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Cohort III International Pain Policy Fellows. Opioid Availability Action Planning Worksheet. Madison, Wisconsin, USA 6 – 10 August 2012. Action Plan - Sri Lanka Dr.Suraj Perera Dr. N. Jeyakumaran 10 August 2012. Provinces (9) & Districts(25) of Sri Lanka. Sri Lanka. Nine Provinces. - PowerPoint PPT Presentation
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University of Wisconsin Pain & Policy Studies GroupWorld Health Organization Collaborating Center forPain Policy and Palliative Care
Cohort IIIInternational Pain Policy Fellows
Opioid Availability Action Planning Worksheet
Madison, Wisconsin, USA
6 – 10 August 2012
University of Wisconsin Pain & Policy Studies GroupWorld Health Organization Collaborating Center forPain Policy and Palliative Care
Action Plan - Sri Lanka
Dr.Suraj Perera
Dr. N. Jeyakumaran
10 August 2012
University of Wisconsin Pain & Policy Studies GroupWorld Health Organization Collaborating Center forPain Policy and Palliative Care
Provinces (9) & Districts(25) of Sri Lanka
Sri LankaSri Lanka
Nine Provinces.Nine Provinces.
Nine Cancer UnitsNine Cancer Units
Types of HospitalsTypes of Hospitals
• Teaching Hospitals • Provincial General Hospitals• District General hospitals • Base Hospitals • Divisional Hospitals.• Central Dispensaries.
National Cancer Control Programme, Sri Lanka
Minister of Health
Secretary of Health
Director General of Health Services (DGHS)
Deputy Director General (DDG/ PHS 1)
Director / National Cancer Control Programme
* Consultant Community Physician
National Advisory National Advisory Committee on Committee on
Cancer ControlCancer Control
National Advisory Committee on Cancer Control
Ministry of Health
National Health Council
National Cancer National Cancer Control Control Programme Programme (NCCP )(NCCP )
National Cancer Institute (Maharagama)
Provincial Cancer Provincial Cancer Treatment Centres Treatment Centres ( Kandy, Galle, ( Kandy, Galle, Jaffna, Jaffna, Anuradhapura, Badulla, Anuradhapura, Badulla, Batticaloa Ratnapura, Batticaloa Ratnapura, KurunegalaKurunegala
Other National level institutions ( FHB , Epidemiology Unit , D/NCD)
Provincial Ministries of Health
Provincial Committees of Cancer Prevention & Control( PDHS, RDHS,Line Ministry Health Institutions of the district., Consultant Oncologist at provincial cancer treatment centres , Curative & Preventive health sectors )
District Committees of Cancer Prevention & Control
Technical working GroupsTechnical working Groups1. Cervical / Breast Cancer 1. Cervical / Breast Cancer PreventionPrevention2. Oral Cancer prevention2. Oral Cancer prevention2. Diagnosis & Cancer Therapy2. Diagnosis & Cancer Therapy
3. 3. Palliative carePalliative care4. Cancer surveillance4. Cancer surveillance5. Cancer research5. Cancer research
Issue
Inadequate Patient access to Opioid
Analgesics
Problems • Less Priority given to Palliative Care • Limitations of existing law related to Opioids
prescription • Inconsistencies on Distribution & Availability
of Opioids at the point of delivery • Gaps in knowledge, attitudes and practices of
health care professionals on pain management in palliative setting
Problem 1: Less Priority given to Palliative Care
• Underlying reasons for the problem .– Multiple health issues with communicable & non
communicable diseases.– About 15,000 to 20, 000 new cancer cases / year.– Most of the cancers are detected in late stages.– Palliative care is given a less priority.– Some aspects of palliative care.
• In Cancer treatment centres.• In four hospices.
– With few facilities.– minimum human resources.
Problem 1 :
Less Priority given to Palliative CareObjective (What) To consider palliative care as a priority in the Cancer
Policy of Sri Lanka
Action steps (How) To include the component of palliative care in the National Cancer control Policy.
Authority and/or Responsibility (Who)
• Secretary/Health• National Advisory Committee on Cancer Control• National Cancer Control Programme .
Timeline (When) September 2012
Assistance (How Much)
Expert participation Reviewing the Draft Policy Document.
Expected outputs Palliative Care is an essential component in the National Cancer Control policy.
Output measurement Relevant palliative care Policy statement.
