**4. The way forwards**

There is a paucity of information on hospice and palliative care provision in Nigeria and only a weak evidence base upon which to build policy and practice development. Overall, services remain scattered and piecemeal in the country, and coverage is poor. Pioneer workers in palliative care established small models of care to act as foci for education initiatives, so that palliative care can spread to wider areas. They saw in education, as the best hope of contributing care for the dying. It would be wishful thinking to assume that age old beliefs could be eradicated in a twinkle of the eye, but education will create awareness, remove taboos, and modify some attitudes and behaviors. The best way to do this is by incorporating palliative care into the medical undergraduate curriculum and residency training program. Public enlightenment through the print and electronic media will further create awareness; eliminate the stigma associated with terminal illness and regard dying as a normal process. It will provide psycho-social, spiritual and bereavement support for family members. Patients with terminal diseases should be encouraged to seek palliative care at a place best suitable for them. Outreach services for home-based care should be encouraged and adequately funded.

We need advocacy to present our case to the general populace. Government alone cannot shoulder the responsibility involved in implementing an effective palliative care. The private sector of the economy, corporate bodies, religious and traditional leaders need to be carried along. The government needs to address its policy on availability and distribution of morphine in the country. Palliative care champions in Nigeria are working to demonstrate how morphine access can be appropriately integrated into healthcare systems. Through political advocacy and public awareness, the necessity of integrated palliative care can be better understood.
