The True Colours Trust | The Palliative Care Association of Malawi

True Colours firmly believes in the importance of long-term, flexible funding to allow sustainable systemic change to take place on the ground. We have been working with partners in Malawi since 2011 on a piece of work designed to integrate palliative care into the public health system.

The STEP UP Project was conceived in 2011 by Fred Chiputula – a Clinical Officer supporting children with palliative care needs at a national referral hospital. Fred was concerned about the lack of palliative care for his patients when they were discharged to their home districts - at that time district hospitals rarely had trained staff, stocks of morphine, an appropriate clinic space or ring-fenced funding for a palliative care service.

Today, the situation has been transformed. Each of Malawi’s district hospitals now has a dedicated palliative care clinic run by a full-time trained member of staff, palliative care is included in all District Health Implementation Plans, with an associated budget line, and there is a consistent supply of morphine at least 82% of the time. The project has also strengthened palliative care in the community, helping to establish effective collaborations between Community Based Organisations and the district hospitals through training and the provision of bicycles for home visits. The number of adult palliative care patients in Malawi doubled between 2011 and 2021, while the number of children receiving palliative care more than quadrupled.

Group of healthcare professionals talking

In addition, the country has a National Palliative Care Policy, includes palliative care indicators in its mandatory national health data collection (DHISII) and has been ranked among the top 29 countries in the world for palliative care integration, sitting alongside the UK, USA, Australia and Germany. This is a truly remarkable achievement made possible by the vision of one man, the leadership of Malawi’s Ministry of Health, the tenacity and the hard work of the Palliative Care Association of Malawi,under the leadership of its CEO Lameck Thambo, and our long-term funding partnership.

Two nurses talking to and sitting on the floor with a patient during a home visit

The main focus of the STEP UP Project between 2011 – 2021 was providing training and clinical mentorship to district hospital staff and community leaders. This included supporting district teams to produce palliative care plans for their area and identify clinic spaces within their sites. Throughout the project there has also been a concerted effort to establish national structures to ensure that achievements to date are sustainable in the long-term.

Examples of these structures include the establishment of a national palliative care drug task force which monitors the supply and demand of essential medicines as well as the creation of peer support networks to ensure learning and best practice can be shared between districts. The formal mentorship and supervision of STEP UP trained staff was a joint PACAM/Ministry of Health initiative from the outset and in 2023/4 the Ministry of Health will resume sole responsibility for this, calling upon PACAM for additional technical support as it identifies need on the ground.

We are aware that change takes time and we will continue to support PACAM as it works with the Ministry of Health towards the long-term sustainability of palliative care services in Malawi.