Background. - In Africa, the growing burden of non-communicable diseases is driving an increasing demand for palliative care (PC). However, development remains uneven. Francophone countries, as a group, have benefited from less international support, resulting in slower progress and entrenched structural inequities. Objectives. - To assess the current state of PC development in 22 francophone African countries and compare these findings with those of non-francophone countries, using WHO-aligned indicators. A further aim was to identify contextual strategies that have enabled progress despite shared systemic constraints. Methods. - A mixed-methods approach was adopted. Quantitative data from the Global Palliative Care Mapping Initiative (2023-2025) were analysed using the Global Development Score (GDS) and 14 indicators grouped into six structural dimensions. Comparisons were conducted using t-tests and Mann-Whitney U tests. Qualitative data, collected from national consultants, were thematically analysed to contextualise results and identify promising practices. Two country case studies are also presented. Results. - Overall, francophone countries showed lower GDS scores, indicating a lower level of PC development. Only Morocco reached the "Established"level, while five countries were "Progressing"and sixteen (73%) remained at the "Emerging"stage. Statistically significant gaps (P < 0.05) were observed in access to essential medicines (P = 0.0115), training (P = 0.0311), and specialised services (P = 0.0475). Francophone countries also had fewer indexed publications and limited access to oral morphine. Qualitative findings pointed to fragmented policies, limited national coordination, and restricted research capacity, but also highlighted local innovations, such as educational integration and context-specific strategies exemplified in the case studies of Morocco and Benin. Conclusion. - This is the first regional assessment of PC development in francophone Africa based on the WHO framework. The findings confirm persistent structural disparities rooted in historical underfunding, regulatory legacies, and epistemic marginalisation. Economic, geopolitical, and socio-anthropological factors -- including the absence of minimum dedicated funding, insufficient human resources, and historical constraints -- further hinder prioritisation. Solutions require strong political commitment and coordinated investments in legal frameworks, specialised training of health professionals, access to essential medicines, local research, and the strengthening of national associations, with support from regional and international platforms such as APCA, FISP, ACREOL and AMCC. (c) 2026 Published by Elsevier Masson SAS.

End-of-life decision making in oncology is a complex landscape, encompassing clinical, ethical, cultural, and human dimensions. It occurs at the intersection of medical possibility, ethical complexity, cultural context, and human experience. Regardless of where they reside, patients at the end of life face profound choices regarding comfort, dignity, and the meaning of hope, regardless of whether cure is no longer attainable or treatment is no longer desired. Across Africa, palliative care, in general, has expanded through community-based and integrated models, yet access, including at life's end, remains limited by resource constraints, workforce shortages, and inadequate availability of essential medicines, particularly opioids. These inequities shape what choice means in practice, often constraining patient preferences and reinforcing the need for system-level integration and culturally responsive care. By contrast, medical aid in dying in the United States reflects a growing emphasis on autonomy and control at the patient level, and it generates evolving clinical practices and ongoing ethical debate. Within the end-of-life spectrum, hope persists as a dynamic and measurable construct associated with improved quality of life and potentially survival, while remaining adaptable to changing goals in advanced illness. Nonetheless, the human dimensions of care—including psychological distress, communication, and relational continuity—are frequently underemphasized in advanced cancer and at the end of life. Addressing these gaps is essential for ensuring that patients obtain support that emphasizes meaning, agency, and dignity at the end of life.

Background:COVID-19 is a new disease with high transmission and mortality rates and can cause or exacerbate a myriad of psychological sequelae, particularly in patients with underlying serious illness. Palliative care patients' experiences have been widely studied, but research on their experiences during COVID-19 pandemic is scanty. Aim:To determine the prevalence of and factors associated with anxiety and depression among palliative care patients and explore palliative care patients' experiences during the COVID-19 pandemic. Materials and Methods:This cross-sectional mixed-methods study used the Hospital Anxiety and Depression Scale (HADS) and face-to-face audio-recorded interviews to collect data from participants between April and May, 2022. Quantitative data were analysed using STATA v.17. Chi-square test and multivariate logistic regression were performed to examine factors associated with depression and anxiety. Qualitative data were analysed using thematic analysis. Results:Of the 96 participants, 74% (n=71) were female. Patients who earned ≥100,000 Ugandan shillings (OR=0.18, p=0.026, CI 0.040-0.818) had lower odds of depression compared to patients who earned less, while patients who missed clinic appointment sometimes (OR=26.02, P=0.025, CI 1.503-450.226) and those who reported change in sleep pattern (OR=15.91, p=001, CI 3.030-83.567) had higher odds of depression. Male participants had lower odds of anxiety (OR=7.93, p=0.003, CI 2.004-31.370) while those who missed medicines very often (OR=6.79, p=0.024, CI 1.288-35.852) and those who reported change in sleep pattern (OR=10.21, p=0.000, CI 2.790-37.393) showed higher odds of anxiety. Three main themes emerged from the qualitative interviews: (1) Navigating multidimensional suffering before and during a pandemic, (2) the healthcare system as a precipitant of suffering, and (3) finding hope and meaning amidst uncertainty and suffering. Conclusion:Mental health morbidities were great in this cohort, occurring in a multifaceted manner, with disruptions to the psychological, social, financial, and physical dimensions of patients' quality of life. Palliative care continuity and mental health, psychosocial and spiritual support services should be integrated into humanitarian emergency health care package in future outbreaks.

