In a significant step forward for South Africa’s palliative healthcare sector, late last year saw the fourth edition of the Standards for Palliative Healthcare Services being recognised internationally and accredited for four years by the global authority on standards development and assessment. This is the International Society for Quality in Health Care’s External Evaluation Association (IEEA).

As the only bespoke and comprehensive set of internationally accredited standards that exists in South Africa for institutions providing palliative care, it is a critical achievement driven by the Hospice Palliative Care Association (HPCA), hospices and The Council for Health Service Accreditation of Southern Africa (COHSASA). These two organisations have worked together since 2005 to develop and implement palliative care standards.

“According to Ewa Skowronska, the CEO of the HPCA: “The ISQua IEEA accreditation process, that has taken a year to complete, underpins the credibility of the excellent palliative care services offered in South Africa. We are also currently engaging with various government departments to ensure that palliative care is recognised for the vital role that it has played, and is still playing, within South Africa’s healthcare sector.”

The philosophy of palliative care is the active total care of patients whose disease is life-threatening. Control of pain and other symptoms as well as the patient’s psychological, social and spiritual needs is paramount. The goal of palliative care is to endeavour to achieve the best quality of life for patients and their families. In the South African healthcare environment, palliative care is provided particularly for patients with advanced progressive diseases including cancer, HIV/AIDS and TB. The focus is on home-based care that extends into the bereavement period. Further, during the pandemic in 2020 and into 2021, members of the HPCA have continued to provide this care with many members having extended their services to assist individuals recovering from COVID-19.

The Standards for Palliative Healthcare Services, once implemented in hospices, are evaluated on a case-by-case basis via an internal survey process to assess required compliance scores.  Further, HPCA offers a mentorship programme and platform to hospices and any other organisations that wish to implement the Standards to assist in implementation.

“Improving quality of palliative care services globally is a continuous process, and all activities linked to monitoring standards need to be as much about developing a culture of quality assurance and continuous improvement within each palliative care programme as meeting external accreditation requirements” says Esme Pudule, Operations Manager at the HPCA. “Since 2005, 50 hospices have been presented to the COHSASA Board for 135 accreditation decisions. These include full accreditation, graded recognition and maintaining of accreditation standards.”

The mentorship programme is further supported by the COHSASA surveyor training of the HPCA mentor coordinators who conduct internal surveys to assess the evidence of improved quality of care for patients and families in hospice programmes.

The hospices are rated on standards that include governance and leadership; human resource management; administrative support, facility, and equipment management; risk management, access to care and patient rights; interdisciplinary team; holistic patient care; medication management; support services and education and research.

Says Pudule: “This internal process has helped to ensure the readiness of hospices before they are recommended for an external survey by COHSASA. The initial Star 1 to Star 4 graded status is awarded to hospices as they progress in their development and meet compliance with the standards. The mentorship programme has also been designed to assist any other hospice service providers to implement the Standards. This internal process ensures that the assessment findings meet the standard compliance requirements to recommend the organisation for an external survey by COHSASA with the view of achieving full accreditation status.

“Having the fourth edition of the palliative care standards internationally accredited by the ISQua External Evaluation Association is testimony to the quality of the content of the standards and that they meet international best practice, says Jacqui Stewart, the CEO of COHSASA. “HPCA and COHSASA have worked together for over 15 years to ensure that there are internationally recognised palliative care standards in South Africa.  Currently eight HPCA member hospices hold internationally recognised COHSASA accreditation awards, with a number of other hospice members working towards compliance with the Standards to achieve full international accreditation status. COHSASA is proud of this relationship and looks forward to many more years of supporting the improvement of palliative care services in South Africa

The revised set of standards consists of ten service elements and is divided into four management performance functions, namely:

  • Healthcare Organisation Management
  • Patient Care
  • Ancillary Services
  • Education and Research

The Standards for Palliative Healthcare Services can be requested by member hospices of the HPCA free of charge by emailing or For other providers interested in purchasing the standards, email:  or  More information is available at: and 

About the HPCA

The Hospice Palliative Care Association (HPCA) is a registered NPO in South Africa. Founded in 1987, the HPCA is a member organisation for South African hospices. As a national charity, the association champions and supports 103 member organisations that provide hospice services to more than 120,000 people per year.

There are nine regional hospice associations that are members of the Hospice Palliative Care Association, representing each province in the country. These are located in the Western Cape, Eastern Cape, Kwazulu-Natal, Free State, Northern Cape and the North-West province. The Association of Northern Hospices represents hospices in Gauteng, Limpopo and Mpumalanga.

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About hospices

Hospices’ mission is to promote quality in life, dignity in death and support in bereavement for all living with a life-threatening illness – which includes COVID-19. Hospices are in 9 provinces and have been providing services for over three decades.

Each hospice has a multidisciplinary health care team that includes a medical doctor, professional nurse, social worker and home-based carers. They provide medical care, psychosocial care, and spiritual support, as well as end-of-life support. Dependent on the medical aid scheme, hospice and palliative care can be claimed for.

All hospice staff are trained in palliative care which aims to ensure a good quality of life for patients who have been diagnosed with life -limiting illnesses and to prevent and relieve unnecessary suffering. Care also extends to families, especially after their loved ones have died and as they process their grief.

Standards background

The first HPCA Standards booklet (Standards for the Provision of Palliative Clinical Care in Hospice) was distributed to member hospices by the HPCA in 1998.

On implementation of these clinical standards, it became apparent that good clinical care was dependent upon good governance. This resulted in the initial collaboration with COHSASA in the development of the first edition of the comprehensive Hospice Palliative Care Standards, with funding received from the President’s Emergency Plan for AIDS Relief (PEPFAR).

In 2005, the HPCA identified that the demand for palliative care services far outstripped available resources. The HPCA and member organisations, in collaboration with COHSASA, initiated the development of palliative care standards.

In 2009 the HPCA star rating system was implemented to build capacity and recognise HPCA member organisations for their achievement towards accreditation in providing quality palliative care services. The HPCA Self-Assessment Tool (SAT) was introduced in 2015.

The second edition of the Hospice Palliative Care Standards was awarded accreditation by ISQua in 2010 and the third edition in 2014.