Why South Africa is a good place to die

A new study reveals the best places in the world for end-of-life care – ranking countries when it comes to facilitating death.

The 2015 Quality of Death Index was put together by the Economist Intelligence Unit, a branch of the Economist Group, and revealed that The UK has the best palliative care in the world.

The new and expanded 2015 Index evaluates 80 countries using 20 quantitative and qualitative indicators across five categories:

  • the palliative and healthcare environment;
  • human resource;
  • the affordability of care;
  • the quality of care;
  • and the level of community engagement

The report showed that in 34 out of 80 countries, fewer than 50% had end-of-life programs that could be described as “good.” These countries made up just 15 percent of the global adult population.

European countries dominate the top 20, with the US and Canada at positions 9 and 11, respectively.

Countries with a high quality of death share several characteristics, including strong and effectively implemented national palliative care policy framework, along with high levels of public spending on healthcare services.

The report found that many countries remain woefully ill-equipped to provide appropriate services to older citizens.

Despite improvements in recent years and greater attention to the issue, just 34 countries have above-average scores in the 2015 Index.

Together these account for just 15% of the total adult population of the countries in the Index (which themselves account for 85% of the global adult population).

Top 10 countries

# Country score
1 United Kingdom 93.9
2 Australia 91.6
3 New Zealand 87.6
4 Ireland 85.8
5 Belgium 84.5
6 Taiwan 83.1
7 Germany 82.0
8 Netherlands 80.9
9 US 80.8
10 France 79.4
GDP Correlation
Correlation to GDP (Click to enlarge)

South Africa tops the African continent for quality of death

The report noted that countries have succeeded in delivering high
quality effective palliative care in the face of low resources and overwhelming need.

“And high- and middle-income countries would be wise to learn lessons from them.”

Top 10 countries in Africa

# Country score
1 South Africa 48.5
2 Uganda 47.8
3 Ghana 34.3
4 Morocco 33.8
5 Tanzania 33.4
6 Egypt 32.9
7 Zimbabwe 31.3
8 Zambia 30.3
9 Kenya 30.0
10 Malawi 27.0

Income levels correlate quite strongly with relative success in delivering palliative care services.

The top 10 countries in the Index are all high-income countries. South Africa features as a middle income country and fares relatively well in its category, at 4th, behind Costa Rica, Panama, and Argentina, and ahead of Malaysia and Brazil.

The country scores relatively well in its ability to deliver palliative care due to its large network of hospices.

“Their hospices don’t just focus on end-of-life care. They are out in the community providing TB control, family education, diagnosis, infection control and going into clinics to provide basic HIV care,” the report said.

With an overall ranking of 34th, South Africa scores well in Quality of care (31st), Palliative and healthcare environment (32nd), and community engagement (33rd). It falls down in affordability of care (44th), and human resources (59th).

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Why South Africa is a good place to die