A bold truth: Africa’s palliative care progress is real, but it’s far from enough to meet the continent’s needs—and the gap is still widening in many places. Here’s a clearer look at what the new Africa Palliative Care Atlas reveals, why it matters, and what could change next.
The Atlas was unveiled in Gaborone, Botswana, during the 8th International African Palliative Care Conference. It presents findings from a study covering 54 countries, led by the ATLANTES Global Observatory of Palliative Care at the University of Navarra in partnership with the African Palliative Care Association (APCA).
What the map shows
- Palliative care development across Africa has grown, but overall impact remains inadequate. Specialized palliative care services increased by 38%, yet the average stands at just 0.06 services per 100,000 people. By contrast, reaching at least 2 services per 100,000 would better reflect a necessary level of access.
- The Atlas updates and expands on the 2017 edition, offering the most comprehensive and rigorous portrait to date of the continent’s situation. The work used a strict methodology aligned with the World Health Organization’s (WHO) conceptual framework, and ATLANTES serves as a WHO collaborating center.
- The data collection involved 121 expert consultants from 50 African countries, trained by ATLANTES, who gathered and verified on-the-ground information.
Urgent needs and gaps
- An estimated 17 million people in Africa experience serious health-related suffering. Despite policy efforts, needs remain urgent. Only Uganda has reached an Advanced level of palliative care development; five countries—South Africa, Malawi, Kenya, Morocco, and Rwanda—have well-established systems.
- Several nations lack specialized services entirely: Angola, Burundi, the Central African Republic, Chad, Equatorial Guinea, Eritrea, Guinea-Bissau, São Tomé and Príncipe, and Somalia. More than half of Africa remains at an emerging stage in palliative care development.
- Access to pain-relief medicines is severely limited. In 76% of countries, oral morphine is available in fewer than 10% of urban primary care centers, and the shortage climbs to 85% in rural areas. Only a few countries (notably Mauritius, Morocco, Namibia, and Rwanda) report urban availability above 70%. Pediatric palliative care is scarce, with only 102 specialized services across the continent, and more than half located in South Africa, Zambia, and Uganda.
- There are notable inequalities between Anglophone and non-Anglophone countries. Anglophone nations generally perform better in access to essential pain medicines, professional training, and availability of specialized services, including pediatric care. They also publish significantly more research—up to fifteen times more—than non-Anglophone countries, which leaves non-Anglophone regions with less locally relevant evidence to guide policy and greater dependence on external models.
Progress and momentum
- Encouraging signs include: 10 countries with independent national palliative care strategies, 25 that have integrated these strategies into broader health plans, and six developing related policies. Chad, Djibouti, Guinea-Bissau, Lesotho, and Niger are among those previously not on the radar now moving forward.
- National palliative care authorities exist in 26 African countries within their Ministries of Health, eight more than in 2017. Benin, Malawi, Rwanda, and Uganda feature fully structured coordinating bodies. Conversely, Equatorial Guinea, Lesotho, The Gambia, and Zambia have seen their national authority status decline, underscoring the fragility of progress.
- Uganda stands out as a benchmark. As a low-income country with over 51 million people, it was among the first to guarantee free, decentralized access to oral morphine and to authorize nurses to prescribe it. Uganda also leads in setting evaluative indicators and integrating palliative care into universal health coverage, including mandating palliative care in university health-professional training. Countries like Malawi, Namibia, Zimbabwe, Kenya, Morocco, and Ghana are following related approaches.
A practical tool for change
- The Atlas is designed as a hands-on resource for advocacy and policy development. Its maps and infographics aim to raise awareness and inform public policy. The report is freely accessible online via the Institute for Culture and Society (ICS) website.
- This Atlas marks the third installment in a five-volume series intended to create a global map of palliative care. Earlier, the Asia-Pacific edition was released in Malaysia (April) and the European edition in Helsinki (May). Later in the year, editions covering the Americas and the Eastern Mediterranean will be published.
About the producers
- Institute for Culture and Society (ICS), University of Navarra, collaborated with the African Palliative Care Association (APCA) to develop this atlas.
- The project involved a broad network of consultants and partners dedicated to compiling a robust, accessible picture of palliative care across Africa.
For further information
- Instituto Cultura y Sociedad – Communications: T +34 948 425 600, ext 805611 / 802545, lescalada@unav.es, nrouzaut@unav.es
- Website: www.unav.edu/ics
And a provocative question to reflect on: If Africa’s current path continues, what concrete policy shifts and investments would close the gap most effectively, and which country or region should lead the way as a model for others to follow? Share your thoughts in the comments.”
