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