New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA\"},{\"#name\":\"affiliation\",\"$\":{\"xmlns:sa\":true},\"$$\":[{\"#name\":\"organization\",\"_\":\"Department of Surgery\"},{\"#name\":\"organization\",\"_\":\"Rutgers University New Jersey Medical School\"},{\"#name\":\"organization\",\"_\":\"185 South Orange Avenue\"},{\"#name\":\"city\",\"_\":\"Newark\"},{\"#name\":\"state\",\"_\":\"NJ\"},{\"#name\":\"postal-code\",\"_\":\"07103\"},{\"#name\":\"country\",\"_\":\"USA\"}]}]},{\"#name\":\"correspondence\",\"$\":{\"id\":\"cor1\"},\"$$\":[{\"#name\":\"label\",\"_\":\"∗\"},{\"#name\":\"text\",\"_\":\"Corresponding author. 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id=\"preview-section-introduction-item\" class=\"\"><a class=\"anchor anchor-primary\" href=\"#preview-section-introduction\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Introduction</span></span></a></li><li id=\"preview-section-snippets-item\" class=\"\"><a class=\"anchor anchor-primary\" href=\"#preview-section-snippets\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Section snippets</span></span></a></li><li id=\"preview-section-references-item\" class=\"\"><a class=\"anchor anchor-primary\" href=\"#preview-section-references\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">References (15)</span></span></a></li><li id=\"preview-section-cited-by-item\" class=\"\"><a class=\"anchor anchor-primary\" href=\"#preview-section-cited-by\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Cited by (4)</span></span></a></li></ul></div></div><article class=\"col-lg-12 col-md-16 pad-left pad-right\" lang=\"en\"><div class=\"Publication\" id=\"publication\"><div class=\"publication-brand u-display-block-from-sm\"><a class=\"anchor u-display-flex anchor-primary\" href=\"/journal/journal-of-cancer-policy\" title=\"Go to Journal of Cancer Policy on ScienceDirect\"><span class=\"anchor-text-container\"><span class=\"anchor-text\"><img class=\"publication-brand-image\" src=\"https://sdfestaticassets-us-east-1.sciencedirectassets.com/prod/c2d2d2e89ef077cbc6663badca517ca70a10db41/image/elsevier-non-solus.svg\" alt=\"Elsevier\"/></span></span></a></div><div class=\"publication-volume u-text-center\"><h2 class=\"publication-title u-h3\" id=\"publication-title\"><a class=\"anchor anchor-secondary publication-title-link\" href=\"/journal/journal-of-cancer-policy\" title=\"Go to Journal of Cancer Policy on ScienceDirect\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Journal of Cancer Policy</span></span></a></h2><div class=\"text-xs\"><a class=\"anchor anchor-primary\" href=\"/journal/journal-of-cancer-policy/vol/20/suppl/C\" title=\"Go to table of contents for this volume/issue\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Volume 20</span></span></a>, <!-- -->June 2019<!-- -->, 100185</div></div><div class=\"publication-cover u-display-block-from-sm\"><a class=\"anchor u-display-flex anchor-primary\" href=\"/journal/journal-of-cancer-policy/vol/20/suppl/C\"><span class=\"anchor-text-container\"><span class=\"anchor-text\"><img class=\"publication-cover-image\" src=\"https://ars.els-cdn.com/content/image/1-s2.0-S2213538319X00028-cov150h.gif\" alt=\"Journal of Cancer Policy\"/></span></span></a></div></div><div class=\"PageDivider\"></div><h1 id=\"screen-reader-main-title\" class=\"Head u-font-serif u-h2 u-margin-s-ver\"><span class=\"title-text\">Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey</span></h1><div class=\"Banner\" id=\"banner\"><div class=\"wrapper 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6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0015\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Claire-Helene</span> <span class=\"text surname\">Mershon</span> </span><span class=\"author-ref\" id=\"baff0005\"><sup>a</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0020\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Kombatende</span> <span class=\"text surname\">Sikombe</span> </span><span class=\"author-ref\" id=\"baff0005\"><sup>a</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0025\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Agnes</span> <span class=\"text