Background Measuring the quality of dying and death is an important component of improving end-of-life (EOL) care, but measures of this outcome have not been available for use in low-resource settings (1,2). The QODD-Revised Global Version (QODD-RGV) questionnaire, a 26-item, proxy-rated measure assessing EOL care was created to address the need for EOL measures with cross-cultural validity (3). The Chichewa version of the QODD-RGV was evaluated for content validity through cognitive interviews with bereaved caregivers of cancer patients in Malawi. Methods We undertook a rigorous, stepwise forward- and back-translation process into Chichewa, including expert panel review. We recruited caregivers of patients who received care at the Kamuzu Central Hospital Oncology Clinic 4-6 months after death. Caregivers completed the QODD-RGV and participated in cognitive interviews, sharing reasoning for individual responses. Interviews were recorded, transcribed, translated into English, and independently coded by two team members followed by consensus coding. Qualitative content analysis assessed the sources of information participants relied on, the judgement strategies used to inform responses, and difficulties in responding. Results Twenty-five bereaved caregivers participated in the cognitive interview protocol. Participants most responded to items from the perspective of the patient. All participants used multiple judgment strategies to respond to questionnaire items. Items of the Chichewa version of the QODD-RGV were found by participants to be relevant and understandable. The judgement strategy used most often was comparison to “state of distress or no distress.” Response difficulty was most frequently due to “no communication with patient regarding that aspect of experience.” Caregivers emphasized the importance of communication, emotional support, and involvement in decision-making to quality of care. Conclusions These findings support the content validity of the Chichewa version of the QODD-RGV and will inform a full validation study, which has the potential to guide improvements for EOL care in low-resource settings.

Introduction: Nursing and medical schools and universities are increasingly integrating palliative and end-of-life care education in their curricula. However, research on the impacts of training and education on future nurses and physicians remains sparse. Aim of the review: The aim of this review was to systematically appraise existing research evidence on undergraduate nursing and medical students’ knowledge, perception, and orientation towards palliative and end-of-life care. Methods: This international systematic review was conducted between April and May 2021 and was updated in May 2024. A systematic search was conducted in four databases: Hinari ‘Research4Life’, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Google scholar and PubMed. Methodological quality of the included studies was assessed using the Mixed-Methods Appraisal Tool. A data extraction sheet was developed for this review. A convergent integrated approach to mixed-method data synthesis and integration was used to analyse and report the evidence. Braun and Clarke’s inductive and deductive thematic analysis approach was used to identify main themes. Results: A total of 64 peer-reviewed research articles met eligibility criteria and were included in the review. Of the 64 eligible research articles, 34 employed a descriptive quantitative cross-sectional design, 11 studies were qualitative, 14 used a quantitative non-randomised design and 5 were mixed methods. The review identified three major thematic categories: (1) students’ knowledge of palliative and end-of-life care, (2) attitude, perception and orientation towards palliative and end-of-life care and (3) predictors of knowledge, orientation, attitude and perception towards palliative and end-of-life care. Conclusion: Findings suggest inadequacy and variability in knowledge levels, self-efficacy, willingness, perception and orientation towards palliative care and end-of-life care. Surprisingly, this is common across studies, including those from high-resource countries. Inadequate, limited and/or inconsistent curricula and training content about palliative and end-of-life care is a common theme in the literature.

