Palliative Care in Latin America: Are We Making Any Progress? Assessing Development Over Time Using Macro Indicators.

Background: Monitoring and reporting palliative care development serves to identify progress as well as remaining challenges for improvement.

Aim: To report on the updated status of palliative care development in Latin America, develop and apply a new index to measure progress, and enable cross-country comparisons.

Methods: We conducted a secondary analysis of the data collected for the first (2012) and second (2020) editions of the Atlas of Palliative Care in Latin America using indicators on Policy, Education, Access to Medicines and Service Provision. The ALCP indicators were reviewed and the ALCP Index-II was constructed adding the z-score for each indicator and used to rank the countries' development as High, Moderate or Low.

Setting/participants: Seventeen Latin American countries.

Results: The number of countries with a national palliative care plan increased from 5 (29%) to 10 (59%); Percentage of medical schools with palliative care as an independent subject at the undergraduate level grew from 4.2 to 15.4%; Distributed Opioid Morphine Equivalence increased from 6.6 to 7.1 mg/capita; and Number of services increased from 1.5 to 2.6/million. The number of palliative care services was correlated to the proportion of medical schools which included palliative care (Rs=0.3; Rs=0.31); and with morphine equivalence/capita (Rs=0.61; Rs=0.72), and with the existence of a national plan (p=0.005). With the standardization of the indicators, three groups ranked by development were identified Uruguay, Chile, Costa Rica, Argentina Panama, and Brazil ranked the highest while the other ranked in the middle or lowest groups. According to the ALCP Index-II, Uruguay registered the highest score (7.5), Honduras the lowest (-3.7). The dispersal in the values was larger than the one registered in 2012, showing more heterogeneity.

Conclusion: Significant advances in palliative care development in Latin America have been achieved. The ALCP-II Index is useful for assessing and comparing palliative care development across countries.