Palliative care in India

Syllabus: Issues Relating to Development and Management of Social Sector/Services Relating to Health

Source: TH

Context: Access to palliative care in India continues to be abysmal.

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 like heart failure, kidney failure, certain neurological diseases, cancer, etc.
Often misinterpreted as end-of-life care, it focuses on the person as a whole, not just the disease.

Objectives of palliative care:

To identify patients at risk of over-medicalisation at the expense of quality of life and financial burden on the family.
To address the physical, psychological, spiritual, and social domains of the health of people suffering from life-limiting diseases.
It also includes bereavement/grieving support for the caregivers in case of the death of the patient.

How many need palliative care in India?

India has experienced a steep rise in the burden of lifestyle-related non-communicable diseases.
Nearly 1.4 million people are diagnosed with cancer in India every year while diabetes, hypertension, and respiratory diseases are also on the rise.
Estimated 7-10 million people need palliative care sooner or later in the disease trajectory.

Status of palliative care in India:

Skewed availability of palliative care services → largely been available at tertiary healthcare facilities in urban areas → only to 1-2% of those who require it in the country.
55 million people in India are pushed below the poverty line every year due to health-related expenditures (over-medicalisation plays a significant role).

Steps taken:

A three-tier health system, multiple national health programmes and schemes (like the Ayushman Bharat Health Insurance Scheme).
National Programme for Palliative Care (NPPC): It was announced in 2012, however, the lack of a dedicated budget has prevented the implementation of the programme since its inception.
National Programme for Health Care for the Elderly: Launched in 2010, to provide accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an Ageing population.
Some best practices: NGOs like Pallium India, Karunashraya, and CanSupport are trying to fill the gap in palliative care in India.
- However, NGOs have limitations on how much they can spend and that doesn’t compare in any way with how much the government can spend.
National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD):
- Launched in 2010 to counter the rising burden of noncommunicable diseases in the country.
- The programme envisaged the provision of promotive, preventive, and curative care from primary to tertiary institutes.
- In order to strengthen palliative care, the GoI revised the operational guidelines of NP-NCD.

What are the gaps in the guidelines?

Mention palliative care in synonymy with cancer only: However, the need for palliative care was higher for non-cancer illnesses.
- Cancer is just one of 20 common health conditions that require palliative care.
No mention of home-based palliative care services: Since most patients who need palliative care are suffering from debilitating diseases, home-based care forms the ideal mode of healthcare delivery.
- However, palliative care service delivery starts only from the district hospital in the revised guidelines.
No mention of paediatric palliative care: The guidelines skipped an opportunity to bring focus on children suffering from chronic diseases.
Linking of 11 programmes (including NPPC) to promote convergence: The mechanisms of the linkage with a programme (NPPC) that has not yet been fully implemented are unclear.

Way ahead:

Broaden the sphere of palliative care to include multiple diseases and services.
Palliative care needs to be integrated into health systems at all levels.
Include palliative care along with curative treatment.
Increased focus should be given to the impact assessment of palliative care programmes.

Conclusion: It is high time for India to realise the ongoing pandemic of non-communicable diseases and strengthen its palliative care services.