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Equipment
Equipment in the EP PHC meets the following criteria. It is
n
necessary for the relief of at least one type of physical or psychological suffering
n
inexpensive
n
simple to use with basic training
n
small enough to store easily. 
The equipment includes nasogastric tubes (for vomiting refractory to medicines and for administration of 
medicines or fluids), urinary catheters (to manage bladder dysfunction or outlet obstruction), foam, water 
or air pressure-reducing mattresses (to prevent and relieve pressure ulcers and pain), locked safeboxes 
for opioids (to be secured to a wall or immovable object), flashlights with rechargeable batteries (when 
inadequate light source is available for nocturnal home care) and adult diapers or cotton and plastic bags 
to make adult diapers (to reduce risk of skin ulceration and infection and caregiver risk and burden). 
In countries where plastic bags are prohibited as part of laudable environmental protection initiatives, 
specialized medical use should be permitted. The EP PHC does not include materials needed for palliative 
care that should be standard equipment for any CHC or hospital such as gauze and tape for dressing 
wounds, nonsterile examination gloves, syringes and angiocatheters.
Human resources and training
The necessary human resources depend primarily on the level and type of the health care delivery site and 
on the competency in palliative care of staff members rather than their professional designations. Any 
medical doctor, clinical officer or assistant doctor trained in basic palliative care using a curriculum such as 
that included in this document should be capable of preventing or relieving most pain and other physical 
suffering (Annex 5). They should be able to competently prescribe opioids such as morphine to treat pain 
for inpatients and outpatients. They also should be able to diagnose and provide pharmacotherapy as 
needed for uncomplicated anxiety disorders, depression or delirium. Not only doctors, nurses, psychologists 
and social workers, but also CHWs can be trained to provide simple, culturally appropriate psychotherapy 
for depression 
(47–50).
Occasionally, clinicians may encounter physical or psychological suffering for which they feel incapable 
of providing adequate treatment. Examples may include pain refractory to escalating morphine doses, 
depression refractory to maximum dose SSRI, or psychotic disorders. In these situations, the patient should 
be referred to a higher level for specialist care. If referral for appropriate specialist care is not possible, then 
a clinician with palliative care training should use whatever resources are available, including telemedicine, 
to provide the best possible care under the circumstances rather than refuse to treat. 
CHWs can have a crucial role in palliative care and symptom control by visiting patients frequently at home. 
With as little as three to six hours of training, CHWs not only can provide important emotional support, 
but also recognize uncontrolled symptoms, identify unfulfilled basic needs for food, shelter or clothing or 

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Integrating palliative care and symptom relief into primary health care
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improper use of medications, and report their findings to a nurse-supervisor at a CHC. In this way, they can 
accompany patients in need of palliative care and help to assure their comfort by serving as the eyes and 
ears of their clinicians. Based on reports from CHWs, it may be possible to arrange an appropriate response 
to an uncontrolled symptom, such as a change in prescription or a home visit by a nurse, that does not 
require the patient to leave home. Visits by CHWs also can help to reduce the often heavy emotional, 
physical and financial burden of family caregivers. Capable family caregivers should be trained, equipped 
and encouraged by clinicians to provide basic nursing care such as wound and mouth care and medicine 
administration. But care should be taken to assess for unmet social needs of family caregivers who typically 
are women and who often also have work and child-care responsibilities, frequently live in poverty.
Clinicians caring for people with serious, complex or life-limiting health problems should ask if they desire 
spiritual counselling. Every effort should be made to facilitate access to spiritual counselling by local 
volunteers that is appropriate to the beliefs and needs of the patient and family.