Striving for Equity, Justice, and Access to Palliative Care Through Cancer and Palliative Nursing in Uganda: A Narrative Review.

BACKGROUND Uganda is recognized as a leader in palliative care in Africa, with advances such as health system integration and nurse prescribing of oral morphine. However, inequities in access to quality cancer palliative care persist, particularly for rural, socioeconomically marginalized, and pediatric populations. Nurses play a central role in service delivery, yet their contributions and challenges have not been synthesized through an equity and justice lens.

OBJECTIVE To examine the development of palliative care in Uganda and the role of cancer and palliative nursing in advancing equity, justice, and access.

METHODS A narrative review of peer-reviewed and grey literature, supported by authors' expert knowledge, was conducted. Publications spanning 30 years were thematically synthesized to describe key developments, challenges, and innovations in palliative and cancer nursing in Uganda.

RESULTS Major advances include policy reform, nurse prescribing, education, leadership development, service expansion, and integration of palliative care into oncology. Nurse-led innovations and task shifting have improved access in resource-limited and rural settings. However, inequities persist due to workforce shortages, uneven service distribution, late diagnosis, limited financing, and weak system integration, with children and remote populations disproportionately affected.

CONCLUSION Strengthening nursing education, leadership, research, and policy engagement, alongside sustained health system investment, is critical to achieving equitable and accessible palliative care. Uganda's experience offers valuable lessons for other countries with a low and middle human development index expanding nurse-led palliative care in resource constrained settings.