1. República de Colombia

2. POPULATION : 46. 044.611 7.6% over 60 years 51.4 % females 48.6 % males

3. PRIVATE PRE-PAID CONTRIBUTIVE Workers Employees 12.5% salary 38.77% SUBSIDIZE Unable to pay for health Subsidy by Goverment and contributive 50.59% COLOMBIAN HEALTH CARE SYSTEM http://www.paho.org http://www.asivamosensalud.org Before 1990 Health coverage 30.4% Law 100 / 1993 : Achive universal access to social security

8. DISEASE ESTIMATED NUMBER OF PATIENTS AFFECTED WITH THE DISEASE PATIENTS IN NEED OF PALLIATIVE CARE COPD3.308.082992.424 Congestive heart failure 206.564 61.969 Neurologic development disorders 597.629179.288 Cerebrovascular 290.705 87.211 Dementia 191.368 57.410 Epilepsy 150.465 45.139 Peripheral neuropathy 124.170 37.251 Parkinson Disease 68.658 20.597 Craneoencephalic trauma sequelae 211.717 63.515 HIV/AIDS 217.681 65.304 Cancer 460.446138.133 Chronic kidney disease 15.819 4.745 TOTAL1.752.986 ESTIMATED OF PATIENTS IN NEED OF PALLIATIVE CARE PREPOCOL Stud. Chest 2008; 133(2): 343-349. Rev Colomb Cardiol 2009; 16(6):249-255 Rev Panam Salud Pública 2003;14(2):104-111. http://www.unicef.org/spanish/infobycountry/colombia_statistics.html#76http://www.unicef.org/spanish/infobycountry/colombia_statistics.html#76. http://www.cancer.gov.co/documentos/Incidencia/Tabla%202.pdf http://www.cancer.gov.co/documentos/Incidencia/Tabla%202.pdf.

9. PALLIATIVE CARE EDUCATION 3 Postgraduate Programs: – For Anesthesiologist, Family Practice, Oncologist, Rehab ( 1 year) – For MD,Nurses, psycologist ( 3 years) 1Undergraduate Program: -For last year medical students as an obligatory course

10. PALLIATIVE CARE PROGRAMS CALI MEDELLIN BOGOTA BARRANQUILLA BUCARAMANGA VILLAVICENCIO CARTAGENA PEREIRA PASTO (9 de 32): 28%

11. Qualitative analysis Strong points: 1. Education 2. Medications 3. Cancer Law Weak points: 1. No reliable data 2. No economical studies 3. No Palliative Care Plan 4. Not enough people trained 5. Not enough PC services

12. Main dilemmas & challenges Dilemmas: 1. Is palliative care cost-efective in Colombian Health System Challenges: 1.Economical studies 2.Improve Education 3.Access to services and availability of medication 4.Include Palliative care in standars of quality of care