Illustrating the importance of advocacy action in Greater Monrovia, where the National Old Folks of Liberia is represented in the Coalition of Caregiving and Advocates for the Elderly, which has formed a strong partnership with the Liberian Ministry of Gender, Children and Social Protection. Photo submitted by IAHPC member Mono Allisonn Bainda; used with permission.

4 Advocacy Objectives to Increase Access for All in Need

By Katherine I. Pettus
Senior Director of Advocacy and Partnerships

This year, when doing its part to develop IAHPC's 2025-2030 Strategic Plan, the Advocacy Committee proposed three strategic objectives that were approved by the board. A fourth is now under consideration. 

The expected output is increased access to palliative care for all those who need it.

The strategic objectives (SOs) developed by the committee in July and August are:

SO#1: Catalyze action-oriented understanding among all relevant stakeholders about the critical function of effective advocacy and the multiple benefits that flow from integrating palliative care into health systems, taking a life course perspective (from conception to death).

National associations are key partners in achieving this. 

We identified the objective as important because so many palliative care associations overlook or misunderstand how advocacy catalyzes the development of population level education, research, and service provision. Although advocacy is not necessarily relevant if palliative care is limited to the private or charitable sectors, those providers cannot meet the growing demand. Only broad policies funded by the public sector can tackle this problem. For an overview of why advocacy is essential, see "Palliative Care Advocacy: Why Does It Matter?"¹ 

The committee identified the following activities, which involve the cooperation of IAHPC's Research Committee, as key to achieving this objective:

• Administer pre- and post-intervention surveys to assess changes in knowledge, attitudes, or perceptions about public sector advocacy.
• Track participation rates over time in IAHPC advocacy events.
• Report regularly on the uptake of advocacy materials distributed or accessed (e.g., courses, toolkits, guides, informational sessions).

SO#2: Support IAHPC members, partners, and key stakeholders at all levels of governance in their efforts to integrate palliative care into all health systems and health systems functions.

This objective follows from SO1: once palliative care associations and other partners recognize the importance of advocacy, we will support them to advocate for integration of palliative care services and education into all levels of health systems (primary through tertiary). We identified the following key activities as essential to evaluate integration efforts: 

• Maintain a database of specific advocacy initiatives undertaken or supported to integrate palliative care, including supporting policy documents.
• Evaluate how those initiatives, and their policy documents, measure up to the relevant WHO actionable indicators.

SO#3: Increase collaboration with key stakeholders to improve the balanced approach to—and rational use of—essential palliative care medications for legitimate medical needs.

This is a much narrower objective that builds on IAHPC’s flagship advocacy effort over the past two decades to improve the availability and rational use of essential palliative care medicines for the 85% of the world’s people who have no access. The focus of this objective are the policymakers, regulators, national palliative care associations, pharmacists, civil society partners, patient advocacy groups and others who can collaborate with us to improve safe, rational access. 

The Advocacy Committee will support the development and dissemination of information about new and revised policies, guidelines, or protocols that reflect a balanced and rational approach to the use of essential palliative care medications and promote uptake of Essential and Expanded Palliative Care Packages. Our members will continue to advocate at the Commission on Narcotic Drugs (CND), the Office of the High Commissioner for Human Rights (OHCHR), the Human Rights Council (HRC), and the World Health Organization (WHO) at all multilateral meetings and consultations as we build on our partnership with the International Narcotics Control Board (INCB). The November webinar “IAHPC, INCB & WHO Webinar: Safe and Adequate Access to Essential Palliative Care Medicines” supported this objective. We invite readers who missed this important webinar to view the recording and share it with their networks.

The IAHPC Executive Committee is currently reviewing a proposal for an IAHPC Interfaith Palliative Care Network that will carry forward the newly proposed SO4.

Without IAHPC's relentless advocacy, the 2018 Declaration of Astana on Primary Health Care would not have included palliative care. The Astana Delegation was (L-R): Dr. Sébastien Moine, Gulnara Kunirova, myself, and Dr. Santiago Corrêa. Photo submitted by Katherine Pettus; used with permission.

SO#4: Support chaplains and faith leaders to integrate palliative care into their practice and teachings aligned with the Essential and Expanded Palliative Care Packages for Adults and Children.

We proposed this objective because the “Human Resource” component of the recently published Essential Package for Adults now includes a spiritual care provider. The Essential Pediatric Palliative Care Package includes a local spiritual counselor. The Expanded Packages for both Adults and Children contain all the elements of the Essential packages, including spiritual care professionals and counselors. 

Although a substantial body of evidence and literature on the benefits of spiritual care for palliative patients of all faiths and the non-affiliated now exists, and accredited palliative care chaplaincy programs are taking root in many countries, the IAHPC has no directors on the board, and very few individual or institutional members, who identify as chaplains, spiritual care counselors, or ordained clergy. Moreover, little is known about how IAHPC individual and institutional members provide spiritual support for their patients and families, and/or receive spiritual support for themselves and their teams in their professional contexts. 

A growing field, lacking evidence

Although palliative care chaplaincy is a growing professional field in some regions, we have been able to identify only a few research studies on the level of knowledge religious leaders or local spiritual counselors of all faiths have about the benefits of palliative care. Internet searches provide no evidence of palliative care curricula in clergy education and faith leader formation. 

Anecdotal reports, however, suggest that many faith leaders lack palliative care literacy, resulting in erroneous beliefs such as the idea that such care is only for the very last stage of life, is limited to cancer patients or, worse still, is the same as euthanasia or assisted suicide. The proposed SO4 intends to investigate and tackle this deficit in faith leader "pal-literacy", and attempt to rectify unhelpful messaging that discourages patients and families of faith from accessing palliative care services. 

The program will send out a message of hope to counteract negative stereotypes and stigma, similar to interfaith campaigns carried out at the height of the HIV/AIDS epidemic (to destigmatize testing) and COVID (to endorse vaccines). 

All committees are united

The Advocacy Committee invites the support of the IAHPC Communication, Education, and Research Committees to develop: 1) benchmarks regarding IAHPC member awareness and provision of spiritual care, and 2) a basic curriculum for spiritual care counselor/religious leader education. Strategic objectives from all IAHPC committees listed above align with proposed Advocacy Committee SO4:

• Design and implement workshops and webinars to disseminate and improve knowledge and understanding of palliative care, including the appropriate use of the Essential and Expanded Palliative Care Packages for Adults and Children. (Education SO)
• Develop research methodology for all committees to monitor and evaluate the effectiveness of the IAHPC programs and initiatives. (Research SO) 
• Disseminate information about IAHPC’s resources, tools, and educational opportunities for and to the global palliative community. (Communications SO)

This pleasing symmetry entails an all-of-IAHPC effort to integrate spiritual care for palliative care practitioners, and palliative care knowledge for faith leaders in the pursuit of IAHPC’s vision of a world free from health-related suffering. 

Please feel free to contact me for more information. My January Pallinews column will report on whether the board has approved SO4 and the Interfaith Network.

References

1. Pettus K, De Lima L. Palliative Care Advocacy: Why Does It Matter? J Palliat Med 2020; 23(8): 1009-1012.

2. Puchalski C, Ferrell B, Otis-Green S, Handzo G. Overview of Spirituality in Palliative Care. UpToDate.com, 2025.

3. Thomas-Newborn RA, Foote B, Irani D, Silva M. Addressing Spiritual Needs in Outpatient Palliative Care: Lessons Learned. J Pain Symptom Manage 2025; 69(5): E497-498.