Operationalising palliative care integration: Experiences of implementers in South Africa

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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.

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