title: Models of delivering palliative and end-of-life care in sub-Saharan Africa: a narrative review of the evidence.
abstract: OBJECTIVE
  This narrative review examines evidence for models of palliative and end-of-life (eol) care delivery in sub-Saharan Africa (SSA) since 2010. It highlights recent developments, on-going challenges and innovative approaches used to address obstacles to increased access to care.
  
  
  RESULTS
  Electronic databases were searched for the literature published in English during the period 2010-2012 around broad thematic areas of palliative and eol care delivery models in SSA. Literature showed increased palliative and eol care service development, underpinned by advocacy work undertaken by regional and national palliative care associations. Despite this increase, care provision remains inadequately integrated in national public health agendas and systems. Consequently, it continues to be heavily reliant upon nongovernmental, community-based and home-based care (HBC) models. Efforts are, however, underway to integrate palliative care into national health systems, which should increase access to care. National policies and government financing will be important to sustain this integration.
  
  
  CONCLUSIONS
  Although community and HBC programs remain primary models of palliative and eol care delivery in SSA, there is an urgent need to develop a public health approach that integrates care into national health systems to increase accessibility.
authors.affiliation: African Palliative Care Association, Kampala, Uganda. faith.mwangi-powell@opensocietyfoundations.org
authors.forename: Faith N
authors.initials: FN
authors.lastname: Mwangi-Powell
authors.forename: Richard A
authors.initials: RA
authors.lastname: Powell
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D017954:Africa South of the Sahara; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006297:Health Services Accessibility; D006699:Home Care Services / Q000458:organization & administration; D017051:Hospice Care / Q000458:organization & administration; D006801:Humans; D017146:Models, Organizational; D010166:Palliative Care / Q000458:organization & administration*; D013727:Terminal Care / Q000458:organization & administration*