Title : Decentralising and decolonising urology palliative care psychosocial services: A model for Nelson Mandela Academic Hospital, urology clinic, Eastern Cape
Abstract:
Background: Patients with advanced urological conditions in the Eastern Cape face multiple barriers to quality palliative psychosocial care: centralised specialist services, limited integration of culturally relevant practices, transport and cost burdens, and mistrust rooted in historical marginalisation. Decentralising services and decolonising care frameworks offer complementary strategies to increase access, cultural congruence, and quality-of-life for patients and families.
Aim: To describe a context-sensitive model for decentralising and decolonising psychosocial palliative services for urology patients at Nelson Mandela Academic Hospital -NMAH- and surrounding district health facilities, and to evaluate anticipated benefits, implementation challenges, and indicators for success.
Methods: A mixed-methods implementation framework is proposed, combining (1) participatory co-design workshops with patients, families, traditional healers, community health workers, and clinicians; (2) task-shifting and capacity-building for primary care and district-level teams; and (3) integration of African epistemologies and local healing practices into psychosocial assessment and bereavement support. Process evaluation metrics include service uptake, travel/time-cost reductions, patient-reported outcome measures (symptom burden, dignity, spiritual well-being), and qualitative assessments of cultural relevance and acceptability.
Results: (anticipated): Decentralisation via trained multidisciplinary teams and telehealth links is expected to increase service reach, reduce missed appointments, and shorten time-to-support. Decolonising approaches acknowledging local cosmologies, involving traditional practitioners, and using vernacular communication are anticipated to improve trust, adherence to care plans, and psychosocial outcomes. Key implementation barriers likely include resource constraints, regulatory uncertainty around collaboration with traditional healers, and the need for clinician training in culturally-sensitive practice.
Conclusion: A combined decentralisation-decolonisation model tailored for NMAH’s urology palliative services promises greater equity, accessibility, and culturally congruent care in the Eastern Cape. Pilot testing, robust process evaluation, and policy engagement are required to scale and sustain the approach.
Keywords: decentralisation, decolonisation, palliative care, psychosocial services, urology, Nelson Mandela Academic Hospital, Eastern Cape, task-shifting, cultural competence