surname\">Musonda</span> </span><span class=\"author-ref\" id=\"baff0005\"><sup>a</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0030\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Jane</span> <span class=\"text surname\">Matambo</span> </span><span class=\"author-ref\" id=\"baff0005\"><sup>a</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0035\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Sharon</span> <span class=\"text surname\">Kapambwe</span> </span><span class=\"author-ref\" id=\"baff0005\"><sup>a</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 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Citonje</span> <span class=\"text surname\">Msadabwe</span> </span><span class=\"author-ref\" id=\"baff0015\"><sup>c</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0045\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Katundu</span> <span 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class=\"given-name\">Kennedy</span> <span class=\"text surname\">Lishimpi</span> </span><span class=\"author-ref\" id=\"baff0015\"><sup>c</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0060\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span class=\"given-name\">Mulindi</span> <span class=\"text surname\">Mwanahamuntu</span> </span><span class=\"author-ref\" id=\"baff0020\"><sup>d</sup></span><svg focusable=\"false\" viewBox=\"0 0 102 128\" height=\"20\" title=\"Author email or social media contact details icon\" class=\"icon icon-envelope react-xocs-author-icon u-fill-grey8\"><path d=\"M55.8 57.2c-1.78 1.31-5.14 1.31-6.9 0L17.58 34h69.54L55.8 57.19zM0 32.42l42.94 32.62c2.64 1.95 6.02 2.93 9.4 2.93s6.78-.98 9.42-2.93L102 34.34V24H0zM92 88.9L73.94 66.16l-8.04 5.95L83.28 94H18.74l18.38-23.12-8.04-5.96L10 88.94V51.36L0 42.9V104h102V44.82l-10 8.46V88.9\"></path></svg></span></span></button>, <button class=\"button-link button-link-secondary button-link-underline\" type=\"button\" data-sd-ui-side-panel-opener=\"true\" data-xocs-content-type=\"author\" data-xocs-content-id=\"aut0065\"><span class=\"button-link-text-container\"><span class=\"button-link-text\"><span class=\"react-xocs-alternative-link\"><span 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anchor-primary\" href=\"https://s100.copyright.com/AppDispatchServlet?publisherName=ELS&amp;contentID=S2213538318300237&amp;orderBeanReset=true\" target=\"_blank\" rel=\"noreferrer noopener\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Get rights and content</span><svg focusable=\"false\" viewBox=\"0 0 8 8\" height=\"20\" aria-label=\"Opens in new window\" class=\"icon icon-arrow-up-right-tiny arrow-external-link\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span></a></div><section class=\"ReferencedArticles\"></section><section class=\"ReferencedArticles\"></section><div id=\"preview-section-abstract\"><div class=\"PageDivider\"></div><div class=\"Abstracts u-font-serif\" id=\"abstracts\"><div class=\"abstract author-highlights\" id=\"abs0005\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Highlights</h2><div id=\"abst0005\"><div class=\"u-margin-s-bottom\" id=\"spar0005\"><ul class=\"list\"><li class=\"react-xocs-list-item\"><span class=\"list-label\">•</span><span class=\"list-content\"><div class=\"u-margin-s-bottom\" id=\"par0005\">Our work confirms the dearth of <a href=\"/topics/medicine-and-dentistry/symptomatic-treatment\" title=\"Learn more about palliative care from ScienceDirect&#x27;s AI-generated Topic Pages\" class=\"topic-link\">palliative care</a> services across Zambia.</div></span></li><li class=\"react-xocs-list-item\"><span class=\"list-label\">•</span><span class=\"list-content\"><div class=\"u-margin-s-bottom\" id=\"par0010\">Community- and home-based palliative care services are not commonly available.</div></span></li><li class=\"react-xocs-list-item\"><span class=\"list-label\">•</span><span class=\"list-content\"><div class=\"u-margin-s-bottom\" id=\"par0015\">Access to essential palliative care medications also remains limited.