The main results are presented next in a narrative by WHO dimensions of PC development following the house model. Summarized findings are presented in Table 1.
Table 1. Main data reported on indicators & level of development in Benin
Table 1: Main data reported on indicators & level of development in Benin
Empowerment of people and communities
In Benin, there are several associations involved at both national and local levels in the defense of patients' rights to palliative care such as cancer patient’s associations like SOS Cancer Bénin or the «Fondation SPH contre le cancer. There is also a specialized professional association, the “Association Béninoise de Soins Palliatifs (ABSP)”, created in 2015 following the model of Hospice Africa Uganda. The ABSP aims at promoting PC through the integration of clinical, psychosocial and scientific aspects. They coordinate information, education, and training activities for health structures to arose PC practice.
Regarding patient´s care planning, there are yet no specific policies for PC such as advance directives, substitute decision makers, living wills or advance care planning. Guidelines are being developed by the National Program for palliative Care (PNSP) but have not yet been validated by the Ministry of Health. However, there is a law on the protection of the health of persons in the Republic of Benin (13).
Policies
Benin has an independent national strategic plan for palliative care: The Five-Year Palliative Care Plan in Benin (PQSP 2022–2026). This plan is recent and has not yet been actively evaluated. It constitutes a reference framework for activities to be carried out to improve the quality of life of people with potentially incurable diseases, reflecting the Beninese government's desire to fulfil its commitments to implement the Sustainable Development Goals (SDGs).
The article 36 of the National health law (2020-37 of 3 February 2021 on the protection of people's health in the Republic of Benin) (13) stipulates that the state promotes access to palliative care, meaning that PC is included in the list of basic health services to be provided to population. In addition, there is a module devoted to palliative care in the training guide for community workers at the national level. This guide is written by the National Council for the Fight against HIV/AIDS, Tuberculosis, Malaria, Hepatitis, Sexually Transmitted Infections and Epidemics (CNLS -TP) which is directly attached to the Presidency of the Republic of Benin (14).
The National Palliative Care Program is the structure of the Ministry of Health that works to prevent and alleviate the suffering of adult and child patients facing problems related to life-threatening diseases. The National Palliative Care Program is headed by a Coordinator appointed by an order of the Minister of Health.
Research
The first Beninese national palliative care congress was held from 6 to 8 October 2022 under the theme "Palliative care, universal health coverage and development". It was coupled with the celebration of the second World Palliative Care Day in Benin with the theme "Healing Hearts and Communities", and is planned to be conducted every year. The 2022 Congress was jointly organized by the National Palliative Care Program (PNSP) and the Beninese Association for Palliative Care (ABSP) under the sponsorship of the Beninese Minister of Health. Although, no publications specific to palliative care were found in indexed databases, a new publication published as an abstract in the abstracts book is about to be published (15, 16) and there is some clinic literature concerning CNMU HKM (17) and a project to create a PC-related research group led by the PNSP.
Use of medicines
According to the INCB, the reported annual consumption of opioids, excluding methadone, in oral morphine equivalent per person in Benin in 2020 was 0.18 mg/capita/year. Morphine represents 0.14 mg, fentanyl 0.03 and pethidine 0.01, according to data from the Walther Global Palliative Care Center (Indiana University) website. There is a peak in morphine consumption after 2015.
Coordinators of health areas reported that 34% of health care centers across the country had pain and PC medicines available. Non-opioids analgesics were available at 98,3% of health centers, non-steroidal anti-inflammatories at 99% (512/521 and 514/521, respectively), while opioids were available at 6,3% of healthcare centers (33/521). In particular, oral morphine is available at those scarce centers where PC is provided and 16,5% of patients followed at the hospital have access to oral morphine. Out of the 44 hospitals, seven (15,9%) report availability of oral morphine, with a greater availability in urban ones (4/13: 30,8%) than in rural ones (3/31: 9,7%).
Education
To date, none of the two university institutions has a compulsory or optional palliative care module in its basic training. However, the Faculty of Medicine in Parakou is planning a module in palliative care from 2024. Also, in the National Medical and Health Institute (INMeS/UAC), training school for nurses and midwives, a master's degree in palliative care has been created for paramedics in August 2021, but is not primarily intended for doctors. There is no accredited specialization course in palliative medicine for physicians.
Provision of services
The evaluation in Benin reported eleven specialized palliative care teams are distributed as follows: Cotonou (2), Abomey (2), Aplahoué (2), Comé (2), Parakou (1), Boko (1), Papane (1) (Fig. 3). Most are hospital teams but four teams provide care also at home. Taking the latest population data published by the World Bank (12,996,895), the ratio of services is 0.08 per 100,000 inhabitants. The teams include at least one doctor, one nurse and one driver and, sometimes, they also include volunteers and students. Although, there are no specialized pediatric palliative care teams yet, Benin has two pediatric oncologists trained with the help of GFAOP (Groupe Franco-Africain d'Oncologie Pédiatrique) and a pediatric oncology unit located in the Centre Hospitalier Universitaire Départemental -Ouémé-Plateau located in the city of Porto-Novo (8). According to the Beninese Society of Pediatrics (SoBePed), at their 5th Congress of to be held in Cotonou from 23 to 26 May 2023, a joint session between the Pediatric Oncology Unit of CHUD-OP, GFAOP and SoBePed to promote pediatric palliative care is planned.