Table 1. Six levels of children’s palliative care development.

Category 1: No known palliative care activity for children	A country in this category is one where current research reveals no evidence of any palliative care activity relevant specifically to children.
Category 2: Capacity building palliative care activity for children	A country in this category shows evidence of wide-ranging initiatives designed to create the organisational, workforce, and policy capacity for the development of palliative care services for children, although no service or specific program has yet been established. There are some developmental activities including attendance at, or organisation of, key conferences, personnel undertaking external training in palliative care, lobbying of policy makers and Ministries of Health, and emerging plans for service development.
Category 3a: Isolated children’s palliative care provision	A country in this category is characterized by the development of children’s palliative care activism that is still patchy in scope and not well-supported; sources of funding that are often heavily donor-dependent; limited availability of morphine; at least a service or program can be identified by other professionals in the country as a best practice model for palliative care for children; there are a few children’s palliative care services or specific programs, but they are limited in relation to the need of the population.
Category 3b: Generalised children’s palliative care provision	A country in this category is characterized by the development of children’s palliative care activism in several locations with the growth of local support in those areas; multiple sources of funding; the availability of morphine; several hospice-palliative care services or programs for children from a range of providers; and the provision of some training and education initiatives by the hospice and palliative care organizations.
Category 4a: Children’s palliative care services at a preliminary stage of integration into mainstream health care services	A country in this category is characterized by the development of a critical mass of children’s palliative care activism in a number of locations; a variety of palliative care providers and types of services and programs; awareness of palliative care on the part of health professionals and local communities; the availability of strong pain relieving drugs other than morphine; some impact of palliative care on policy; the provision of a substantial number of training and education initiatives by a range of organizations; and the existence of a national palliative care association.
Category 4b: children’s palliative care services at an advanced stage of integration into mainstream health care services	A country in this category is characterized by the development of a critical mass of children’s palliative care activism in a wide range of locations; comprehensive provision of all types of children's palliative care by multiple service providers; broad awareness of children’s palliative care on the part of health professionals, local communities, and society in general; unrestricted availability of morphine and most strong pain-relieving drugs; substantial impact of children’s palliative care on policy; the existence of children’s palliative care guidelines; the existence of recognized education centres and academic links with universities with evidence of integration of children’s palliative care into relevant curricula; and the recognition of children’s palliative care by a national association that has achieved significant impact.