Partnership to ensure the sustainability of a public health palliative care project in Bangladesh through community theater: A follow on project

这项提议的目的是为了贯彻MRC-AHRC(GCRF)资助的题为“通过社区剧院确保孟加拉国公共卫生姑息关怀项目可持续性的伙伴关系”的项目，并将现有的项目活动带给新的受众。姑息治疗本质上是对临终病人的护理。虽然最近人们承认获得姑息治疗是一项人权，但提供姑息治疗也被认为是一项全球健康挑战。几乎80%可以从姑息治疗中受益的成年人目前生活在低收入和中等收入国家，无法获得大多数发达国家预期的姑息治疗服务水平。在这种全球范围内姑息治疗的框架和实施方式存在差异的背景下，作者认为，寻求一个提供全民健康覆盖的全球卫生系统应该将姑息治疗作为一个基本目标。因此，公共卫生姑息治疗--对绝症患者的护理应该回归社区的想法--获得了全球的关注。目前的世界姑息治疗发展地图显示，孟加拉国正处于“3a阶段”，这意味着孤立的姑息治疗服务和培训服务的存在。最近的一项情况分析显示，尽管孟加拉国在任何时候都有大约60万名无法治愈的患者，但该国只有几个姑息治疗项目，在2013年为不到1500名患者提供服务。受其他社区驱动的公共卫生姑息治疗方法的启发，BSM医科大学(BSMMU)姑息治疗中心于2015年启动了一个试点项目，通过使用社区姑息治疗助理在达卡的城市贫民窟提供姑息治疗。对该项目的评价认为，社区参与不足是对贫民窟项目可持续性的重大威胁。在这方面，先前的项目旨在发展一种创新的跨学科伙伴关系，通过制定一项文化上适当和科学上合理的战略，通过“社区剧院”加强公众参与，从而为孟加拉国城市贫民窟姑息关怀项目的可持续性提供支持。孟加拉国最大的非政府组织BRAC的社区剧院单位目前正在城市贫民窟组织戏剧表演。最近，BSM医科大学获得了世界临终关怀和姑息关怀协会的赠款，将以社区为基础的姑息关怀活动从城市贫民窟扩展到孟加拉国的周边城市和农村地区。因此，他们在首都达卡附近的城乡周边地区启动了一个新项目。这为公众参与带来了新的机会，这在较早的项目申请阶段是无法预见的，因为没有迹象表明世界防止虐待儿童会提供这种支持。借鉴城市贫民窟社区临终关怀的经验，项目组认为，BSM医科大学从项目开始就让社区参与到他们刚刚开始的新的城乡社区临终关怀项目中是至关重要的。通过从新项目开始就将社区剧院纳入城乡周边环境，可以确保社区参与的层面，并可以避免城市项目的错误。孟加拉国城市剧院项目的发展经验可用于为新的用户群体制定一个项目。后续赠款将加强与现有AHRC-MRC项目的接触和影响。后续赠款将允许通过表演艺术修订资源匮乏环境中公共卫生缓和护理的社区参与战略，使之更加全面，包括孟加拉国农村、城市周边和城市社区的经验。

The aim of this proposal is to follow on the MRC-AHRC(GCRF) funded project titled 'Partnership to ensure the sustainability of a public health palliative care project in Bangladesh through community theatre' and take the existing project activities to a new audience. Palliative care is essentially care for the dying. While access to palliative care has recently been acknowledged as a human right, providing palliative care has also been recognized as a global health challenge. Almost eighty percent of adults who could benefit from palliative care are currently living in low and middle-income countries and do not have access to the levels of palliative care provision expected in most developed countries.In this context of global disparity in how palliative care is both framed and practiced authors argue that the quest for a global health system offering universal health coverage should include palliative care as a fundamental goal. As a result public health palliative care - the idea that care for terminally ill people should be returned to communities - has gained global interest.The current map of world palliative care development shows Bangladesh as being in 'stage 3a', which means that isolated palliative care services and training provision exist. A recent situation analysis revealed that although Bangladesh has approximately 600,000 incurable patients at any point in time, the country only has few palliative care programs that served less than 1500 patients in 2013. Inspired by other community-driven, public health approaches to palliative care, the Centre for Palliative Care (CPC) of the BSM Medical University (BSMMU) initiated a pilot project in 2015 to provide palliative care in urban slums in Dhaka, through the use of Community Palliative Assistants. An evaluation of the project identified lack of community engagement as a major threat to the sustainability of the slum project. In this context the earlier project aimed to develop an innovative boundary-crossing interdisciplinary partnership to provide support to the sustainability of the urban slum palliative care project in Bangladesh, by developing a culturally appropriate and scientifically sound strategy for enhancing public engagement through 'Community theatre'. The community theatre unit of BRAC, the largest NGO of Bangladesh is currently organizing the theatre performances in the urban slum. Recently BSM Medical University has received a grant from World Hospice and Palliative Care Association, WHPCA to expand the community based palliative care activities from urban slum to the peri-urban and rural areas of Bangladesh. Accordingly, they have started a new project in a peri urban and rural area near capital Dhaka. This has given rise a new opportunity for public engagement which was not foreseeable at the application stage of the earlier project as there was no indication of such support from WHPCA. Learning from the community based palliative care in urban slum the project team believe that it is crucial for the BSM Medical University to engage the community from the onset of their project in new peri urban and rural community based palliative care project that they have just started. By incorporating the community theatre from the inception of the new project in peri urban and rural context the community engagement dimensions could be ensured and the mistake of the urban project could be avoided. The experience of the development of the theatre project in urban Bangladesh could be utilized in developing a project for new user community. The follow on grant will enhance the engagement with, and impacts from the existing AHRC-MRC project. The follow on grant will allow to revise the community engagement strategy for public health palliative care in resource-poor settings through the performing arts to be more comprehensive including experience ranging from rural, peri urban and urban communities of Bangladesh.