India Grapples with Palliative Care Crisis: Only a Fraction of Those in Need Receive Support

As World Palliative Day approaches, experts are highlighting the critical lack of access to palliative care in India, where a staggering number of people are left without the support they desperately need. Recent data reveals that barely 4% of the 7 to 10 million Indians who require palliative care annually can access it. This leaves millions to suffer from chronic illnesses without adequate pain management and holistic care.

Palliative care focuses on improving the quality of life for patients and their families facing life-threatening illnesses. It involves managing pain and other physical, psychosocial, and spiritual problems. Unlike curative treatments, palliative care aims to alleviate suffering and improve the overall well-being of patients, regardless of their stage of illness.

Several factors contribute to this stark reality. One significant barrier is the restrictive prescription policies for controlled pain medications, such as morphine. Although morphine and other pain relievers are essential for managing severe pain associated with life-limiting illnesses, their availability and accessibility remain limited. The National List of Essential Medicines (NLEM) needs to be adequately stocked with drugs recommended by the International Association for Hospice and Palliative Care (IAHPC).

Beyond medication access, a lack of awareness and understanding of palliative care contributes to the problem. Many medical professionals and the public view palliative care as an admission of defeat, rather than a vital component of comprehensive healthcare. Cultural and social barriers further compound the issue, as discussions around death and terminal illness remain taboo in many parts of India, making families reluctant to seek palliative care services early on.

The COVID-19 pandemic has exacerbated these challenges. Lockdown restrictions disrupted physical contact between healthcare providers and patients, a crucial element of palliative care. The risk of infection in hospitals and hospices has also made home-based palliative care services more critical, allowing patients to receive care in the safety of their homes.

The deficiency in trained professionals is another significant impediment. While India's doctor-to-population ratio exceeds WHO norms, there is a shortage of specialists in palliative care. This limits access to comprehensive pain management and end-of-life support. Moreover, palliative care is often not integrated sufficiently into tertiary care settings.

To address this crisis, experts are calling for a multi-pronged approach. Integrating palliative care into all levels of healthcare, particularly primary and community-based services, is essential. This includes training MBBS and nursing graduates in pain management, equipping field-level healthcare professionals to identify and support patients, and embedding home-based palliative services within existing healthcare systems. Increasing awareness about the benefits of palliative care is also crucial. Educating healthcare professionals and the public can help dispel misconceptions and encourage early referrals.

Innovative solutions like mobile palliative care clinics are also emerging to bridge the gap. These clinics bring palliative care services directly to underserved communities, offering medical, nursing, nutritional, psychosocial, and financial support to patients and their caregivers.

Kerala has demonstrated a successful model for palliative care implementation. The state's network of palliative care units and its community-based approach have significantly improved access to care. Experts suggest replicating this model in other states to ensure equitable access to palliative care across the country.

The need for palliative care in India is immense and growing. With an aging population and a rise in chronic diseases, integrating palliative care into the healthcare system is more critical than ever. By addressing the barriers to access and promoting a compassionate, patient-centered approach, India can alleviate suffering and improve the quality of life for millions facing life-limiting illnesses.