Need to Focus on Palliative Care

India has experienced a steep rise in the burden of lifestyle-related non-communicable diseases (NCD) as millions of people are diagnosed with cancer in India every year while diabetes, hypertension, and respiratory diseases are also on the rise.

• All these diseases need palliative care sooner or later in the disease trajectory.

What is Palliative Care?

• Palliative care is the branch of medicine focusing on improving the quality of life and preventing suffering among those with life-limiting illnesses.
• It aims to identify patients at risk of over-medicalisation at the expense of quality of life and financial burden on the family.
• It is often misinterpreted as end-of-life care. However, palliative care aims to improve the quality of life by addressing the physical, psychological, spiritual, and social domains of the health of people suffering from life-limiting diseases like heart failure, kidney failure, certain neurological diseases, cancer, etc.

Situation of Palliative Care in India:

• Palliative care in India has largely been available at tertiary healthcare facilities in urban areas.
• Due to this skewed availability of services, it is accessible to only 1-2% of the estimated 7-10 million people who require it in the country.

How its accessibility is measured?

• Access to palliative care will be assessed by estimating morphine-equivalent consumption of strong opioid analgesics (excluding methadone) per death from cancer.
• The World Health Organisation recommends the use of morphine consumption per capita to assess morphine access for palliative care services.
• Using this indicator would also have allowed us to compare the progress of palliative care services in India with other countries.

Steps Taken:

• The National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD), includes chronic diseases whose treatment contributes the most to health-related expenses.
• Launched in 2010 to counter the rising burden of non-communicable diseases in the country, the programme envisaged the provision of promotive, preventive, and curative care from the primary to tertiary institutes, thus providing health services delivery across the continuum of care.
• National Programme for Palliative Care (NPPC): NPPC was announced in 2012; however, the lack of a dedicated budget has prevented the implementation of the programme since its inception.

Concerns:

• Loopholes in policy implementation: Existing policies are not reaching the real population and thus unable to grow to its fullest.
• Lack of Accessibility: Due to lack of policy implementation, the rural population is unable to access the facilities related to palliative care.
• Excluding other chronic diseases: As the policy is limiting its attention to cancer, the guidelines have also skipped an opportunity to bring focus on children suffering from chronic diseases.
• Limited scope of measurement: Including an indicator to assess morphine access is a welcome move, but an indicator focusing only on patients with cancer might lead to an inaccurate assessment of coverage of services.

Suggestive measures:

• These diseases progress to a stage where, in an ideal scenario, palliative care should take over curative care.
• Palliative care must be delivered at least at the health and wellness centre and sub-center level.
• The 67th World Health Assembly in 2014 called for palliative care to be integrated into health systems at all levels.