Palliative Care Worldwidefrom villages to metropolis
Katalin Muszbek MD.
Hungarian Hospice Foundation
Palliatvive care development in Eastern – European Region
Poland – first steps at the 70es
Jaczek Luczak – key person Regional PC education in Poland with
international faculty British model From 90es - activities of the hospice groups in
the region
Palliative Care in Hungary
Since 1991 – start of the Hungarian hospice movement: first palliative care group:
Hungarian Hospice Foundation
Strenghts of Palliative Care in Hungary
Well orgaized care based on minimum standards
Legal backround, strong policy High public awareness International training resource centre
Strengths - clinical activities
Well organized PC services Activities only on minimum standards PC guideline
Strengths - legal background
Hospice paragraph in the health law – 1997 Regulation on PC – 2004 Palliative Care Development Project –
collaboration with National Health Insurance Fund – 2004 PC is a part of National Cancer Control
Program
Strengths - public relations
High public awareness Publicity campaignes since 2000 High media representation
in 2007 more than 100 publications, interviews in electronic and written media
Programs for children
Strengths - education
Budapest is an International Training Resource Centre
Open Society Institute Conferences for Eastern Central European PC professionals – 2003, 2004, 2005 - 12 countries
40 hours PC courses for Eastern European region and former Sowjet Union countries
Weeknesses of PC in Eastern-Europe
PC sevices are not awailable all over the country
Lack of PC training of physicians Low – scarce financial resources
Weeknesses – PC services
PC services are not awailable all over the country
White spots of care 225 PC beds – WHO recommends 500 for 10
million population
Weeknesses - education
Medical curriculum without PC issues6000 hours of whole curriculum – less than 200 on symptom controll, on death and dying,on breaking bad news
No PC specialisation for physicians Low motivation of physicians for PC
Weeknesses - finance
Low financial resources NHIF covers 50% of the budgets of PC services Donation is not traditional Few grants on PC topic
Where is Hungary now?
Increased number of PC services (2x)
Legal development: (2004)
- minimum standards of palliative care
- Ministry of Health decree on finance
Finance: financial demonstration project for palliative care (NHIF) (2004)
Second part of this year new opportunities for extending PC - NHIF support
Where is Hungary now?
National development plan 2007-2013: integraton of Palliative Care into the National Health System (new reform) (2006)
Palliative care and psychosocial care became an integrated part of National Cancer Control Program (2006)
However…
PC is not awailable all over the country Scarce of training and interest of physicians to
PC Low state fund and lack of donation are barriers
for further development
Conclusion
Further lobby is needed for increase number of PC services and to involve more physicians
New approach – to influence attitude of children toward end of life and solidarity:
FIELDS OF HOPE project since 2007