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Specialist palliative care
Palliative care specialist physicians are needed in every country to be palliative care teachers, implementers, 
advisers, supervisors and consultants and to provide specialist palliative care for patients with the most 
complex or refractory symptoms at third-level referral hospitals. But specialist palliative care is not necessary 
to address the palliative care needs of most patients and families 
(7,27). The great majority of palliative 
care needs can be met by general practitioners, family physicians or non-physician health care workers in 
the community with basic training in palliative care or by hospital-based physician specialists in fields such 
as oncology or critical care who frequently care for patients with serious or life-threatening illnesses and 
who have intermediate-level training in palliative care as per WHO recommendations 
(2). Even in HICs, 
palliative care specialists do not provide most palliative care
(11,33).
Task shifting within PHC
General practitioners and family physicians may be the most common leaders, teachers and practitioners of 
PHC, especially in HICs. But professional designation is less important than competencies; task sharing and 
task shifting have been shown to be safe and effective ways to improve access to some PHC services. These 
services include treatment of hypertension diabetes mellitus, asthma, epilepsy, anxiety and depression, 
and screening for oral and cervical cancer 
(36–39). They can also include opioid therapy for moderate or 
severe pain due to advanced cancer or AIDS by specially trained nurses 
(40). Thus, appropriately trained and 
supervised non-physician health workers, including CHWs, can have important roles in PHC 
(41). 
Integrated PHC and palliative care are necessary to achieve UHC
United Nations Sustainable Development Goal 3.8 is to achieve UHC. UHC includes financial risk protection, 
access to quality essential health care services and access to safe, effective, quality and affordable essential 
medicines and vaccines for all 
(42). UHC is not achievable without universal access to PHC to provide 
essential illness prevention and treatment in the community and without universal access to community-
based palliative care to provide pain and symptom control, psychosocial support and home care for patients 
facing serious or life-threatening illness and financial risk protection for their families 
(1). In most settings, 
universal access to community-based palliative care requires that it be integrated into PHC 
(7).

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A WHO guide for planners, implementers and managers

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