Pain, other symptoms, and psychosocial distress are highly prevalent among patients with serious chronic diseases such as cancer and HIV/AIDS and significantly reduce the quality of life. Palliative care focuses on the relief of suffering of any kind including pain, other physical and psychological symptoms, social distress, and spiritual distress, and on maximizing the quality of life of patients and their families. For these reasons, palliative care is widely considered a human right that should be accessible to all. Yet it is rarely accessible in resource-limited settings such as Rwanda. Patients with advanced chronic illnesses typically are discharged from the healthcare system and return home with no follow-up when they are most likely to have severe or worsening symptoms, when they are most physically and socio-economically vulnerable, and when their families are under the most significant stress. With support from the Rwanda Biomedical Center, ACREOL will create a first-of-the-kind model palliative care district networks in Rwanda that are integrated into the government healthcare system, affordable, and thus both sustainable and scalable, and that measurably improve the quality of life of serious chronic illnesses. We propose to build on this foundation by completing and refining the first district palliative care networks and extending a new one in another district.