ObjectivesA lack of palliative care training for nurses has been identified as a barrier to patients' access to palliative care services. Although nurses account for nearly 50% of the global healthcare workforce, those in low- and middle-income countries (LMICs) often lack sufficient training and education in palliative care. This review identified and synthesised literature on palliative care education for students and practicing nurses at LMICs.MethodsA systematic review approach with narrative synthesis was employed to review studies published in English from January 2002 to October 2022, focusing on training interventions in palliative care education programmes for nurses. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided this review. The study protocol was registered in PROSPERO.ResultsThe review included 56 studies. Key topics in the palliative care education interventions focused on helping patients and their families understand disease processes, symptom management, empathetic communication, decision-making, cultural concerns, quality of life, breaking bad news, bereavement, and post-mortem care. The most common instructional materials were presentation slides. However, some programmes used e-learning resources, role-plays, high-fidelity simulation manikins, storytelling, reflection, riddles, and poems. Intervention outcomes included improved attitudes, confidence, and knowledge acquisition.ConclusionsPalliative care education interventions can effectively enhance nurses' knowledge and confidence in providing care to individuals needing such services. Findings suggest the need for further research and the implementation of practical, innovative educational approaches in various regions, particularly Africa and Eastern Europe.

BACKGROUND:The collection and aggregation of individual genomic data into large-scale repositories is now a common approach in biomedical research. Funding agencies increasingly require researchers to include data sharing plans in new project proposals, unless there are strong, clearly justified reasons. While sharing human genomic data promotes scientific discovery, innovation, and transparency, it also raises significant ethical, legal, and social concerns (ELSI). This review collated evidence on data sharing practices, context, facilitators and barriers in collaborative human genomic research in low and middle income countries (LMICs). METHODS:The systematic review was done following a priori criteria. A protocol was registered in PROSPERO (CRD42022297984) and published with PLOS ONE journal. The articles were imported into EndNote software, duplicates were removed and the remaining articles were then transferred to Epi-Reviewer software. Independent reviewers (DES, LN; GK, DES) screened the articles for inclusion and extracted data in pairs. Any disagreements between the reviewers were resolved through discussion and consensus. The JBI checklist was used for assessing quality of the included articles and studies were classified as good, fair or poor. The assessment yielded overall ratings of good which demonstrated sound methodological rigor. We did not exclude any study from our analysis. Seven distinct categories emerged from the narrative synthesis. RESULTS:A total of 2061 articles were identified from the initial search (PubMed, 594; Web of Science 340; Google scholar, 1127; and 30 from Bibliography search). The review included 11 articles and explored the context and the ELSI of sharing genomic data. The results included the practice of sharing data collaboratively, the ethical issues identified included: informed consent, data misuse and mistrust, inequity, the social dimensions included stigma and discrimination and the legal issues include data ownership and data protection. The barriers included mistrust and inequity in collaborative research and over regulation. CONCLUSION:Overall, trust and comprehensive cultural consenting process are critical during data sharing. Emphasis should be placed on striking a balance between protecting rights of research participants, the interests of researchers from LMICs and promoting scientific research. Policymakers should establish ethical and regulatory frameworks that emphasize equity and fairness in collaborative relationships.

Background:Palliative care is a key component of comprehensive humanitarian health; yet, access and service capacity remain limited in displacement settings, where fragile health systems struggle to meet the complex needs of people living with advanced illness. Digital health technologies have the potential to enhance the reach and delivery of palliative care; yet, their feasibility and acceptability in humanitarian settings remain underexplored. Objective:We evaluated the feasibility and acceptability of mPallCare, a mobile health intervention integrating patient-reported symptom and outcome monitoring with a clinician dashboard, to support palliative care delivery in the Bidibidi Refugee Settlement, Uganda. Methods:A 6-week, uncontrolled, exploratory concurrent mixed methods feasibility study was conducted, involving 32 participants with advanced cancer. Community health workers (ie, village health teams) used the mobile app to document patient-reported symptoms and multidimensional outcomes, which were accessible to clinical teams via a dashboard. Following the use of mPallCare, patient and clinical team participants participated in face-to-face interviews. Data collected via mPallCare were analyzed using descriptive statistics to assess feasibility (ie, compliance with reporting, with a feasibility threshold of ≥65% of scheduled reports), and interview data from a subsample of patient and clinical team participants were analyzed using framework analysis to assess acceptability. Results:Participants completed 84.9% (163/192) of symptom reports and 59.4% (266/448) of outcome reports, with a combined 67% (429/640) of all scheduled reports completed. A modest decline in engagement with report submissions occurred across the 6-week study period. Commonly reported symptoms included headache (27/32, 84.4%), muscle pain (27/32, 84.4%), and dizziness (26/32, 81.3%). Interview findings indicated strong acceptability among patients and clinicians, who described improved communication, enhanced symptom management, and greater continuity of care. Reported challenges included initial navigation difficulties, limited translation accuracy, and technical synchronization issues. Participants and clinical leaders identified the potential for integrating mPallCare within Uganda's district health information system to strengthen data use and visibility of palliative care within health reporting structures. Conclusions:mPallCare is a feasible and acceptable digital health intervention for palliative care in a humanitarian setting. While initial uptake was high, sustaining engagement over time may require simplified reporting processes, enhanced language accessibility, and optimizing the mobile app's connectivity and usability. This feasibility phase highlights key priorities for scale-up, including integration with existing health information systems and adaptation for sustained, equitable use across low-resource and displaced populations.

