1. Palliative Care Worldwide from villages to metropolis Katalin Muszbek MD. Hungarian Hospice Foundation

2. Palliatvive care development in Eastern – European Region  Poland – first steps at the 70es Jaczek Luczak – key person  Regional PC education in Poland with international faculty  British model  From 90es - activities of the hospice groups in the region

3. Palliative Care in Hungary Since 1991 – start of the Hungarian hospice movement: first palliative care group: Hungarian Hospice Foundation

4. Strenghts of Palliative Care in Hungary  Well orgaized care based on minimum standards  Legal backround, strong policy  High public awareness  International training resource centre

5. Strengths - clinical activities  Well organized PC services  Activities only on minimum standards  PC guideline

6. Strengths - legal background  Hospice paragraph in the health law – 1997  Regulation on PC – 2004  Palliative Care Development Project – collaboration with National Health Insurance Fund – 2004  PC is a part of National Cancer Control Program

7. Strengths - public relations  High public awareness  Publicity campaignes since 2000  High media representation in 2007 more than 100 publications, interviews in electronic and written media  Programs for children

8. Strengths - education  Budapest is an International Training Resource Centre  Open Society Institute Conferences for Eastern Central European PC professionals – 2003, 2004, 2005 - 12 countries  40 hours PC courses for Eastern European region and former Sowjet Union countries

9. Weeknesses of PC in Eastern-Europe  PC sevices are not awailable all over the country  Lack of PC training of physicians  Low – scarce financial resources

10. Weeknesses – PC services  PC services are not awailable all over the country  White spots of care  225 PC beds – WHO recommends 500 for 10 million population

11. Weeknesses - education  Medical curriculum without PC issues 6000 hours of whole curriculum – less than 200 on symptom controll, on death and dying,on breaking bad news  No PC specialisation for physicians  Low motivation of physicians for PC

12. Weeknesses - finance  Low financial resources  NHIF covers 50% of the budgets of PC services  Donation is not traditional  Few grants on PC topic

13. Where is Hungary now? Increased number of PC services (2x) Legal development: (2004) - minimum standards of palliative care - Ministry of Health decree on finance Finance: financial demonstration project for palliative care (NHIF) (2004) Second part of this year new opportunities for extending PC - NHIF support

14. Where is Hungary now? National development plan 2007-2013: integraton of Palliative Care into the National Health System (new reform)(2006) Palliative care and psychosocial care became an integrated part of National Cancer Control Program (2006)

15. However…  PC is not awailable all over the country  Scarce of training and interest of physicians to PC  Low state fund and lack of donation are barriers for further development

16. Conclusion  Further lobby is needed for increase number of PC services and to involve more physicians  New approach – to influence attitude of children toward end of life and solidarity: FIELDS OF HOPE project since 2007