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New palliative care funding system needed
Editorial
Child wellbeing in Africa: the true wealth of nations
Reuters
The printed journal includes an image merely for illustration
For the African Child Policy Forum see http://www. africanchildforum.org
The logic is simple: investing in children is an investment in tomorrow’s peace, stability, security, democracy, and sustainable development. And nowhere in the world is the case for investment in children as clear-cut and powerful as it is in Africa—a continent so often seen as synonymous with conflict, instability, and poverty. But although governments are never short of good words to say about advancing children’s wellbeing, how committed are they in practice? This is the fundamental question posed by The African Child Policy Forum in The African Report on Child Wellbeing 2011: Budgeting for Children. The report’s authors took national budgets to be indicative of the true extent to which governments are prepared to match speeches with tangible action. To assess how far national budgets went toward addressing the needs of children, the authors analysed budget spending on health, education, early childhood development, and social protection in 52 African countries up to 2008. The picture for health was mixed. Despite encouraging improvements in immunisation coverage, nutritional status, and reduced infant mortality in many African
countries over the past 10 years, investment in child health is still low across much of the continent. At Abuja in 2001, African Governments pledged to allocate at least 15% of their annual budgets to the improvement of the health sector. By 2008, only four countries— Liberia, Rwanda, Tanzania, and Zambia—had achieved that target, with most of the rest investing only between 4 and 6%. Only two-thirds of African countries spend more than the WHO minimum amount of US$34 per person per year. Little wonder that almost half the countries in Africa were found in the report to have child mortality levels more than two times higher than the Millennium Development Goal target for 2015. The progress made by some of the poorest countries in Africa, such as Rwanda, is proof positive that commitment to child wellbeing is not a question of resources; it is a question of both political will and the ability to translate that will into action. National budgets must reflect the importance of children’s rights and wellbeing to the future social, economic, and political health of a nation. ■ The Lancet
Richard Gardner/Rex Features
New palliative care funding system needed The printed journal includes an image merely for illustration
For the Palliative Funding Review see http:// palliativecarefunding.org. uk/2010/12/palliative-carefunding-review-interim-reportpublished/ For the Quality of Death report see www.eiu.com/sponsor/ lienfoundation/qualityofdeath For the Dying for Change publication of UK think tank Demos see http://www.demos. co.uk/publications/ dyingforchange
1960
With ageing populations and their associated chronic diseases, the demands for end-of-life care have risen sharply. However, palliative care is often poorly coordinated, even in the UK, which ranks top among 40 countries in a recent report by the Economist Intelligence Unit entitled Quality of Death. Palliative care should be the responsibility of every health professional, whereas for most health professionals there is limited training in end-of-life care. Moreover, according to the UK think tank Demos, of 500 000 deaths each year, only 18% of people die at home, yet 66% of those surveyed would like to do so. To enable the provision of palliative care to adults and children where and when needed, the Secretary of State for Health, Andrew Lansley, has asked the Chief Executive of Marie Curie Cancer Care, Tom Hughes-Hallett, to chair an independent review to recommend a new funding system. The interim report, published on Dec 3, not only sheds light on defining dedicated palliative care as “care which enables people with progressive, and/or life threatening
conditions or who are approaching the end of life to live according to their wishes and preferences wherever possible”, but also urges the government to provide immediate investment to support round-the-clock access to community services. The report also seeks to make it clear to providers in the forthcoming NHS Operating Framework and NHS Outcomes Framework that 24-h community services are a priority. The final report, due next summer, will focus on ways of developing the new funding system. End-of-life care is important. All health professionals must be acquainted with palliative management of pain and symptoms of non-curable conditions, psychological support, and ethical issues. It is important that the final report identifies the barriers that might confront health professionals with regard to the provision of comprehensive supportive care, and how to overcome them. Comprehensive education and training in palliative care is necessary to enable health professionals to assure dignity at the end of life. ■ The Lancet www.thelancet.com Vol 376 December 11, 2010