</div></span></li></ul></div></div></div><div class=\"abstract author\" id=\"abs0010\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Abstract</h2><div id=\"abst0010\"><h3 class=\"u-h4 u-margin-m-top u-margin-xs-bottom\" id=\"sect0015\">Background</h3><div class=\"u-margin-s-bottom\" id=\"spar0010\">With high rates of HIV/AIDS and rising burdens of non-communicable diseases, Zambians increasingly need palliative care. While efforts are underway to grow Zambia’s palliative care system, the most recent situational analysis of palliative care in Zambia, conducted in 2008, revealed substantial gaps in availability.</div></div><div id=\"abst0015\"><h3 class=\"u-h4 u-margin-m-top u-margin-xs-bottom\" id=\"sect0020\">Methods</h3><div class=\"u-margin-s-bottom\" id=\"spar0015\">To provide an updated appraisal of breast and cervical cancer services in Zambia, including palliative care, we conducted a nationwide provincial and tertiary hospital survey. All 9 provincial hospitals and the University Teaching Hospital and Cancer Diseases Hospital in Lusaka Province participated (N = 11). The survey was conducted between August 2014 and January 2015 and administered in-person at each facility. Data regarding the availability of inpatient, outpatient, and community-based palliative care services, palliative medications, and psychosocial supports was obtained at each facility. The reported results are descriptive in nature.</div></div><div id=\"abst0020\"><h3 class=\"u-h4 u-margin-m-top u-margin-xs-bottom\" id=\"sect0025\">Results</h3><div class=\"u-margin-s-bottom\" id=\"spar0020\">Although the need for palliative care services was recognized, many facilities (64%) lack palliative care policies and only 18% offer palliative care in a coordinated program. The majority of services are only available to inpatients and rarely include community-based programs. While all facilities had adequate supplies of acetaminophen, 82% reported unavailability of codeine and 45% reported no access to oral morphine.</div></div><div id=\"abst0025\"><h3 class=\"u-h4 u-margin-m-top u-margin-xs-bottom\" id=\"sect0030\">Conclusions</h3><div class=\"u-margin-s-bottom\" id=\"spar0025\">This assessment confirms the dearth of palliative care services across Zambia. Less than half of its provincial hospitals offer community- or home-based services and only 55% offer opioid analgesics. Immediate and substantial improvements in policy, drug procurement and distribution, and service expansion are needed to ensure high-quality palliative care is available throughout Zambia.</div></div></div></div></div><div id=\"preview-section-introduction\"><div class=\"PageDivider\"></div><div class=\"Introduction u-font-serif u-margin-l-ver\"><h2 class=\"u-h4 u-margin-s-bottom\">Introduction</h2><section id=\"sec0005\"><div class=\"u-margin-s-bottom\" id=\"par0020\">Palliative care emphasizes improving quality of life through medical, psychological, and spiritual services. These approaches are applicable to many diseases including cancer and HIV/AIDS [1,2]. Globally, palliative care models are associated with positive outcomes including reduced symptom burden, increased quality of life, and improved psychosocial wellbeing [[3], [4], [5], [6]]. Unfortunately, the global need for services far exceeds availability, this is especially true throughout sub-Saharan Africa. While efforts to increase palliative care services across Africa have led to improvements in care in the last 12 years, the majority of African countries (52%) lack organized palliative care services [7].</div><div class=\"u-margin-s-bottom\" id=\"par0025\">In Zambia, there is a generalized HIV/AIDS epidemic, the cervical cancer rate is the 5<sup>th</sup> highest in the world, and breast cancer is routinely diagnosed at advanced stages. Such a setting demands comprehensive palliative care services [8,9]. Although momentum is building, research indicates Zambia’s palliative care infrastructure remains weak [10,11].