Background: Engaging children in research processes is recognised as best practice, as it ensures studies are relevant and responsive to their needs. Limited evidence exists on effective approaches for engaging children with serious illnesses, particularly in palliative care and in resource-limited settings. This study aimed to work with children and young people with serious physical illness to co-design processes and practices for meaningful engagement and involvement in palliative care research within resource-limited settings. Methods: A co-design workshop approach was used to develop best practices for engaging and involving children in research. Twenty participants living with serious illnesses were purposively recruited from three heterogeneous tertiary care services in Uganda. Guided by the NIHR framework of public engagement and involvement, workshops were facilitated by members of a multi-disciplinary team, parents, and caregivers. The resulting practices were piloted in our research with the advisory involvement of the young people. Results: The process established 9 principles for engaging and involving children in palliative care research were co-designed. Examples include: Involve children early to ensure that objectives, questions and outputs are relevant to their needs and concerns; Creative and flexible co-design of workshop and meeting agendas makes sessions enjoyable, thus increasing attendance; Involvement of children in the design of research study materials ensures that they are child-centred and easily understood; Sharing decision-making power with children to strengthen efficiency, coordination, communication, and group management. Conclusions: This study presents approaches to engaging children in research and highlights some of the benefits of doing so. Working collaboratively, strategies were co-designed for engaging and involving children with serious illnesses across the research life cycle. The process produces child-centred research practices, outputs, and dissemination strategies, and provides practical models for workshop agendas and guidance on managing child advisory groups. These findings can inform future research, practice, and policy to ensure children are meaningfully represented in palliative care research and promote more inclusive and responsive research practices.

Children face multiple challenges in accessing controlled medicines-defined here as any pharmaceutical product whose active principles are listed under the international drug Conventions-particularly in low-income and middle-income countries. Although many barriers to accessing controlled medicines for children are known, there is a need for comprehensive, policy-driven, and system-level responses to address this global inequity. With a paucity of research on effective policy strategies for improving access to paediatric controlled medicines, transferrable policy lessons and expert guidance are crucial for informing such responses. This Health Policy purposively reviews relevant policy guidance and resources and highlights policy lessons from three low-income and middle-income countries (Uganda, India, and Costa Rica). Guided by key literature and the multidisciplinary expertise of the authors, it proposes research and intervention priorities and formulates a functional framework that outlines actionable levers for improving appropriate access to controlled medicines for children.

Background: Improving advanced illness care is a health-system priority across Africa. Existing assessments evaluate structural indicators of palliative care capacity rather than the quality of care experienced by patients and families. We developed Quality of Care for Patients with Advanced Illness (QCPAI)-Africa, the first preference-weighted patient-reported experience measure for advanced illness care in African settings, and applied it across four countries. Methods: 1,225 bereaved informal caregivers from Kenya, Nigeria, South Africa, and Uganda completed an online survey with the 17-item QCPAI measure and a discrete choice experiment to generate preference weights. Latent class logit models estimated preferences and determined whether a common Africa-wide scoring algorithm was appropriate. Preference-weighted QCPAI-Africa scores (1 to 5 stars) were calculated and compared across countries using linear and ordered logit regressions. Findings: Affordability, waiting times, and place of death were among the poorest-rated aspects of care, whereas caregivers placed greatest importance on clinically appropriate care, alignment with patient goals, and management of physical symptoms. A single Africa-wide scoring algorithm was supported given that 80.6% of respondents comprised a common preference class and less than 3.2% belonged to any country-specific class. Mean QCPAI-Africa scores were 4.26 in Kenya, 4.26 in Nigeria, 4.05 in South Africa, and 3.83 in Uganda. After adjustment for patient and caregiver characteristics, scores did not differ significantly between Kenya and Nigeria but were 0.16 points lower in South Africa (95% CI −0.28 to −0.04) and 0.26 points lower in Uganda (−0.38 to −0.15) than in Kenya. Compared with patients of middle socioeconomic status, scores were 0.29 points higher among those who were somewhat or very wealthy (0.19 to 0.39) and 0.20 points lower among those who were poor or very poor (−0.33 to −0.07). Lack of health insurance was associated with scores 0.13 points lower (−0.21 to −0.04), and rural or small-town residence with scores 0.12 points lower (−0.21 to −0.03). Socioeconomic disparities were evident across all 17 care domains. Interpretation: Country differences in caregiver-reported care quality did not mirror established assessments of palliative care capacity, suggesting that stronger health-system structures do not necessarily translate into better experiences. Socioeconomic, insurance, and geographic disparities extended across multiple care domains, highlighting inequities beyond financial access alone. QCPAI-Africa can complement structural indicators and help identify priorities for quality improvement.