Child wellbeing in Africa: the true wealth of nations
Reuters
The printed journal includes an image merely for illustration
For the African Child Policy Forum see http://www. africanchildforum.org
The logic is simple: investing in children is an investment in tomorrow’s peace, stability, security, democracy, and sustainable development. And nowhere in the world is the case for investment in children as clear-cut and powerful as it is in Africa—a continent so often seen as synonymous with conflict, instability, and poverty. But although governments are never short of good words to say about advancing children’s wellbeing, how committed are they in practice? This is the fundamental question posed by The African Child Policy Forum in The African Report on Child Wellbeing 2011: Budgeting for Children. The report’s authors took national budgets to be indicative of the true extent to which governments are prepared to match speeches with tangible action. To assess how far national budgets went toward addressing the needs of children, the authors analysed budget spending on health, education, early childhood development, and social protection in 52 African countries up to 2008. The picture for health was mixed. Despite encouraging improvements in immunisation coverage, nutritional status, and reduced infant mortality in many African
countries over the past 10 years, investment in child health is still low across much of the continent. At Abuja in 2001, African Governments pledged to allocate at least 15% of their annual budgets to the improvement of the health sector. By 2008, only four countries— Liberia, Rwanda, Tanzania, and Zambia—had achieved that target, with most of the rest investing only between 4 and 6%. Only two-thirds of African countries spend more than the WHO minimum amount of US$34 per person per year. Little wonder that almost half the countries in Africa were found in the report to have child mortality levels more than two times higher than the Millennium Development Goal target for 2015. The progress made by some of the poorest countries in Africa, such as Rwanda, is proof positive that commitment to child wellbeing is not a question of resources; it is a question of both political will and the ability to translate that will into action. National budgets must reflect the importance of children’s rights and wellbeing to the future social, economic, and political health of a nation. ■ The Lancet
Richard Gardner/Rex Features
New palliative care funding system needed The printed journal includes an image merely for illustration
For the Palliative Funding Review see http:// palliativecarefunding.org. uk/2010/12/palliative-carefunding-review-interim-reportpublished/ For the Quality of Death report see www.eiu.com/sponsor/ lienfoundation/qualityofdeath For the Dying for Change publication of UK think tank Demos see http://www.demos. co.uk/publications/ dyingforchange
1960
With ageing populations and their associated chronic diseases, the demands for end-of-life care have risen sharply. However, palliative care is often poorly coordinated, even in the UK, which ranks top among 40 countries in a recent report by the Economist Intelligence Unit entitled Quality of Death. Palliative care should be the responsibility of every health professional, whereas for most health professionals there is limited training in end-of-life care. Moreover, according to the UK think tank Demos, of 500 000 deaths each year, only 18% of people die at home, yet 66% of those surveyed would like to do so. To enable the provision of palliative care to adults and children where and when needed, the Secretary of State for Health, Andrew Lansley, has asked the Chief Executive of Marie Curie Cancer Care, Tom Hughes-Hallett, to chair an independent review to recommend a new funding system. The interim report, published on Dec 3, not only sheds light on defining dedicated palliative care as “care which enables people with progressive, and/or life threatening
conditions or who are approaching the end of life to live according to their wishes and preferences wherever possible”, but also urges the government to provide immediate investment to support round-the-clock access to community services. The report also seeks to make it clear to providers in the forthcoming NHS Operating Framework and NHS Outcomes Framework that 24-h community services are a priority. The final report, due next summer, will focus on ways of developing the new funding system. End-of-life care is important. All health professionals must be acquainted with palliative management of pain and symptoms of non-curable conditions, psychological support, and ethical issues. It is important that the final report identifies the barriers that might confront health professionals with regard to the provision of comprehensive supportive care, and how to overcome them. Comprehensive education and training in palliative care is necessary to enable health professionals to assure dignity at the end of life. ■ The Lancet www.thelancet.com Vol 376 December 11, 2010