• Mhoira Leng, Julia Downing, Gursaran Purewal, Liz Namukwaya, Vicky Opia, Chitra Venkateswaran, Elizabeth Nabirye, and Peace Bagasha.
• Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
• Palliat Med. 2024 Sep 1; 38 (8): 818829818-829.

BackgroundPalliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations.AimThis study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda.DesignConsecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4 years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation.Setting/ParticipantsA rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities.ResultsAt baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4 years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care.ConclusionCommunity engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community.

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