</div><div class=\"u-margin-s-bottom\" id=\"par0030\">According to the World Health Organization’s Public Health Strategy for expanding palliative care, key elements of national palliative care programs include: policies, drug availability, education, and service implementation [12]. To obtain an overview of the availability of palliative care in Zambia, we completed an analysis of results from a nationwide, structured assessment documenting the availability of breast and cervical cancer screening, treatment, and care services in Zambia, including palliative care. The primary findings from this assessment as well as an overview of the methodology utilized were published in this journal in 2017 [8]. Adding to that publication, we report here our findings specific to palliative care, using the WHO Public Health Strategy as a benchmark.</div></section></div></div><div id=\"preview-section-snippets\"><div class=\"PageDivider\"></div><div class=\"Snippets u-font-serif\"><h2 class=\"u-h4 u-margin-l-ver\">Section snippets</h2><section><section id=\"sec0010\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Methods</h2><div class=\"u-margin-s-bottom\" id=\"par0035\">This analysis utilizes data from a facility assessment survey completed at all 9 provincial hospitals as well as the University Teaching Hospital and Cancer Diseases Hospital in Lusaka (N = 11). The survey methods are described in detail in our prior publication of the primary findings [8]. Briefly, facilities were chosen due to their priority listing for service expansion in the Zambian National Cancer Control Strategic Plan. At each facility, we administered an in-person survey to collect</div></section></section><section><section id=\"sec0015\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Results</h2><div class=\"u-margin-s-bottom\" id=\"par0050\">Between August 2014 and January 2015, 11 Zambian hospitals participated in our study. Our survey revealed a national average of 2 healthcare workers per 10,000 population, an estimate devised from the total number of clinical providers (physicians, nurses, midwives, pharmacists, and clinical officers) and population estimates. Eight facilities (72%) reported a demand for palliative care, with 4 (36%) reporting that patients often present seeking palliative care, 1 (9%) reporting that patients</div></section></section><section><section id=\"sec0020\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Discussion</h2><div class=\"u-margin-s-bottom\" id=\"par0065\">The results of our health facility assessment reveal major gaps and opportunities for improving the availability of palliative care services across Zambia. As noted, only 36% of facilities reported having a policy governing the provision of palliative care, highlighting the need for national guidance on palliative care development throughout the country. While inpatient palliative care services are accessible at the majority of provincial-level facilities in Zambia, few offer outpatient or</div></section></section><section><section id=\"sec0025\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Conclusion</h2><div class=\"u-margin-s-bottom\" id=\"par0080\">Palliative care is an essential healthcare service. Our findings demonstrate that while inpatient palliative care services are accessible at 72% of provincial-level facilities in Zambia, few facilities offer outpatient or home-based services. Access to palliative care medications is also limited. Implementation of a national framework that outlines guidance for (1) inpatient, outpatient, and home-based services, (2) educational programs, and (3) procurement of palliative care medications will</div></section></section><section><section id=\"sec0030\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Authors&#x27; contributions</h2><div class=\"u-margin-s-bottom\" id=\"par0085\">BF and CJC conceived of and designed the study, performed the analyses, and drafted the manuscript. GPP conceived of the study and provided critical input on the manuscript. CHM, KS, AM, JM, SK, and AB participated in the study design, the acquisition of data, and provided critical input on the manuscript. SCM, KK, MM, and KL reviewed and provided critical input on the manuscript. All authors approved the final version of the manuscript for publication.</div></section></section><section><section id=\"sec0035\"><h2 class=\"section-title u-h4 u-margin-l-top u-margin-xs-bottom\">Declarations of interest</h2><div class=\"u-margin-s-bottom\" id=\"par0090\">None.