Background Children and their families attending palliative care have not been able to benefit from the use of person-centred outcome measures due to the lack of a valid tool. A key step in tool development and validation is cognitive interviewing, especially for children, for whom appropriate language and format is critical. Aim To adapt the African Children’s Palliative Care Outcome Scale (African C-POS) and establish its comprehensibility, comprehensiveness, relevance, and acceptability. Design: Stage 1: Co-design workshops to refine the C-POS. Stage 2: 3 rounds of cognitive interviews were conducted using 'think aloud' and verbal probing techniques. Setting/participants: Health care providers, academics and commissioners, Children 7–19 years old with life-limiting conditions and parents/carers of children 0->19 years with a life limiting condition, were recruited from three tertiary care centres in Uganda. Results Stage 1: Drawing on existing evidence of priority needs, a stakeholder workshop developed seven versions from the original African C-POS. We added three items to address conceptual gaps on spiritual and psychosocial concerns and to address developmental and cognitive age differences of the children. Response scales were revised to 3 levels for children aged 5–7 years, and 5 levels for other age groups. Stage 2: Cognitive testing, 27 children, 19 proxy family/caregivers and 14 proxy health professionals across the 7 C-POS versions participated in 3 interview rounds. Content, recall times, and length were acceptable. Conclusion Co-design and cognitive interviewing enhanced the face and content validity of the African C-POS. The current versions address the developmental/cognitive age, symptoms, and concerns of children living with life-limiting conditions.

BACKGROUND:Little is known about how Mozambicans feel about end-of-life preferences, especially their preferences for truth-telling in serious illness. AIM:To understand the end-of-life preferences and priorities of Mozambicans in Maputo City Province and their preferences for truth-telling in serious illness. DESIGN:A face-to-face community-based street survey was performed with Mozambican nationals, aged ≥18, and fluent in Portuguese. METHODS:Using convenience sampling, structured interviews investigated preferences in a hypothetical scenario of serious illness such as cancer. Descriptive analysis examined variations. General data were collected about illness understanding/steps in treatment, experiences/preferences with death, preferences in decision making, and end-of-life priorities. SETTING/PARTICIPANTS:The sample (n = 397) was stratified by province, age, and gender. Participants were from five districts of Maputo City Province. RESULTS:The primary analysis was truth-telling. Binary logistic regression analyses were performed to explore the influence of age, gender, education, religion, and ethnicity on preferences for truth-telling. There was a statistically significant association with higher education and all variables examined: assessing the association between education/religion and the preference for truth-telling over all other responses (OR = 3.6, p = 0.002), as well as, education/religion and the preference of truth-telling to the individual, versus family (OR = 3.627, p = 0.020), and the association between education/ethnicity and the preference of telling-telling to the individual, not family (OR = 3.832, p = 0.015). Catholics were more likely to desire truth-telling to the individual versus family (OR = 2.975, p = 0.042). CONCLUSIONS:Those with higher education and Christian religion were more likely to desire doctors to tell the truth about diagnosis.

