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Catalogue Item

Public Health Model Colombia

Organization: WHO

Country: Colombia

Forum: End-of-life

A Public Health Model developed by the WHO was implemented in Colombia to increase awareness about palliative and end-of-life care, include palliative and end-of-life care as a component of care in legislation, and improve opioid availability. A national workshop was organized and attended by pain and palliative care specialists from all over Colombia in November 2007 as part of this model. The aim of the workshop as to identify barriers and possible solutions to opioid availability, inform regulators about the challenges physicians identify in the prescription process, and inform physicians about the limitations that regulators face.

The outputs of the workshop were these recommendations which were delivered to the Ministry of Health:

  1. Modify a national policy to guarantee availability of opioid analgesics 24 hours a day/7 days a week in the capital cities of the 10 main states in Colombia.
  2. Involve and engage the health maintenance organizations in order to inform them of the results of the workshop so that they can incorporate strategies in their quality improvement process to improve opioid availability.
  3. Form an advisory group of pain and palliative care clinicians to help the National Drug Authority in the identification of essential medicines and in the development of estimates of controlled medications to submit to the International Narcotics Control Board.
  4. Require Regional Hospitals to provide opioid medication for outpatients.

This workshop led to a variety of positive improvements to palliative care in Colombia; including the establishment of a course on Pain and Palliative Care at the Universidad de la Sabana which was made mandatory for all undergraduate students in the school of medicine. A new regulation mandated all 32 states in Colombia have at least one place where opioids are guaranteed to be in stock. This resulted in a 42% increase in the sale of morphine between 2006 and 2009 and 195% increase in the sale of hydromorphone nationwide. These improvements in education and opioid availability provide evidence that the WHO Public Health Model can be crucial in the development of palliative care.

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