</div></section></section><section><section id=\"ack0005\"><h2 id=\"sect0080\" class=\"u-h4 u-margin-l-top u-margin-xs-bottom\">Acknowledgements</h2><div class=\"u-margin-s-bottom\" id=\"par0095\">Special thanks to all survey respondents from the participating hospitals and provincial health offices who gave generously of their time in responding to our questionnaire.</div><div class=\"u-margin-s-bottom\" id=\"par0100\">The nationwide facility assessment survey was funded by the <span id=\"gs0005\">Susan G. Komen Foundation</span> Award GSP14UNC006. Additional investigator support was provided through a Fulbright-Fogarty Fellowship Award, the <span id=\"gs0010\">National Cancer Institute</span> Award 1D43CA153784, and the <span id=\"gs0015\">Fogarty International Center</span> Award R25TW009340 to the UNC Hopkins</div></section></section></div></div><div class=\"related-content-links u-display-none-from-md\"><button class=\"button-link button-link-primary button-link-small\" type=\"button\"><span class=\"button-link-text-container\"><span class=\"button-link-text\">Recommended articles</span></span></button></div><div class=\"Tail\"></div><div id=\"preview-section-references\"><div class=\"paginatedReferences u-font-serif\"><div class=\"PageDivider\"></div><header><h2 class=\"u-h4 u-margin-l-ver\"><span>References</span><span> (15)</span></h2></header><ul><li class=\"bib-reference u-margin-s-bottom\"><span class=\"u-font-sans\"><span class=\"author u-font-sans\"><span>G. </span>Vanbutsele</span><em> et al.</em></span><h3><a class=\"anchor title anchor-primary\" href=\"/science/article/pii/S1470204518300603\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomized controlled trial</span></span></a></h3><span class=\"host u-clr-grey6 u-font-sans\"><div class=\"series\"><h3 class=\"title\">Lancet Oncol.</h3></div><div class=\"series\">(2018)</div></span></li><li class=\"bib-reference u-margin-s-bottom\"><span class=\"u-font-sans\"><span class=\"author u-font-sans\"><span>J.Y. </span>Rhee</span><em> et al.</em></span><h3><a class=\"anchor title anchor-primary\" href=\"/science/article/pii/S1470204517304205\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Palliative care in Africa: a scoping review from 2005-16</span></span></a></h3><span class=\"host u-clr-grey6 u-font-sans\"><div class=\"series\"><h3 class=\"title\">Lancet Oncol.</h3></div><div class=\"series\">(2017)</div></span></li><li class=\"bib-reference u-margin-s-bottom\"><span class=\"u-font-sans\"><span class=\"author u-font-sans\"><span>C. </span>Chibwesha</span><em> et al.</em></span><h3><a class=\"anchor title anchor-primary\" href=\"/science/article/pii/S2213538317300358\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">A comprehensive assessment of breast and cervical cancer control infrastructure in Zambia</span></span></a></h3><span class=\"host u-clr-grey6 u-font-sans\"><div class=\"series\"><h3 class=\"title\">J. 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While often oversupplied in high-income countries, significant shortages exist in low- and middle-income countries. We conducted a scoping review on availability and usage of opioids in Sub-Saharan Africa (SSA).</div><div class=\"u-margin-s-bottom\" id=\"abspara0015\">The five-stage approach of Arksey and O&#x27;Malley (2005) was used. MEDLINE via PubMed, EMBASE, and SCOPUS were search and results categorized into themes: 1) Local/regional availability and supply, 2) Consumption patterns, 3) Legislation and policy, 4) Costs and financing, 5) Knowledge and cultural beliefs, and 6) Education and training.</div><div class=\"u-margin-s-bottom\" id=\"abspara0020\">6923 studies were identified from which 69 (1%) met inclusion criteria. Five key findings were: 1) Significant shortages exist, especially in rural areas, 2) Non-opioid analgesics commonly used as first-line acute pain management, 3) Barriers to market entry and bureaucratic processes prevent local production, 4) Significant knowledge gaps/myths exist amongst healthcare practitioners on opioid use, and 5) Continuous education and short courses will be critical.