With a population constituting nearly 20% of the global total, India experiences a significant impact of non-communicable diseases such as cancer, diabetes, hypertension, and respiratory conditions. These persisting health issues have brought to light the need for appropriate palliative care. However, limited availability and accessibility of these services pose substantial challenges in the Indian context.
Understanding Palliative Care
Palliative care is a branch of healthcare recognized under the right to health; it focuses on enhancing the life quality of patients grappling with serious illnesses. Its objectives are to alleviate suffering, identify over-treated patients, and manage medical expenses thereby avoiding financial burdens on the patients’ families. It is intended to cater to physical, emotional, spiritual, and social needs arising from severe conditions like cardiac or kidney failures, cancer, certain neurological diseases, etc.
According to World Health Organization (WHO), each year sees approximately 40 million people worldwide requiring palliative care. A staggering 78% of these are inhabitants of low- and middle-income countries. However, globally, only around 14% of those in need receive palliative care. The WHO Global Action Plan for the Prevention and Control of NCDs 2013–2020 explicitly includes palliative care as part of comprehensive services for NCDs.
Non-Communicable Diseases (NCDs)
NCDs are not communicable from one person to another and include a wide range of medical disorders, both acute and chronic. These cover conditions like cancers, diabetes, hypertension, cardiovascular diseases among others.
Status of Palliative Care in India
In India, palliative care is primarily accessible in urban areas and tertiary healthcare facilities. Out of an estimated 7-10 million people needing palliative care in India, only 1-2% are able to access it. Despite no separate budget allocation, palliative care in India is integrated under the ‘Mission Flexipool’ of the National Health Mission (NHM). The National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) also aims to tackle the growing NCD-related issues in India.
Challenges in Palliative Care Implementation
The understanding and awareness about palliative care among the general public and healthcare professionals in India are limited. There is a dearth of dedicated palliative care centers, hospices, trained healthcare providers, and infrastructure. Healthcare professionals often lack adequate training in palliative care, which affects their ability to manage pain, symptoms, and provide psychosocial support to patients.
The aspect of pediatric palliative care has been neglected for a long time, with around 98% of children in lower-and-middle-income countries like India experiencing moderate to severe suffering due to conditions like cancer, birth defects, neurological disorders, etc.
The Way Forward
To improve the state of palliative care in India, strengthened implementation and monitoring of the NPPC at the state level, robust infrastructure, adequate funding, and competent human resources are imperative.
National standards and guidelines for palliative care services and quality assurance must be developed and implemented. There should be an emphasis on enhancing the education and training of palliative care professionals and volunteers at various levels.
The 67th World Health Assembly in 2014 asserted the need for integrating palliative care into health systems at all levels. This also includes improving referral and linkage mechanisms among diverse levels and types of healthcare providers for palliative care.