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Medicines
The list of medicines in the EP PHC is based on the 2015 WHO Model List of Essential Medicines for 
palliative care for adults and children and adapted for this document 
(43). Medicines were selected based 
on the following criteria, namely that
n
they are necessary to prevent or relieve the specific symptoms or types of suffering most commonly 
encountered in the community (Table 1);
n
their safe prescription or administration require a level of professional competency achievable by 
doctors, clinical officers, assistant doctors or nurses with basic training in palliative care; and
n
offer the best balance in their class of accessibility on the world market, clinical effectiveness, safety, 
ease of use and minimal cost.

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Integrating palliative care and symptom relief into primary health care
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Morphine and other opioids
Morphine, in oral fast-acting and injectable preparations, is the most clinically important of the essential 
palliative care medicines 
(44). It must be accessible in the proper form and dose by any patient with terminal 
dyspnea or with moderate or severe pain that is either acute, chronic and associated with malignancy, or 
chronic in a patient with a terminal prognosis. Opioids should not be the first-line treatment for chronic 
pain outside of cancer, palliative and end-of-life care, except under special circumstances and with strict 
monitoring 
(45). Morphine, in both injectable and oral fast-acting formulations, must be accessible by 
prescription at any hospital-based clinic. In general, at least oral fast-acting morphine should be accessible 
by prescription at CHCs. All doctors who provide primary care should be adequately trained and legally 
empowered to prescribe oral and injectable morphine for inpatients and outpatients in any dose necessary 
to provide adequate relief as determined by the patients. Doctors inexperienced in prescribing morphine 
can be trained adequately with the curriculum in basic palliative care training described in this document 
or similar curricula. Physicians should also be enabled to prescribe an adequate supply of morphine so 
that obtaining refills is feasible for patients or families without requiring unreasonably frequent, expensive 
or arduous travel. Whenever clinically possible, oral morphine rather than the injectable form should be 
prescribed. All doctors should be trained to assess and treat opioid side-effects and to avoid injudicious use 
of morphine for mild pain or chronic non-malignant pain. In at least one setting (Uganda), specially trained 
and supervised nurses are allowed to prescribe and manage morphine analgesia 
(41).