Gender-based violence (GBV) is an increasingly prevalent problem that can take many forms, have different levels of severity, and different ways of perpetuation. Palliative care providers' holistic focus assists in improving the quality of life of patients by identifying and responding to various factors that cause suffering in their patients, which provides a unique perspective on identifying GBV. In Uganda, there is a high rate of GBV due to cultural norms, gender inequities, and gender roles. This qualitative case study explored perspectives on GBV through the lens of palliative care providers in Uganda. During 2023, five focus group discussions were conducted across Uganda among different palliative care providers. Thematic analysis was used to identify six themes from the data: Perceptions of What Constitutes GBV, Training Experiences & Recommendations, Identification of GBV, Factors Influencing GBV, Intersectionality of GBV and Palliative Care, and Impact on Family. This study displays the need for developing targeted training, improving collaborative efforts, and creating culturally tailored and appropriate interventions to address GBV through the lens of palliative care providers.

Background: About a decade after the introduction of palliative care teaching for undergraduate nurses and medical students in Uganda, it is unclear to what extent the course impacts students' understanding, perceptions and orientation to deliver palliative and end-of-life care.Objectives: To (1) explore final-year nursing and medical students' knowledge and perceptions of palliative and end-of-life care, (2) examine students' orientation and perceived self-efficacy to provide palliative and end-of-life-care.Design: A multicentre exploratory qualitative study.Methods: A total of 82 undergraduate nursing and medical students were selected from seven medical and nursing schools in Uganda. Data were collected through 10 face-to-face focus group discussions using a pilot-tested interview guide and analysed using inductive thematic analysis.Results: Five master themes emerged: (1) Palliative care as a concept with multiple meanings, (2) Misinformation about palliative care, opiates and pain management, (3) Students' experiences of the course, (4) Dilemmas in knowledge and action, and (5) Palliative and end-of-life care as emotional labour.Conclusion: Participants generally had inadequate and varied understanding of, and very few demonstrated low willingness and limited confidence to provide, palliative and end-of-life care. They blamed this mainly on the huge emotional labour of palliative/end-of-life care and inadequate teaching and/or limited clinical exposure.

Contexte En Afrique, le fardeau croissant des maladies non transmissibles entraîne une demande accrue de soins palliatifs (SP). Leur développement reste toutefois inégal. Les pays francophones, dans leur ensemble, ont bénéficié d’un soutien international moindre, entraînant un progrès plus lent et des inégalités structurelles. Objectifs Évaluer l’état actuel du développement des SP dans 22 pays francophones d’Afrique et comparer ces résultats à ceux des pays non francophones, selon des indicateurs alignés sur l’OMS. Identifier également des stratégies contextuelles ayant permis des progrès malgré des contraintes systémiques partagées. Méthodes Une approche mixte a été utilisée. Les données quantitatives de l’Initiative Globale de Cartographie des SP (2023–2025) ont été analysées via le « Global Development Score »(GDS) et 14 indicateurs regroupés en six dimensions structurelles. Des comparaisons ont été menées par tests t et U de Mann-Whitney. Les données qualitatives, issues de consultants nationaux, ont été analysées thématiquement afin de contextualiser les résultats et d’identifier des pratiques prometteuses. Deux études de cas pays sont également présentées. Résultats Globalement, les pays francophones affichaient des scores GDS plus faibles, indiquant un niveau de développement des SP inférieur. Seul le Maroc atteignait le niveau « Établi », tandis que cinq pays étaient « En progrès » et seize (73 %) restaient « Émergent ». Des écarts significatifs (p<0,05) concernaient l’accès aux médicaments essentiels (p=0,0115), la formation (p=0,0311) et les services spécialisés (p=0,0475). Les pays francophones comptaient également moins de publications indexées et révélaient un accès limité à la morphine orale. Les résultats qualitatifs évoquaient des politiques fragmentées, une coordination nationale limitée et des capacités de recherche restreintes, mais signalaient des innovations locales, telles que l’intégration éducative et les stratégies contextuelles mises en évidence dans les études de cas du Maroc et du Bénin. Conclusion Première évaluation régionale du développement des SP en Afrique francophone selon le cadre OMS. Les résultats confirment des disparités structurelles persistantes liées à un sous-financement historique, aux héritages réglementaires et à la marginalisation épistémique. Des facteurs économiques, géopolitiques et socio-anthropologiques — dont l’absence d’un financement minimum dédié, la faiblesse des ressources humaines allouées et certaines contraintes historiques — freinent également leur priorisation. Les solutions nécessitent un engagement politique fort et des investissements coordonnés dans les cadres juridiques, la formation spécifique du personnel de santé, l’accès aux médicaments essentiels, la recherche locale et le renforcement des associations nationales, avec l’appui de plateformes régionales et internationales telles qu’APCA, FISP, ACREOL et AMCC.