ABSTRACT
CONTEXT: In the early 2000s, palliative care was largely unknown in the Eurasian region. For a period of twenty years starting around 2002, Open Society Foundations (OSF) supported palliative care pioneers in the region to establish palliative care services, train health providers, and advocate for the integration into health services. OBJECTIVES: To report on the development of palliative care in Armenia, Georgia, Moldova, Tajikistan and Ukraine during the period 2017-2021 and explore the impact of OSF's sustained funding for palliative care in these countries. Activities and developments to 2017 were described in country-specific papers in 2018. METHODS: A retrospective case study analysis was used to examine how palliative care developed in each country. We reviewed theories of change, funding and advocacy strategies, implemented activities and interventions, and their outputs and outcomes, and compared them to legal, policy and service developments in practice. RESULTS: By the mid-2010s, each country had laid the foundations for rolling out palliative care-basic policies and guidelines were in place; palliative care medications were available; key health providers were trained; and training capacity and models of care had been created-but service availability remained limited. In subsequent years, advocates increasingly embraced public advocacy to hold governments accountable for meeting their commitments and to include palliative care in universal health insurance. By 2021, Armenia, Moldova, and Ukraine had significantly scaled up service availability and palliative care was firmly embedded in universal health coverage in Moldova and Ukraine whereas progress in Georgia and Tajikistan was more modest. CONCLUSION: Experiences in these countries suggest that a strategy that initially emphasizes training, technical assistance, and engagement to create the building blocks for palliative care combined with or followed by public advocacy and campaigning to demand roll out of services can result in significant advances. Continued progress, however, is not guaranteed, especially considering the COVID-19 pandemic and dwindling donor support.