Table 5.

Recommendations

Governance and leadership	Ministries of Health (MoH) need to integrate palliative care services in country policies, strategic plans and budgets. Ministries should drive this integration with a nominated person responsible for national palliative care who can work with all the stakeholders, including national associations and the various external donors and other development partners who frequently deliver standalone palliative care services.
Service delivery	Patients with palliative care needs are found throughout all levels of the health care system. Therefore care should be integrated into each level (tertiary, secondary and primary levels) and across all life–threatening illnesses, with good referral networks for continuity of care. Clear service delivery protocols should be in place. Palliative care interventions should be based on the needs of patients and their families and not limited by disease or health care setting.
Human Resources	A critical mass of staff should be trained to understand and deliver a palliative care approach in all settings. Senior hospital staff should be included for effective integration. Both ongoing mentorship and modeling of palliative care are important to ensure the sustainability of services and enable the necessary behavior change in clinicians. The MoH should also ensure strategic deployment of palliative care trained staff with palliative care being incorporated into deployment planning, job descriptions, and training programmes.
Finances	This program showed that it is possible to integrate palliative care by utilizing existing staff and procurement systems. The main financial implications elate extra staff hours, staff capacity building for PC, mentorship and supervision all of which need to addressed in MoH budgets. The project also reveals that districts are willing to incorporate palliative care in their budgets once they obtain an understanding of the importance of the service.
Medicine, vaccines and technology	The MoH should ensure that palliative care essential medicines are on the country essential medicines list and that the necessary documentation and regulation are in place to make these medicines available and accessible to all who need them over 24 hours. They should also ensure that there is sufficient capacity for prescribing (by encouraging, for example, nurse prescribing) and resilient procurement processes with special attention to oral morphine.
Strategic information	The MoH should include palliative care in the Health Management Information Systems, such that all facilities are required and supported to report palliative care interventions. This should be wider than referral to specialist services. National level tools for data collection along with support and supervision will also be needed. The development of an evidence base which is contextual, high quality and value based should be resourced.