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part of the planning and implementation of PHC in their communities 
(70). This empowerment or capacity-
building can be initiated by exploring community health care needs and describing community-based 
primary and palliative care at a community meeting 
(71).

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Integrating palliative care and symptom relief into primary health care
34
Training
Management of pain and other common distressing symptoms, prognostication and communication skills 
have been identified as basic tasks in palliative care 
(30). The European Association for Palliative Care 
(EAPC) undergraduate curriculum identifies the basics of palliative care; pain and symptom management; 
psychosocial and spiritual aspects; ethical and legal issues; and communication and teamwork and self-
reflection as basic areas in which competence is necessary 
(72). In addition, it has been suggested that the 
palliative care team at the grassroot level ideally should have basic organizational and coordination skills 
(73).
The capacity to prevent and relieve suffering and to improve the quality of life of people with serious or 
life-threatening illnesses depends on the number, knowledge, skill and commitment of the professional 
and non-professional caregivers 
(3). People who can be involved in palliative care at the PHC level include: 
n
doctors/assistant doctors/clinical officers/nurse practitioners
n
nurses
n
social workers/psychologists/trained lay counsellors
n
pharmacists
n
CHWs and volunteers
n
family caregivers.
Core palliative care competencies for PHC providers include 
(74):
n
identifying early any suffering due to serious or life-threatening illness or injury;
n
assessing palliative needs; 
n
preventing and relieving of the most common and distressing symptoms associated with serious or 
life-threatening illness or injury, which have been identified as 
(1):
o pain
o dyspnea
o fatigue/weakness
o nausea and/or vomiting
o diarrhoea
o constipation
o dry mouth
o pruritus
o bleeding
o wounds
o anxiety/worry
o depressed mood
o confusion/delirium
o dementia
n
knowing when to refer a patient to a higher level of care; and
n
providing emotional support and future care planning for patients and families that is sensitive to 
each patient’s and family’s culture, values and prior experiences with death. 

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35
A WHO guide for planners, implementers and managers
WHO suggests training requirements for PHC staff members who provide palliative care as follows 
(3).
Doctors, clinical officers, assistant doctors, nurse practitioners, feldshers:
n
minimum: basic course (30–40 hours)
n
ideal: intermediate-level course (60–80 hours).
Nurses:
n
minimum: basic course (30–40 hours)
n
ideal: intermediate-level course (60–80 hours).
Implementers or leaders of community-based or mobile palliative care teams (doctors or nurses):
n
5–6-week course focused on developing palliative care services:
o Example: the Palliative Care Initiators’ Course offered by Hospice Africa Uganda http://uganda.
hospiceafrica.or.ug/index.php/int-l-programmes/initiator-courses
See Annex 5 for sample curricula for doctors, nurses and CHWs.
CHWs and volunteers:
n
minimum: 3–6 hours (for established, supervised CHWs):
o Example: a workbook for training CHWs, volunteers and family carers from the Institute 
of Palliative Care in Kerala, India, a WHO Collaborating Centre (75) http://www.
instituteofpalliativemedicine.org/downloads/Palliative%20Care%20Workbook%20for%20
Carers.pdf; topics include: