Palliative Care in South Africa

Understanding Care That Puts Quality of Life First

When people hear the words palliative care, many immediately think of hospice or end-of-life care. But palliative care is much broader than that. It’s about improving the quality of life in serious illness for people of all ages – from the time of diagnosis, not just the final days.

The World Health Organization (WHO) defines palliative care as:

“An approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness, through the prevention and relief of suffering, the early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” (WHO, 2002)

In simple terms: palliative care helps people live as fully and comfortably as possible, while also supporting their families.

Principles of Palliative Care

According to the WHO, palliative care is built on a set of principles that go beyond medicine alone. These include:

• Relieving pain and distressing symptoms.

• Affirming life while seeing dying as natural. Palliative care doesn’t try to hasten or delay death.

• Caring for the whole person. Emotional, social, and spiritual needs matter just as much as physical ones.

• Supporting families as well as patients.

• Working in teams. Doctors, nurses, social workers, and counsellors often collaborate.

• Starting early. Palliative care is not only for the last days—it can be given alongside treatments such as chemotherapy or dialysis.

As Dr. Robert Twycross, a pioneer in the field, has said: quality of life relates to a person’s own sense of satisfaction with life. For one person that may mean pain relief; for another, spending time with family.

Palliative vs Hospice Care

One common question is about the difference between palliative vs hospice care. The two overlap, but they are not the same:

• Palliative care can begin as soon as someone is diagnosed with a life-threatening or life-limiting illness. It runs alongside other treatments aimed at curing or slowing the illness.

• Hospice care usually refers to palliative care given in the last months of life, when active treatment is no longer possible or desired.

Understanding this difference is important: palliative care is not “giving up.” It is active, supportive care aimed at living as well as possible, for as long as possible.

Palliative Care for Children

The WHO also emphasizes that children need palliative care:

“Palliative care for children is the active total care of the child’s body, mind and spirit, and also involves giving support to the family. It begins when illness is diagnosed and continues regardless of whether a child receives treatment directed at the disease.” (WHO, 1998a)

Because death is not seen as “normal” in childhood, families often need more psychosocial and bereavement support. Care teams may include teachers, play therapists, or counsellors for siblings. The goal remains the same: quality of life in serious illness for both the child and their family.

Why Early Integration Matters

For many years, palliative care was offered only when doctors felt nothing more could be done. Patients often felt abandoned, and doctors experienced guilt. Today, the approach is different:

• Integrated palliative care works alongside medical treatments from early on.

• Research shows it reduces depression, improves family outcomes, and in some cases even increases life expectancy (Temel, 2010; Greer, 2013).

This shift recognizes that relieving suffering is as important as treating disease.

Palliative Care in South Africa: A Growing Field

In South Africa, palliative care was traditionally provided by hospices. This led many to assume it was only for end-of-life care. But palliative care is much wider—it starts at diagnosis and continues through the course of illness.

The World Health Assembly confirmed in 2014 that:

“Palliative care is an ethical responsibility of health systems, and that it is the ethical duty of health care professionals to alleviate pain and suffering, whether physical, psychosocial or spiritual.” (WHA Resolution 67.19)

South Africa co-sponsored this resolution and has committed to integrating palliative care into its health system. The National Policy Framework and Strategy for Palliative Care (2017) sets out goals to strengthen services, train more professionals, and ensure that palliative care is available not only in hospitals and hospices but also in homes, clinics, and community settings.

Today, most people receiving palliative care in South Africa are cared for at home, but it can also be provided in:

• Hospitals

• Clinics

• Children’s homes

• Frail care facilities

• Hospice inpatient units

• Even prisons (if release home isn’t possible)

This flexibility ensures that care happens where the patient and family are most comfortable.

Why Palliative Care Matters

At its core, palliative care is about dignity and compassion. It ensures that no one has to face illness in unnecessary pain, fear, or isolation. It empowers families to cope, and it allows patients to focus on what matters most to them.

The WHO reminds us that palliative care:

“Will enhance the quality of life, and will also positively influence the course of illness.” (WHO, 2002)

That is why Palliative Care in South Africa is not just a service, but a movement—one that ensures comfort, meaning, and humanity remain at the centre of healthcare.

Key Takeaways

• Palliative care is about quality of life in serious illness, not just end-of-life care.

• Palliative vs hospice care: palliative can begin early, hospice is usually near the end.

• Families are central. Palliative care supports both patients and loved ones.

• South Africa is committed. Through national policies and global agreements, palliative care is being integrated into the health system.

Palliative care is about living fully—whether for weeks, months, or years. It helps patients and families find comfort, strength, and even peace in the midst of serious illness.