Palliative Care Worldwide from villages to metropolis

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Palliative Care Worldwidefrom villages to
metropolis

• Katalin Muszbek MD.
• Hungarian Hospice Foundation

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Palliatvive care development in Eastern
European Region

• Poland first steps at the 70es
• Jaczek Luczak key person
• Regional PC education in Poland with
  international faculty
• British model
• From 90es - activities of the hospice groups in
  the region

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Palliative Care in Hungary

• Since 1991 start of the Hungarian hospice
  movement first palliative care group
• Hungarian Hospice Foundation

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Strenghts of Palliative Care in Hungary

• Well orgaized care based on minimum standards
• Legal backround, strong policy
• High public awareness
• International training resource centre

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Strengths - clinical activities

• Well organized PC services
• Activities only on minimum standards
• PC guideline

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Strengths - legal background

• Hospice paragraph in the health law 1997
• Regulation on PC 2004
• Palliative Care Development Project
  collaboration with National Health Insurance Fund
  2004
• PC is a part of National Cancer Control Program

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Strengths - public relations

• High public awareness
• Publicity campaignes since 2000
• High media representation
• in 2007 more than 100 publications, interviews
  in electronic and written media
• Programs for children

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Strengths - education

• Budapest is an International Training Resource
  Centre
• Open Society Institute Conferences for Eastern
  Central European PC professionals 2003, 2004,
  2005 - 12 countries
• 40 hours PC courses for Eastern European region
  and former Sowjet Union countries

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Weeknesses of PC in Eastern-Europe

• PC sevices are not awailable all over the country
• Lack of PC training of physicians
• Low scarce financial resources

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Weeknesses PC services

• PC services are not awailable all over the
  country
• White spots of care
• 225 PC beds WHO recommends 500 for 10 million
  population

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Weeknesses - education

• Medical curriculum without PC issues
• 6000 hours of whole curriculum less than 200
  on symptom controll, on death and dying,on
  breaking bad news
• No PC specialisation for physicians
• Low motivation of physicians for PC

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Weeknesses - finance

• Low financial resources
• NHIF covers 50 of the budgets of PC services
• Donation is not traditional
• Few grants on PC topic

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Where is Hungary now?

• Increased number of PC services (2x)
• Legal development (2004)
• - minimum standards of palliative care
• - Ministry of Health decree on finance
• Finance financial demonstration project for
  palliative care (NHIF) (2004)
• Second part of this year new opportunities for
  extending PC - NHIF support

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Where is Hungary now?

• National development plan 2007-2013 integraton
  of Palliative Care into the National Health
  System (new reform) (2006)
• Palliative care and psychosocial care became an
  integrated part of National Cancer Control
  Program (2006)

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• However
• PC is not awailable all over the country
• Scarce of training and interest of physicians to
  PC
• Low state fund and lack of donation are barriers
  for further development

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Conclusion

• Further lobby is needed for increase number of
  PC services and to involve more physicians
• New approach to influence attitude of children
  toward end of life and solidarity
• FIELDS OF HOPE project since 2007

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