Strengthening Palliative Care In India

Context: 

Recently, the Union Government has released the operational guidelines for the management of non-communicable diseases (NCDs), acknowledging the increasing burden of such diseases as the country’s population continues to grow. 

• This emphasizes the need for palliative care services to individuals affected by NCDs.

About Palliative Care:

• Palliative care is a specialised branch of medicine that focuses on enhancing the quality of life and alleviating suffering for individuals with life-limiting illnesses. 
• Approach:
  • Comprehensive approach: Improve patients’ well-being by addressing their physical, psychological, spiritual, and social needs. 
  • Proportional actions: Prevent over-medicalization and the financial burden on families while prioritising quality of life. 
  • Counselling support: Provides support to families and caregivers, including bereavement support after the patient’s death.
• Applicability: Heart failure, kidney failure, certain neurological diseases, cancer, etc. 

Need for Palliative Care In India:

• Burden of Non-Communicable Diseases: Diseases such as cancer, diabetes, hypertension, and respiratory diseases have seen a steep rise in prevalence.
• High Cancer Incidence: With nearly 1.4 million people diagnosed with cancer in India each year, there is a substantial need for palliative care services.
• Addressing Rural Healthcare Needs: Two-thirds of India’s population resides in rural areas, where access to healthcare services, including palliative care, can be limited. 

Existing Program for Palliative Care:

• National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD):
  • NP-NCD was launched in 2010 to address the burden of noncommunicable diseases (NCDs).
  • Originally called NPCDCS, it aimed to provide promotive, preventive, and curative care for chronic diseases like cancer, diabetes, cardiovascular diseases, and stroke.
  • In an ideal scenario, palliative care should take over curative care for advanced-stage diseases.

Gaps in the Revised NP-NCD Guidelines:

• Limited Focus on Non-Cancer Illnesses:
  • The guidelines mention palliative care mainly in relation to cancer, overlooking the higher need for palliative care in non-cancer illnesses.
  • The Global Atlas of Palliative Care in 2020 emphasised the broader scope of palliative care beyond cancer.
• Exclusion of Chronic and Debilitating Conditions:
  • In the previous operational guidelines (2013-2017), chronic and debilitating conditions were included under palliative care.
  • The revised guidelines fail to encompass these conditions, narrowing the scope of palliative care.
• Lack of Emphasis on Home-Based Care:
  • The previous guidelines acknowledged the importance of home-based palliative care services.
  • The revised guidelines overlook home-based care, with palliative care delivery starting only from the district hospital.
• Inadequate Delivery at Primary Healthcare Level:
  • Palliative care service delivery in the revised guidelines starts only from the district hospital, bypassing the health and wellness center and sub-center levels.
• Gaps in the Implementation of the NPPC:
  • The guidelines highlight the linkage of 11 programs to promote the convergence of services for non-communicable diseases (NCDs).
  • One of these programs is the National Programme for Palliative Care (NPPC).
    • The NPPC was announced in 2012 with the aim of enhancing palliative care services.
  • However, the program has faced challenges due to the lack of a dedicated budget and awareness.
• Measurement of Access:
  • Narrow Indicator Focus: The chosen indicator in the guidelines assesses access based on morphine-equivalent consumption of strong opioid analgesics per death from cancer, which may not reflect the full coverage of palliative care services.
  • World Health Organisation Recommendation: The World Health Organisation suggests using morphine consumption per capita as a broader indicator to assess morphine access and compare progress across countries.

Challenges to Palliative Care:

• Limited Accessibility: It 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.
• Poor Implementation: Despite the presence of government programs like the National Programme for Healthcare of Elderly, access to palliative care remains inadequate.
• Role of NGOs: NGOs such as Pallium India, Karunashraya, and CanSupport try to fill the gap but face limitations due to resource constraints compared to the government.
• Neglected Pediatric Palliative Care: The guidelines primarily focus on cancer, overlooking the urgent need for palliative care for children with various chronic diseases.

Way Forward:

• World Health Assembly Resolution: Implement the 2014 World Health Assembly Resolution 67.19 on Palliative care by integrating palliative care into national health policies.
• Strengthening Healthcare Infrastructure: There is a need to invest in building robust palliative care services at the grassroots level, ensuring that quality care is accessible to all individuals in need.
• Training and Education: Providing specialized training programs to healthcare professionals in palliative care will help address the shortage of trained personnel and enhance the delivery of services.
• Access to Essential Medications: Facilitating improved access to opioids and other essential medications for pain management is crucial for effective palliative care.
• Collaboration and Integration: Strengthening collaboration between healthcare professionals, specialists, and palliative care teams can ensure a coordinated approach to patient care and the continuity of support.
• Public Awareness and Acceptance: Promoting awareness and acceptance of death as a natural part of life can help foster a more compassionate and supportive environment for palliative care.
• Rehabilitation and Social Support: Recognizing the holistic needs of patients and their families, integrating rehabilitation and social support services within palliative care programs can enhance overall well-being.

News Source: The Hindu