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Challenges/barriers for moving forward
Ernesto JaramilloWHO/Stop TB Department
Palliative Care and M/XDR-TB
18-19 November, 2010Geneve, Switzerland
Non-exhaustive list of challenges
• Awareness
• Advocacy
• Assessment of need
• Policy-guidelines
• Financing
• Human resources
• Models for palliative care in M/XDR-TB
• Needs for technical assistance
• Monitoring and evaluation (indicators, targets, goals)
• Drug management in palliative care for TB
AWARENESSWhat else apart from anti-TB drugs are
patients in need of?
ADVOCACYHealth care workers and health care systems not only have
the ethical duty but CAN deliver effective palliative care
Universal access to palliative care must match
universal access to diagnosis and treatment of M/XDR-TB
Policy-guidelines…in need of updating
FinancingWhat and hw to budget and fund palliative
care in M/XDR-TB?
Models for palliative care in M/XDR-TB
Human resources
Needs of technical assistance
Monitoring and evaluation (indicators, targets, goals)
How to measure coverage,
quality, and impact of
palliative care in the response to M/XDR-TB?
Drug management in palliative care for TB
Which are the challenges in the health systems for scaling up palliative care?
Health System Building Blocks
BottlenecksService delivery
Health workforce Information
Medical products
and technologies
Health financing
Leadership and
governance
Still major gaps in TB control
Extremely weak M/XDR-TB management and care
Health workforce crisis
Inadequate laboratories
Quality of anti-TB drugs not assured
Limited access to drugs for pain relief
Absent infection control
Insufficient body of evidence on PC in TB
Major financial gaps
What means a patient-centred approach in TB care and control
without palliative care?