Problem 1 : (Cont…)
Less priority given to Palliative CareObjective(s) (What) To coordinate planning, implementation and evaluation of
palliative care initiatives nationally
Action steps (How) To establish a National Working Group on Palliative Care for Cancer Patients
Authority and/or Responsibility (Who)
National Advisory Committee on Cancer Control National Cancer Control Programme
Timeline (When) September 2012 onwards At least two meetings in each year
Assistance (How Much)
Technical advice on initiatives
Expected outputs Palliative care initiatives are conducted in coordinated manner
Output measurement Functional National Working Group on Palliative Care for Cancer Patients established.No. of meetings held per year, No. of Meeting Reports
Problem 1 : (Cont…)
Less priority given to Palliative CareObjective(s) (What) To conduct advocacy leading to acceptance of palliative care
as a priority
Action steps (How) To conduct an advocacy meeting to obtain support from all stakeholders
Authority and/or Responsibility (Who)
National Advisory Committee on Cancer Control, National Cancer Control Programme ‘ Sri Lanka Medical Association, Sri Lanka College of Oncologists/ Anethesiologists/ Family Medicine WHO Country Office - Sri Lanka Sri Lanka Cancer Society
Timeline (When) Every year in the month of October, commencing from year 2012
Assistance (How Much)
Logistic support for an International expert
Expected outputs Participation of stakeholders to the advocacy meeting Ability to get support from stakeholders
Output measurement Report of advocacy meeting
Guest Lecture : Palliative Care
Symposium on Palliative Care – 2010
Symposium on Palliative Care – 2010
Problem 2 :Limitations of existing law related to Opioids prescription
Underlying reasons for the problem Deficiencies of POISONS,OPIUM, AND DANGEROUS DRUGS ordinance & its
Amendments Under section 56 (1)• “A medical practitioner may administer, prescribe or supply any dangerous drug for the
treatment of his patients, but shall not supply to any patient more than the amount to be taken by him during three days.”
Under section 59 (2c)• “The total amount of the drug prescribed shall not exceed the amount to be taken by
the patient during three days: Provided that the prescription may direct that the amount prescribed may be supplied on more than one but not more than three occasions at intervals to be specified in the prescription”
Problem 2 : Limitations of existing law related to Opioids prescription
Objective (What) To amend the existing law that restrict duration of opioid prescription to the patients
Action steps (How) Detailed review of existing legal documents (amendments, regulations, administrative orders)Identify the necessary amendments & submit to Legal Draftsmen Department for further action Cabinet Approval, Public Opinion, Parliamentary approval
Authority and/or Responsibility (Who)
Ministry of Health National Advisory Committee on Cancer ControlLegal Draftsmant Department
Timeline (When) 2012-2014
Assistance (How Much)
Technical Assistance – Information related to similar amendments in other countries
Expected outputs Relevant law is amended
Output measurement Availability of amended legal document
Problem 3: Inconsistencies related to the distribution & availability of opioids at the point of delivery• Reasons for the problem..
– In Sri Lanka, palliative care and pain management is mainly offered at cancer units.
– There is a varying level of availability of drugs and practice of dispensing analgesics including opioids.
– Supply of Morphine: from one week to a month.
– An availability of minimal pain management without access to Oral Morphine in the District General and Base Hospital.
Problem 3: Inconsistencies on Distribution & Availability of Opioids at the point of deliveryObjective ( What) To Identify the Reasons for the Inconsistencies
Action steps (How) Reviewing the current problem at the Institutional level including Health System Research in each Cancer Hospital. (BOAT Survey)
Authority and/or Responsibility (Who)
National Advisory committeeNational Cancer Control Programme.Director, MSDDirectors of each Hospitals.Oncologists.Pharmacists.IPP Fellows.
Timeline (When) Till February 2013.
Assistance (How Much)
1. Technical assistance for Research activities eg. Research papers / Questionnaires / advise on methodology.
2. Study Materials / Books on Health System Research.3. Support on Statistics
Expected outputs Better understanding of the reasons for the problem.
Output measurement Reports.
Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of deliveryObjective(s) (What) To ensure the availability of the opioids at the Teaching
Hospitals and Provincial General Hospital (9) level.
Action steps (How) Conducting pilot studies to forecast the amount of opioids in two cancer centres
Authority and/or Responsibility (Who)
Director, MSDDirectors of each Hospitals.Oncologists.Pharmacists.
Timeline (When) September 2013
Assistance (How Much)
Technical assistance.
Expected outputs To see the estimates.
Output measurement The reports of estimates.
Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of deliveryObjective(s) (What) To make availability of opioids at the District General
Hospital(16) level.
Action steps (How) Conducting pilot programmes in two District General Hospital.
Authority and/or Responsibility (Who)
National Cancer Control Programme.Directors of each Hospitals.Oncologists. Pharmacists.IPP Fellows.
Timeline (When) December 2013
Assistance (How Much)
Technical and financial assistance to do the pilot study
Expected outputs Achieving Cancer Pain Management. Model at District General hospital.
Output measurement Patient satisfaction.
Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of deliveryObjective(s) (What) To conduct pilot projects on achieving community based
palliative care
Action steps (How) conducting pilot studies in two districts to provide pain management.
Authority and/or Responsibility (Who)
National Cancer Control Programme. Provincial Directors of Health servicesDirectors of each Hospitals..Oncologists. Pharmacists.IPP Fellows.
Timeline (When) February 2014
Assistance (How Much)
Technical and financial support.