</div><div class=\"u-margin-s-bottom\" id=\"abspara0025\">Major challenges significantly limit availability and utilization of essential opioids in SSA. Reforms needed to upscale training and education, increase uptake by professionals, and increase market entry.</div></div></div></div></li><li class=\"ListArticleItem u-margin-l-bottom\"><div class=\"sub-heading u-margin-xs-bottom\"><h3 class=\"u-font-serif\" id=\"citing-articles-article-1-title\"><a class=\"anchor anchor-primary\" href=\"/science/article/pii/S0955395923001263\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review</span></span></a></h3><div>2023, International Journal of Drug Policy</div><div class=\"CitedSection u-margin-s-top\"><div class=\"u-margin-s-left\"><div class=\"cite-header u-text-italic u-font-sans\">Citation Excerpt :</div><p class=\"u-font-serif text-xs\">Only one government facility in Nigeria and Cameroon stocked oral morphine in 2018 (Nchako et al., 2018), and 50% of nurses in Eritrea indicated that lack of opioids was a barrier to access (Kahsay &amp; Pitkäjärvi, 2019). Stockouts were a problem in Zambia, where 45% of surveyed hospitals indicated that morphine had been stocked out for at least 90 days (Frett Utter et al., 2019). In Zimbabwe 22% of surveyed healthcare workers (HCWs) indicated opioids had been stocked out in the last three months (Tapera &amp; Nyakabau, 2020).</p></div></div></div><div class=\"buttons\"><button class=\"button-link button-link-primary button-link-icon-right\" type=\"button\" data-aa-button=\"sd:product:journal:article:location=citing-articles:type=view-details\" aria-describedby=\"citing-articles-article-1-title\" aria-controls=\"citing-articles-article-1\" aria-expanded=\"false\"><span class=\"button-link-text-container\"><span class=\"button-link-text\">Show abstract</span></span><svg focusable=\"false\" viewBox=\"0 0 92 128\" height=\"20\" class=\"icon icon-navigate-down\"><path d=\"M1 51l7-7 38 38 38-38 7 7-45 45z\"></path></svg></button></div><div class=\"u-display-none\" aria-hidden=\"true\"><div class=\"abstract u-margin-xs-top u-margin-m-bottom u-font-serif\" id=\"reference-abstract\"><div class=\"u-margin-ver-m\"><div class=\"u-margin-s-bottom\" id=\"spara008\">Access to internationally controlled essential medicines (ICEMs), medicines that are listed on both the World Health Organization&#x27;s Essential Medicines List and one of three international drug control conventions, remains problematic in Sub-Saharan Africa (SSA). Previous reviews have focused only on specific ICEMs or ICEM-related healthcare fields, but none have focused on all ICEMs as a distinct class. This scoping review therefore aims to identify the barriers to accessing ICEMs across all relevant healthcare fields in SSA.</div><div class=\"u-margin-s-bottom\" id=\"spara009\">A scoping review was conducted across indexing platforms Embase, PubMed, Scopus and Web of Science of studies published between January 1 2012 and February 1 2022. Articles were eligible if they mentioned barriers to accessing ICEMs and/or ICEM-related healthcare fields, if studies were conducted in SSA, or included data on an SSA country within a multi-country study. The review was guided by the Access to Medicines from a Health System Perspective framework.</div><div class=\"u-margin-s-bottom\" id=\"spara010\">The search identified 5519 articles, of which 97 met the inclusion criteria. Many barriers to access were reported and were common across the ICEMs drug class. Main barriers were: at the individual level, the lack of knowledge about ICEMs; at the health service delivery level, low availability, stockouts, affordability, long distances to health facilities, insufficient infrastructure to store and distribute ICEMs, and lack of ICEM knowledge and training among healthcare workers; at the health sector level, lack of prioritisation of ICEM-related healthcare fields by governments and subsequent insufficient budget allocation. Cross-cutting, governance-related barriers pertained to lack of proper quantification systems, cumbersome procurement processes, and strict national laws controlling ICEMs, leading to overly restrictive prescription practices.