Palliative Care in Bolivia: A Scoping Review and Needs Assessment.

Equitable access to palliative care remains an important goal for many low- and middle-income countries working to expand health care systems. This scoping review examines the development and current state of palliative care in Bolivia through the framework of the World Health Organization's (WHO) pillars of public health strategy: health care policy, medicine availability, education, implementation, and research. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, six electronic databases were systematically searched from inception through September 2023. Studies were eligible if they specifically addressed palliative care in Bolivia. Data were abstracted and thematically synthesized according to the WHO pillars. Of 645 records identified, 507 titles and abstracts were screened, 96 underwent full-text review, and 34 studies met inclusion criteria. Most publications were descriptive or narrative in nature, with limited empirical research. Health care policy and implementation were the most frequently addressed pillars, while research was the least represented. Findings demonstrate expansion of palliative care programs since 2008 alongside gradual improvements in universal health coverage; however, barriers identified include opioid availability and accessibility, geographic distribution of care, standardized training and education, and policy development. Although palliative care in Bolivia has advanced over the past two decades, gaps remain across all WHO pillars. Ongoing and future initiatives are helping to strengthen education, policy, and research, building on recent momentum to ensure equitable and sustainable access to palliative care for all Bolivians.