Expected outputs Two models in two cultures.
Output measurement Project Reports.
Problem 3: (Cont…)Inconsistencies on Distribution & Availability of Opioids at the point of deliveryObjective(s) (What) Include Oral liquid morphine available.
Action steps (How) Ensuring purchase of oral liquid Morphine through MSD,
Authority and/or Responsibility (Who)
National Cancer Control Programme. MSD.
Timeline (When) June 2013
Assistance (How Much)
Donation initially from available countries for 2013,
Expected outputs Availability of Oral Solution of Morphine for Cancer pain Mx.
Output measurement Report from Director / Hospitals
Problem 4: Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting.
• Reasons for the problem..• In Sri Lanka Health Care Professionals have
varying levels of Knowledge, Attitudes and Practice towards Pain Management in general and opioid prescription in particular. – Imposes barriers to receive opioids for pain
management.
Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative settingObjective(s) (What) To have Continuing Medical Education (CME) on Palliative care and pain
management in each District at least one per year.
Action steps (How) Discussing this idea with the National Cancer Control Programme to arrange this programme Developing guidelines / Desktops / Power point Slides.
Authority and/or Responsibility (Who)
Secretary, Ministry of Health.
Director Genearal of Health
Director / National Cancer Control Programme
Sri Lanka Medical Association.
Professional Colleges.
Timeline (When) 2013 -2014 ( Year 2)
Assistance (How Much)
Technical and financial assiaatance .
Expected outputs Programmes are conducted.
Output measurement No. of Programmes conducted and reports of them
Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting
Objective(s) (What) To have detailed component of palliative care module in postgraduate streams such as Oncology, anaesthesiology and Family Medicine .
Action steps (How) To initiate this matter with Director Postgraduate Institute of Medicine and Boards of study in Clinical Oncology and Family Medicine.
Authority and/or Responsibility (Who)
Director PGIM.
Chairman BOS in Oncology and Family Medicine
Timeline (When) 2013 - 2014
Assistance (How Much)
International Experts (PPSG) and Local experts
Expected outputs Inclusion of Palliative care components in the curricula.
Output measurement Prospectus of Board of Study
Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting
Objective(s) (What) To commence Postgraduate Diploma course on palliative care for Medical Officers
Action steps (How) To discuss this matters with Director, PGIM involving members from specialties concerned.
Authority and/or Responsibility (Who)
Secretary of Health,Director Genearal of Health Services Director PGIM.National Cancer Control Programme.
Timeline (When) 2013-2014
Assistance (How Much)
Technical support of International Experts (PPSG) to Post Graduate Institute to develop curricula.
Expected outputs Acceptance establishment of Curriculum Development Committee.
Output measurement Study Prospectus.
Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting
Objective(s) (What) To include training modules on palliative care nursing to the basic nursing training curricula
Action steps (How) Conducting a Training programme for tutors of Nursing Training Schools
Authority and/or Responsibility (Who)
Director Genearal of Health Director / Nursing (Training)
Timeline (When) 2014
Assistance (How Much)
Technical support of international experts
Expected outputs Availability of trained palliative care nursing tutors
Output measurement No. of programmes conducted.
Problem 4: (Cont…)Gaps in knowledge, attitudes and practices of health care professionals on pain management in palliative setting
Objective(s) (What) To strengthen the knowledge of Nurses in Palliative Care Services.
Action steps (How) Conduct Certificate course in Palliative Care for Nurses
Authority and/or Responsibility (Who)
Secretary of Health.Director General Health Services.Director / Nursing (Training)
Timeline (When) 2014
Assistance (How Much)
Technical support of international experts
Expected outputs Availability of trained palliative care nurses.
Output measurement No. of trained palliative care nurses
To include palliative care as a priority in the Cancer Policy of Sri Lanka
September 2012
To establish a National Working Group on Palliative Care for Cancer Patients
September 2012
To conduct an advocacy meeting to obtain support from all stakeholders
October 2012
To amend the existing law that restrict duration of opioid prescription
2012 - 2014
Reviewing the current problem at the Institutional level including Health System Research in each Cancer Hospital. (BOAT Survey)
February 2013
Conducting pilot studies to forecast the amount of opioids in two cancer centres
September 2013
conducting pilot studies in two districts to provide pain management.
December 2013
Ensuring purchase of oral liquid Morphine through MSD. June 2013
Time Line of Activities
To have Continuing Medical Education (CME) on Palliative care and pain management in each District.
2013 - 2014
Inclusion of Palliative care components in the curricula of Oncology & Family Medicine.
2013 - 2014
Acceptance establishment of Curriculum Development Committee.
2013 - 2014
Conducting a Training programme for tutors of Nursing Training Schools
2013 - 2014
Conduct Certificate course in Palliative Care for Nurses
2014
Time Line of Activities (cont..)
Goal :
Opioid analgesics are available to the patients who need them.
Quality of life of patients and families are improved.
Thank You