{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T22:40:10Z","timestamp":1790721610611,"version":"4.1.0"},"reference-count":25,"publisher":"AOSIS","license":[{"start":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T00:00:00Z","timestamp":1769472000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Providing palliative care (PC) is an ethical obligation, and health systems must ensure access for all patients with life-limiting and life-threatening conditions. South Africa\u2019s National Policy Framework and Strategy for Palliative Care mandates integration into public services.\nAim:\u00a0To assess integration of PC services, previously neglected, before and 2 years after policy implementation.\nSetting:\u00a0South Africa\u2019s Cape Metro District.\nMethods:\u00a0A cross-sectional descriptive study compared baseline (March 2019\u2013June 2019) and follow-up (March 2021\u2013June 2021) via desktop and document review. Fifteen documents and quantitative changes in deidentified morphine use, as a tracer for outpatient PC pain control, and International Classification of Diseases (ICD)-10 coding, as a proxy for PC service availability, were reviewed. Other key measures included financing (number of beds, funding per bed), planning and service delivery (care pathways, referral process).\nResults:\u00a0Palliative care was partially integrated into primary care. Indicators of policy adoption included an increased number of PC beds in intermediate care facilities, significant growth in healthcare professionals trained in PC and increased morphine usage in some sub-districts. However, integration remained uneven across the district.\nConclusion:\u00a0Integrating PC into an already overburdened health system is challenging. Further integration of PC is needed, together with training tailored for diverse professionals. Effective practices in some subdistricts of the region, such as optimised morphine prescribing and streamlined referral pathways, could serve as models for subdistricts where integration is less advanced.\nContribution:\u00a0The study documents positive changes following policy implementation and underscores the importance of strong project management and resource mobilisation for successful integration of complex services like PC.<\/jats:p>","DOI":"10.4102\/hsag.v31i0.3242","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T09:15:18Z","timestamp":1769418918000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Integration of palliative care into South Africa\u2019s health system: A before and after implementation study"],"prefix":"10.4102","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-2114-4168","authenticated-orcid":false,"given":"Juanita","family":"Arendse","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3914-2156","authenticated-orcid":false,"given":"Virginia","family":"Zweigenthal","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7602-6168","authenticated-orcid":false,"given":"Liz","family":"Gwyther","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03p74gp79","id-type":"ROR","asserted-by":"publisher"}],"name":"University of Cape Town"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"ref0","unstructured":"Arendse, J., 2023, \u2018An assessment of the integration of palliative care in the health system of the Cape Metro District of South Africa\u2019, Doctoral dissertation, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town."},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Atun, R., De Jongh, T., Secci, F., Ohiri, K. & Adeyi, O., 2010, \u2018Integration of targeted health interventions into health systems: A conceptual framework for analysis\u2019, Health Policy and Planning 25(2), 104\u2013111. https:\/\/doi.org\/10.1093\/heapol\/czp055","DOI":"10.1093\/heapol\/czp055"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Bowen, G.A., 2009, \u2018Document analysis as a qualitative research method\u2019, Qualitative Research Journal 9(2), 27\u201340. 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