Governments have cut international aid at the same time as the need for palliative care increases, elevating the role of private donors
In her latest blog post, EMMS CEO Cathy Ratcliff writes of the growing challenge to secure funding from private donors to ensure we continue to develop, expand and improve our programmes for the sake of families in their times of greatest need.
EMMS has several specialisms, one of which is palliative care.
We follow the World Health Organization’s definition of holistic palliative care, which covers healthcare needs for people near the end of life, experiencing long-term disability, chronic illness and congenital conditions, while also addressing the physical, emotional, spiritual and social needs of patients and whole families. EMMS’ specialisation in palliative care has been strategic. We assess the need, deliver programmes, and publish evidence-based research. This work has largely been supported through large private grants, generous donations, and occasional government funding.
Two examples of this whole journey are Malawi and Nepal.
We began to specialise in palliative care in Malawi in 2009. This initial work was funded through trusts, mainly the Diana Fund and The True Colours Trust. We first enabled 2-week placements for hospital staff, then 5-day classroom training plus 2-week placements. This was followed by working with a mission hospital to start outreach clinics and train the nearby district hospital. A Malawi-wide assessment of curricula was subsequently developed.
The combined evidence built through this initial work enabled us to secure UK Government Funding through the Department for International Development (DFID) to establish services in two hospitals, supported by the Palliative Care Association of Malawi (PACAM) and Palliative Care Support Trust (PCST). This project, called METHOD, ran from 2015 to 2018.
Critically, we established a BSc in Palliative Care at the University of Malawi, which later transferred to Kamuzu University of Health Sciences. We also held conferences where Malawian students presented their research.
We gained further DFID funding for a 2018-21 project called Chifundo - Compassion -which established palliative care services in 30 hospitals throughout Malawi. All services achieved the standards of the African Palliative Care Association.
By 2021, due to our advocacy in Chifundo, the Malawian Government added palliative care to its Essential Healthcare Package, meaning that palliative care is provided free to all patients whose health facility requests this from its district health office.
Gratifyingly, in a 2025 review, we found that 21 of the 30 services that we had been involved in setting up were still operating, four years after they were first established. (These 21 were in districts experiencing drought, and we did not check the other 9 services, but expect that they too were still operating.)
In Nepal, we similarly started with private funding, including a generous grant from the McClay Foundation, with which we built a beautiful palliative care unit in Pokhara. This too led to funding from the UK Government, in this case to develop seven palliative care services all over Nepal, supported by a hub in Pokhara, western Nepal.
In Zambia and India the development of palliative care was supported through private funding only.
In Zambia, we have, since 2017, supported the postgraduate education of a senior palliative care nurse, who is currently improving her teaching of Zambia’s Palliative Care MSc.
Our approach in India was as strategic as in Malawi and Nepal. By 2017, we had developed palliative care in seven hospitals and a support hub in Delhi. By then UK and Scottish Government funding of projects in India had stopped. and with no known prospect of funding for palliative care, we stopped developing palliative care in India in 2017.
In this age of reduced government funding, we can expect that most of our work may now rely on private funding only, and for this we must hope that private donors will step up to the plate. We have established a strong reputation of delivering our strategic approach of starting small, producing evidence, putting in place the building blocks of education and training and research, adding infrastructure where necessary, and spreading services nationally to suit the national health system.
The epidemic of non-communicable disease is increasing the need for palliative care, and we will keep wanting to develop, expand and improve it with our partners, for the sake of families in their times of greatest need. Some governments may continue to fund palliative care development, but increasingly our challenge is to persuade private donors to do so too.
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