Operationalising palliative care integration: Experiences of implementers in South Africa

African Journal of Primary Health Care & Family Medicine

 
 
Field Value
 
Title Operationalising palliative care integration: Experiences of implementers in South Africa
 
Creator Arendse, Juanita O. Zweigenthal, Virginia Gwyther, Liz
 
Subject palliative care; public health; health systems palliative care integration; implementation research; multidisciplinary team; community health workers; qualitative research; street-level bureaucrats; operational managers
Description Background: South Africa’s 2017 National Policy Framework and Strategy for Palliative Care mandated the integration of palliative care (PC) into the public health system using existing resources.Aim: To explore PC implementers’ (1) experiences at least 1 year after implementation; (2) implementers’ capability in providing PC; (3) approaches to PC integration at selected sites and (4) perceived enablers and obstacles requiring managerial support.Setting: Healthcare facilities in the Cape Metro District (CMD) of South Africa.Methods: A qualitative, exploratory design was employed in five primary healthcare facilities classified as higher- or lower-morphine-usage sites based on dispensing trends. Purposive sampling identified 29 stakeholders: 22 implementers (clinical and support staff) and seven operations managers. Data were collected in four virtual focus group discussions and one in-depth interview with implementers and one in-depth interview with managers.Results: Three main themes emerged: (1) Provider capability: implementers reported variable confidence in clinical skills and in providing psychosocial support; (2) health systems response: participants cited insufficient staffing and time, limited training opportunities and inconsistent multidisciplinary team functionality and (3) provision of patient-centred PC: stakeholders emphasised the need for clear referral pathways, interprofessional communication and supportive leadership to ensure continuity of care.Conclusion: Palliative care implementers’ engagement in policy design and resource allocation is essential for sustainable implementation. Strengthening multidisciplinary teamwork, embedding PC content in undergraduate curricula and providing ongoing managerial support will enhance equitable access to quality palliative services.Contribution: Understanding how frontline stakeholders operationalise PC integration is essential for refining policy and practice in low-resource settings.
 
Publisher AOSIS
 
Contributor NIH award U54CA284030
Date 2026-03-30
 
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Qualitative; focus groups; interviews
Format text/html application/epub+zip text/xml application/pdf application/pdf application/pdf
Identifier 10.4102/phcfm.v18i1.5221
 
Source African Journal of Primary Health Care & Family Medicine; Vol 18, No 1 (2026); 12 pages 2071-2936 2071-2928
 
Language eng
 
Relation
The following web links (URLs) may trigger a file download or direct you to an alternative webpage to gain access to a publication file format of the published article:

https://phcfm.org/index.php/phcfm/article/view/5221/9174 https://phcfm.org/index.php/phcfm/article/view/5221/9175 https://phcfm.org/index.php/phcfm/article/view/5221/9176 https://phcfm.org/index.php/phcfm/article/view/5221/9178 https://phcfm.org/index.php/phcfm/article/view/5221/9179 https://phcfm.org/index.php/phcfm/article/view/5221/9177
 
Coverage Africa; South Africa; Cape Town Metro — —
Rights Copyright (c) 2026 Juanita O. Arendse, Virginia Zweigenthal, Liz Gwyther https://creativecommons.org/licenses/by/4.0
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