From Training to Transformation: Palliative Care Development in Sri Lanka

In 2014, we began collaborating with Sri Lanka’s National Cancer Institute and its National Cancer Control Programme to launch an in-country training programme. Since then, we have successfully completed our Train-the-Trainers programme, training over 50 institutions and more than 100 participants. As a result, prescriptions for oral morphine have increased from just 3 to 30 days. Furthermore, Diplomas in Palliative Care for both Doctors and Nurses have been established, and the government has developed a strategic framework to advance palliative care in the country.

Acknowledging the ongoing commitment of the Ministry of Health to this critical area, we were honored to be invited back to Sri Lanka for further collaborations. Therefore, the APHN-Lien Collaborative team visited Sri Lanka from March 11 to 14, 2024, to witness the current progress and discuss areas where our expertise could contribute further.

On Day 1 of the arranged programme, we met with Dr Champika Wickramsingha (DDG, NCD, Ministry of Health), Dr Dewanee Ranaweera (Director, NCCP), and and Dr Sherine Balasingham (Directorate, NCD) to discuss the potential for Phase 2 of our APHN-Lien Collaborative training, as well as our intention to observe and learn over the next few days of presentations to identify gaps before designing the Phase 2 programme. Dr Champika Wickramsingha expressed her support for the plans to proceed with Phase 2.

On Day 2, we attended a Progress Review Meeting for Palliative Care Nursing Services in the country at the Post Basic College of Nursing, Colombo. Dr Suraj Perera, Consultant Community Physician, National Cancer Control Programme, as well as the coordinator of our visit, presented on the Journey towards the expansion of palliative care nursing services through the National Strategic Framework on Palliative Care Development in Sri Lanka. Through his presentation, we gained insight into the challenges faced, including disruptions caused by the Easter Sunday attack, COVID-19, and economic crises. While there are 9 provinces and 25 districts in Sri Lanka, the majority of palliative care nursing trainees are in Colombo, with some districts lacking trained nurses.

The sharing sessions included discussions on:

  • Developing Post Basic Diploma in Palliative Nursing and Palliative care module in Post Basic Diploma in public health nursing.
  • Palliative Care Service Development at Tertiary Care / Secondary Care Hospitals by Nursing Officers with Palliative Nursing Diploma.
  • Experience in providing community-based palliative nursing by Public Health Nursing Officers.

These presentations provided us with valuable insights into the progress of palliative care services in Sri Lanka, as well as the current challenges and limitations, which are crucial for planning Phase 2 of the training.

Our faculty also presented on the following:

  • The role of nursing officers as crucial team members in providing Palliative Care – Overview by A/Prof Ghauri Aggarwal (Vice Chair APHN, Country Lead, Sri Lanka Programme).
  • The Role of APHN in empowering nursing officers by Dr Ednin Hamzah (Chairperson, Asia Pacific Hospice Palliative Care Network (APHN)).

The highlight of the engagement trip was the audience with Dr. Palitha Mahipala, Secretary to the Ministry of Health, during which we discussed plans for Phase 2 of training in Sri Lanka. He expressed his full support, highlighting areas where we could provide assistance, including nurse training, capacity building at the primary healthcare level, and consultant development. Both the Directors of the National Cancer Programme and the Non-Communicable Disease Program were given the green light to plan Phase 2 collaborative training with the APHN.

On Day 3, we attended a programme on ‘Case-based discussions on serious illness communication and advanced care planning’ at the National Cancer Institute Maharagama. This included case presentations by participants as well as presentations by our faculty. One of the segments involved a role play on breaking bad news between a consultant oncologist and a patient and their spouse facilitated by A/Prof Ghauri Aggarwal, which provided valuable insights into communication strategies in difficult situations.

We also had the opportunity to visit Suwa Arana, the first Paediatric Palliative Care Centre in Sri Lanka, where we observed their in-house natural hair wig making, which is distributed to their patients throughout Sri Lanka.

On the final day of the trip, we attended an ‘Advocacy Workshop on the establishment of palliative care services for non-cancer conditions’ at the Sri Lanka Medical Association organised by the Directorate of NCD & SLMA Palliative Care & End of Life Care Task Force. It was an insightful session where representatives shared milestones achieved and future plans.

We would like to extend our gratitude to everyone involved in this four-day programme for taking time out of their schedules to share their insights with us. We are greatly impressed with the progress made thus far and eagerly anticipate the next phase of our work in Sri Lanka. Special thanks to Dr Suraj Perera for coordinating the entire trip.

Written by Ms Trudy Giam (APHN Executive )

Published on: 27 March, 2024 | Last modified: 27 March, 2024