Palliative care in Togo: urgent need for dignified support for the chronically ill

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Extract from the article: Faced with the silent suffering of thousands of patients with life-threatening illnesses, Togo's healthcare professionals - including doctors, nurses, heads of palliative care associations and media professionals - have joined forces to make a strong

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Faced with the silent suffering of thousands of patients with life-threatening illnesses, Togo's healthcare professionals - including doctors, nurses, heads of palliative care associations and media professionals - have joined forces to make a strong plea for the development of palliative care in our country. This was the theme of a press conference organized by the Ministry of Health and Public Hygiene, with technical support from Hospice Africa, through the Non-Communicable Disease Surveillance Division, on Thursday May 22, 2025 in Lomé.

“Palliative care is not a luxury, but a fundamental human right. Togo wants to make palliative care a national priority.Whatever the illness or condition, people must be able to live out their final days with dignity, free from suffering. We want to mobilize all players - ministries, healthcare professionals, civil society, technical and financial partners - around a shared vision: to fully integrate palliative care into the Togolese healthcare system”, hammered out Pr Mofou Belo, Head of Togo's Non-Communicable Diseases (NCD) Surveillance Division, during the meeting, the aim of which is to federate energies to strengthen the promotion and awareness of palliative care in Togo.

This advocacy also aims to draw the attention of health authorities and media decision-makers to the urgent need for a national palliative care framework, with a clear strategy, dedicated resources and adequate training for healthcare professionals.

For Sylvie Dive, a Ugandan nurse and palliative care teacher at Hospice Africa Uganda, offering palliative care means recognizing the value of every life until its end. “This plea reminds us that the challenge is to transform this awareness into concrete action, so that every life, even at its last breath, is respected, surrounded and soothed.Providing decent support to terminally ill patients is not a privilege, but an ethical and humanitarian obligation,” she emphasizes.

The benefits of palliative care

Palliative care is active, holistic care for people with serious, progressive or terminal illnesses. Palliative care should not be seen as a last resort, but should wherever possible be integrated into the patient's care process at an early stage.Palliative care teacher Sylvie Dive explains that the main mission of palliative care is to relieve physical pain and accompany psychological, social and spiritual suffering. This considerably improves quality of life, even when recovery is no longer possible.

For her, “integrating palliative care into Togo's hospitals and health centers means humanizing care and recognizing that every life deserves dignity, attention and respect, right to the end. Not to offer this care is to let patients die in pain, which is contrary to fundamental rights”.

Prof. Mofou Belo showed that palliative care is “an imperative of public health and social justice, because the poorest people, who do not have the possibility of accessing expensive care abroad, also have the right to a dignified end of life”, he explained.

According to Koffi Tengue, Executive Director of the NGO Organisation Jeunesse pour le Développement Communautaire (ORJEDEC), such care is interdisciplinary, addressing the patient as an individual, his or her family and loved ones, both at home and in an institution.

A public health issue still too often ignored

In Togo, palliative care remains one of the most ignored aspects of the healthcare system, says Koffi Tengue, Executive Director of the NGO ORJEDEC.

Palliative care is an imperative for public health and human dignity. “Unfortunately, in Africa, many people only seek help at an advanced stage of the disease, which considerably limits the impact of this approach,” laments Dr Eddie Mwebesa, Director of International Programs at Hospice Africa Uganda.

While thousands of people are living with serious or terminal illnesses, the management of pain and suffering remains minimal or non-existent, admits Prof. Belo.

According to data from the STEPS Togo 2021 survey, the prevalence of non-communicable diseases (hypertension, diabetes, cancer, etc.) is on the rise, resulting in a growing demand for palliative care. According to GLOBOCAN, Togo recorded 5491 new cases of cancer in 2022, including 3605 deaths. Among other chronic diseases of infectious origin, HIV/AIDS ranks first, with an average prevalence of 1.9% in 2022, according to the statistical yearbook. Based on the average prevalence of HIV/AIDS in 2022, over 100,000 people in Togo would require palliative care every year.

“Pain, often intense and persistent, remains the major symptom for these patients. It is unacceptable that so many Togolese still live and die in pain without access to dignified and humane care. Palliative care is not synonymous with death.It enables people to live with dignity until the end of their lives”, stresses the head of the NCD monitoring division.

Lack of political commitment, combined with cultural taboos on death and illness, contribute to the silence surrounding a fundamental need: to die with dignity,” points out Sylvie Dive, a palliative care teacher. Too many patients die in suffering, isolated, without medical, psychological or spiritual support,” she warns.

Challenges remain

Despite Togo's efforts to train staff and build partnerships, stakeholders believe that palliative care is struggling to develop and is not being taken into account to have a real impact on the healthcare system. The Division for the Surveillance of Non-Communicable Diseases (DivSMNT), having participated in the 3rd Benin Palliative Care Congress held in Cotonou from October 17 to 19, 2024, has once again taken stock of Togo's lag in this field.

Prof. Mofou Belo mentioned a number of difficulties, including the lack of a high-level political commitment and a legal regulatory framework to support and accompany the development of palliative care, the failure to integrate palliative care into the training curricula of health professionals, the non-existence of mobile palliative care units and teams, home and public community hospices, the poor availability of morphine products for the management of patient pain, and the absence of a national palliative care association in Togo.

Unanimous involvement of all players

Palliative care has been integrated into the healthcare system since 2014. Currently, 22 palliative care specialists have been trained nationwide, notes Pr Belo.

However, despite Togo's international commitments, notably within the framework of the World Health Organization (WHO), palliative care is still not a national public health priority.Yet neighboring countries such as Benin and Ghana have already undertaken reforms in this area.

Many have called for a structured national palliative care policy. Esinam Mawuli Daké, President of the Association pour la prise en charge des personnes âgées vulnérables au Togo (APAV-Togo), offers recommendations to strengthen advocacy for the development of palliative care.  “The State needs to be very attentive to the issue of palliative care. Policies must integrate palliative care into public health programs. Raising public awareness is also essential to overcome taboos about death and suffering,” she adds.

Journalists also have a crucial role to play in strengthening palliative care advocacy. “Media professionals must inform the public about palliative care, demystifying preconceived ideas.They must help all stakeholders understand the importance of equitable access to palliative care to improve the quality of life of people with serious illnesses or at the end of life. They also need to work with health organizations, patient associations and medical institutions to reinforce the reach of awareness-raising messages,” says Prof. Belo.

The call for palliative care in Togo is not limited to a medical approach. It's more than just a fight, it's a moral and health emergency, because everyone may need it at some point in their lives.

William O.