</div><div class=\"u-margin-s-bottom\" id=\"spara011\">This review showed that there are a multitude of barriers to accessing ICEMs in SSA across all health system levels. Many of the barriers identified are applicable to all ICEMs, highlighting the importance of tackling barriers for this entire class of drugs together.</div></div></div></div></li><li class=\"ListArticleItem u-margin-l-bottom\"><div class=\"sub-heading u-margin-xs-bottom\"><h3 class=\"u-font-serif\" id=\"citing-articles-article-2-title\"><a class=\"anchor anchor-primary\" href=\"/science/article/pii/S0885392422008223\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Can You Hear Us Now? Equity in Global Advocacy for Palliative Care</span></span></a></h3><div>2022, Journal of Pain and Symptom Management</div><div class=\"CitedSection u-margin-s-top\"><div class=\"u-margin-s-left\"><div class=\"cite-header u-text-italic u-font-sans\">Citation Excerpt :</div><p class=\"u-font-serif text-xs\">Zambia&#x27;s Ministry of Health launched the country&#x27;s first National Palliative Care Strategic Plan (2021–2026) on May 26, 2021, which will support further development and integration of palliative care in the country.34 Despite this important advancement, there is a dearth of palliative care specialty education, teachers, curricula, and centers of excellence, as well as inconsistent access to short-term training programs in Zambia.35 There are only three individuals with masters-level palliative care education at the time of this writing – one physician, one nurse, and one social worker.</p></div></div></div><div class=\"buttons\"><button class=\"button-link button-link-primary button-link-icon-right\" type=\"button\" data-aa-button=\"sd:product:journal:article:location=citing-articles:type=view-details\" aria-describedby=\"citing-articles-article-2-title\" aria-controls=\"citing-articles-article-2\" aria-expanded=\"false\"><span class=\"button-link-text-container\"><span class=\"button-link-text\">Show abstract</span></span><svg focusable=\"false\" viewBox=\"0 0 92 128\" height=\"20\" class=\"icon icon-navigate-down\"><path d=\"M1 51l7-7 38 38 38-38 7 7-45 45z\"></path></svg></button></div><div class=\"u-display-none\" aria-hidden=\"true\"><div class=\"abstract u-margin-xs-top u-margin-m-bottom u-font-serif\" id=\"reference-abstract\"><div class=\"u-margin-ver-m\"><div class=\"u-margin-s-bottom\" id=\"spara004\">Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice &amp; Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.</div></div></div></div></li><li class=\"ListArticleItem u-margin-l-bottom\"><div class=\"sub-heading u-margin-xs-bottom\"><h3 class=\"u-font-serif\" id=\"citing-articles-article-3-title\"><a class=\"anchor anchor-primary\" href=\"https://doi.org/10.3389/frhs.2024.1425353\" target=\"_blank\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">Comprehensive scoping review of palliative care development in Africa: recent advances and persistent gaps</span><svg focusable=\"false\" viewBox=\"0 0 8 8\" height=\"20\" aria-label=\"Opens in new window\" class=\"icon icon-arrow-up-right-tiny arrow-external-link\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span></a></h3><div>2024, Frontiers in Health Services</div></div><div class=\"buttons\"></div><div class=\"u-display-none\" aria-hidden=\"true\"><div class=\"abstract u-margin-xs-top u-margin-m-bottom u-font-serif\" id=\"reference-abstract\"></div></div></li></ul></div></div></section></div><div class=\"PageDivider\"></div><a class=\"anchor full-text-link anchor-primary\" href=\"/science/article/pii/S2213538318300237\" aria-disabled=\"true\" tabindex=\"-1\"><span class=\"anchor-text-container\"><span class=\"anchor-text\">View full text</span></span></a><div class=\"Copyright\"><span class=\"copyright-line\">© 2019 Elsevier Ltd. 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curl -H "Authorization: Bearer e47fd9fc67f1bde198132d4404c902b9cb75223c50babdbc22e41698d4c06468" -H "Content-Type: application/json" -d '[{"url":"https://example.com/","filter":"/product/","exclude_filter":"/ads/","ignore_sitemap":true,"depth":0}]' "https://api.brightdata.com/datasets/v3/trigger?dataset_id=gd_m6gjtfmeh43we6cqc&include_errors=true&type=discover_new&discover_by=domain_url"