Health policy, health services, and cancer pain management in the new South Africa

In 1982, the World Health Organization (WHO) identified inadequate relief f rom cancer pain as an international health problem. WHO recommended that go vernments develop and implement national policies and programs for cancer p ain relief This report evaluates national health policy and the systems of health care delivery in relation to cancer pain management in the new South Africa. This field study included multiple methods of data collection: ana lysis of documents, field trips with participant observation in sites of ca re delivery, focused interviews, and in-depth interviews of key informants. The purposive sample of hey informants (n = 33) represented multiple stake holders in a variety of settings. Strengths of the developing health policy include specific recommendations related to palliative cal-e; the shift to universal primary care; policies to support drug availability; the inclusi on of morphine and codeine as essential drugs at the primary health care le vel; and the development of a national standard related to cancer pain mana gement. Health services are characterized by two parallel systems of care ( private and public) with numerous vestiges of the inequities of apartheid. The management of pain varies by provider and setting major problems with a ccess exist in the rural areas. Health services in South Africa have been p lagued by inequity and inadequate resources. New health policies have set a path to ensure universal access to health care including palliative care f or cancer: Their successful implementation is the next necessary step towar d improving health services and alleviating the suffering of increasing num bers of individuals with cancer. (C) U.S Cancer Pain Relief Committee, 1998 .