Strengthening Palliative Care in India

India continues to face a significant gap in access to palliative care, with only 1%-2% of the nearly 10 million people requiring such services annually receiving appropriate care. Despite its inclusion in the 2017 National Health Policy, inadequate funding, workforce shortages, and weak public awareness hinder its nationwide implementation.

Understanding the Palliative Care Gap in India

• Magnitude of Unmet Need: According to WHO, 40 million people require palliative care annually, 78% of them in low- and middle-income countries. In India, 7–10 million need it, but only 1%–2% have access, reflecting a critical public health shortfall.
• Systemic and Infrastructural Deficiencies: While palliative care is part of the primary health sector, it lacks integration in tertiary care and remains underfunded, with rural and economically disadvantaged populations being the most neglected.
• Shortage of Trained Workforce: Despite a doctor–population ratio of 1:834 (better than WHO norm), India suffers from a severe shortage of palliative care-trained doctors, impeding pain management and end-of-life support services.

Policy Measures and Capacity Building

• Educational Integration: Integrating palliative care into the MBBS curriculum and expanding training initiatives through AIIMS and ICMR can develop a skilled workforce sensitive to end-of-life issues.
• Leveraging Allied Health Workforce: India has 33 lakh registered nurses and 13 lakh allied health professionals. Task-shifting and targeted training can help decentralize palliative care delivery, particularly in rural regions.
• Role of Health Insurance and State Funding: Inclusion of palliative care under Ayushman Bharat and dedicated government budget allocations can ensure affordability and institutionalization of these services across both public and private sectors.

Strategic Reforms and Global Learning

• Public Awareness and Early Access: Public outreach campaigns must clarify that palliative care is not limited to terminal care, but extends to improving quality of life across all serious illnesses, thereby encouraging timely utilization.
• International Best Practices: The S. model of hospice-based, insurance-backed care underscores the role of funding and end-of-life dignity, offering a useful template for India’s adaptation within its socio-economic realities.
• Collaborative and Evidence-Based Approach: Partnerships with NGOs, private providers, and continuous research-based improvements can accelerate delivery and enhance trust in palliative care systems across the country.

Practice Question:

Despite policy inclusion, palliative care remains a neglected domain in India’s public health landscape. Examine the systemic challenges in its implementation and suggest a multi-tiered strategy to improve palliative care delivery in India.
(250 words)