Organisation des soins palliatifs intégrés en Belgique

In the Declaration of Astana (2018), the World Health Organization underlines the emergency of strengthening our health systems and the relevance of the primary health care (PHC) model to achieve this, including regarding palliative care. In the light of the principles of PHC, this article presents and questions the current organization of palliative care in Belgium: do they meet their main criteria, which are comprehensiveness, accessibility, acceptability, permanence and continuity of care? As palliative support is provided at all levels of the health care pyramid, the base – the first line – supports a large part of it. This organization encourages practices where local health professionals – the general practitioner and the family nurse – are the main actors in the support. Specialists in the palliative sector only intervene to help front-line professionals in difficulty or to enable them to accompany particularly complex situations. The decompartmentalization of health specialties and the meeting of palliative care with PHC brings here a gain in quality and meaning. However, this perspective on our care model also reveals certain shortcomings – mostly financial – and certain inadequate practices that jeopardize an organization that is nevertheless sustainable, up to the challenges of today and tomorrow.