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

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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.