A recent study has revealed a stark reality regarding palliative care accessibility in India: only four palliative-care centers exist for every 10 million people. This scarcity leaves millions in need without adequate support for managing pain and improving their quality of life.
The study, utilizing data from Pallium India's 2022 directory of active palliative care centers, highlights the significant gap between the number of people requiring palliative care and the resources available. It indicates that an estimated 7 to 10 million Indians need palliative care annually, but less than 4% have access to it.
Geographical disparities further compound the issue. While the highest densities of palliative care centers are found in regions like Lakshadweep, Goa, and Kerala, other states lag significantly behind. This uneven distribution results in varying travel times to reach the nearest center, with a median travel time of 118 minutes. A substantial portion of the population, 23.6%, resides within 30 minutes of a palliative care center, while 39.8% and 71% can access one within 60 and 120 minutes, respectively. Rural areas face greater challenges compared to urban areas, further exacerbating the inequity.
The consequences of limited access to palliative care are far-reaching. Palliative care is essential for individuals facing chronic or life-limiting illnesses, providing pain relief, symptom management, and psychosocial support. Without it, millions of Indians endure unnecessary suffering, impacting not only their physical health but also their emotional and mental well-being.
Experts emphasize the urgent need for a shift towards community-based palliative care models. Integrating palliative care into existing healthcare infrastructure, particularly at the primary and community levels, can significantly improve accessibility. This involves training healthcare professionals, including MBBS graduates, nurses, ASHAs, and ANMs, in pain management and palliative care principles. Embedding home-based palliative services within Health and Wellness Centers under Ayushman Bharat is also crucial.
Several initiatives are underway to address the palliative care gap in India. The National Programme for Palliative Care, introduced in 2012, aims to promote palliative care services across the country. Palliative care has also been included in the National Health Policy (2017) and listed as part of the Ayushman Bharat's comprehensive primary care packages. Additionally, organizations like Pallium India are working to improve access to palliative care and effective pain relief. The Indian Association of Palliative Care (IAPC) is also actively involved in education and training programs.
Despite these efforts, significant challenges remain. A survey of palliative care centers in India revealed that many centers struggle to meet essential quality standards, including providing uninterrupted access to oral morphine. Furthermore, palliative care services are often facility-based, leaving those who are home-bound or bed-bound without adequate care.
Addressing these challenges requires a multi-pronged approach. Increased investment in palliative care infrastructure, training of healthcare professionals, and integration of palliative care into the broader healthcare system are essential. Community-based models that prioritize home-based care and utilize the expertise of community health workers can play a vital role in reaching underserved populations. Furthermore, raising awareness about palliative care and its benefits can help to reduce stigma and improve access to these essential services.
