Progress Update: Development of Palliative Care From 2017 to 2020 in Five Countries in Eurasia.

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.

Development of Palliative Care in Armenia.

In the last seven years, considerable progress has been made in palliative care (PC) in Armenia, but many problems remain unresolved. Policies developed include completion of a national needs assessment, a recognized working group on PC formed, national standards approved, a concept paper on PC approved, resolutions on PC as a specialized service approved, PC became a subspecialty in medicine, PC qualifications developed, and a social assistance package approved. In addition, the Government of Armenia lately approved the National Strategy on Palliative Care for Adults and 2017-2019 Action Plan. Oral morphine was added to the list of essential medicines but remains unavailable in Armenia, and many highly restrictive regulations remain in force. Progress in basic training in PC for physicians and nurses has been made, and two nursing schools now require it for all students. A "Pain Control and Palliative Care Association" began in 2003, and for two years, four pilot PC programs successfully operated with Global Fund resources. However, now only one service provider is operating. The public has begun to learn about PC, but funding remains a challenge.

Palliative care and human rights in patient care: an Armenia case study.

This paper examines palliative care within the human rights in patient care framework, which clarifies state obligations and addresses the rights of both patients and providers. In the context of palliative care, these rights extend beyond the right to health and include patient rights to freedom from torture, cruel and inhuman treatment, non-discrimination and equality, bodily integrity, privacy and confidentiality, information, and right to a remedy. They also encompass provider rights to decent working conditions, freedom of association, and due process. The paper then looks at a case study of Armenia, acknowledging how the government's commitment to palliative care, combined with awareness raising and advocacy by human rights organizations, created an enabling environment for the realization of human rights in patient care in the context of palliative care.