Edinburgh Napier University

  Background
The number of people needing palliative care is rapidly increasing in sub-Saharan Africa (SSA) . Healthcare systems in SSA are heterogenous, so broadly defining and operationalizing primary palliative care is a major obstacle to achieving Universal Health Coverage. We aimed to conceptualize and operationalize primary palliative care in SSA by developing an evidence-based logic model and consensus definition.

Methods
We purposively sampled expert participants in a workshop in Harare, Zimbabwe. They collaboratively developed a logic model using the Centers for Disease Control and Prevention's guide for developing and using logic models and a consensus definition using modified nominal group technique.

Results
Twenty-four primary palliative care experts comprised of researchers (70.1%), physicians (37.5%) and nurses (29.2%) from 8 countries (7 in SSA) participated. Twenty (83.3%) participants fell into multiple role categories. Primary palliative care essential resources (i.e., medications, funding, health workers), activities (i.e., clinical guidelines and referral pathway development, education), outputs (i.e., care pathways, cost-benefit ratios), and outcomes (i.e., improved quality of life, skilled primary palliative care workforce, reduced health-related suffering) relevant for countries in SSA were identified. To define primary palliative care in SSA, participants identified and ranked crucial components, including holistic care (provided by health workers with role-appropriate training), culturally congruent delivery of care, and accessibility at the entry point of healthcare systems. The definition highlights that "primary" pertains to how people access care, rather than who or where it is provided.

Conclusion
The identified essential components of primary palliative care address the region's specific context, challenges and strengths. Training the existing primary healthcare workforce in palliative care and providing necessary support and resources must be prioritized in order to improve outcomes in SSA.