INTRODUCTION:
Palliative care is recognized as an essential component of Universal Health Coverage, yet access remains limited in low- and middle-income countries where the burden of serious health related suffering is highest1. In Sub-Saharan Africa, rising noncommunicable diseases, persistent HIV/AIDS and population ageing have increased the need for palliative care services delivered beyond hospital settings through primary health care and community-based models2.

METHODS:
A comparative case study design was used to examine the integration of palliative care into public health systems in Tanzania, Uganda and Rwanda. The analysis was guided by the World Health Organization Public Health Model for Palliative Care. Data sources included national policy documents, published literature, epidemiological reports and documented implementation experiences.

RESULTS:
Uganda demonstrates advanced integration through regulatory innovation, including task-shifting that enables trained nurses and clinical officers to prescribe oral morphine, expanding access to pain relief in rural communities3. Rwanda’s approach emphasizes primary health care and community health workers to deliver home-based palliative care within a universal health coverage framework2. Tanzania shows progressive integration through health sector reforms and training initiatives, though services remain relatively centralized. Across all settings, nurses and allied health professionals play a central role in service delivery and continuity of care. Persistent challenges include workforce shortages, limited opioid availability and sociocultural barriers1.

CONCLUSIONS:
Integrating palliative care into public health systems in East Africa is feasible through context-specific and community-based approaches. Strengthening policy support and primary health care integration is critical for expanding equitable access to palliative care in resource-limited settings1.