Prioritising Palliative Care in India: A Compassion-Driven Health Imperative

Why in the News ?

In July 2025, Dr. Naresh Shetty, an orthopaedic surgeon and Project Director of the Niram-RIMH Palliative Care Centre in Tumkur, Karnataka, raised critical concerns regarding the lack of accessible and equitable palliative care in India. 

• Despite the inclusion of palliative care in India’s National Health Policy, 2017, millions continue to suffer from chronic pain and psychological distress, particularly during terminal stages of illness.
• A recent commentary by Dr. Shetty underscores the urgent need for systemic reform, capacity building, and integration of palliative services within India’s healthcare system. 
• His analysis comes at a time when the global burden of non-communicable diseases (NCDs) like cancer, diabetes, and heart disease continues to rise, making it essential to reorient health systems toward not just cure, but also comfort and dignity.

Background

What is Palliative Care?

The World Health Organization (WHO) defines palliative care as an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering using early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual.

It does not aim to cure the disease but rather focuses on:

• Alleviating suffering
• Managing pain and symptoms
• Providing emotional and psychological support
• Respecting the dignity and choices of patients
• Supporting families during and after bereavement

Globally, 40 million people require palliative care annually, with 78% of them in low- and middle-income countries (LMICs) like India. Yet, only 14% of patients worldwide have access to such care.

Features of Palliative Care in the Indian Context

A Vast, Unmet Need

In India:

• An estimated 7 to 10 million people need palliative care annually.
• Less than 2% have access to it.
• Most care is concentrated in urban tertiary hospitals, leaving rural and semi-urban patients dependent on informal or inadequate support.

A Shift in Disease Burden

With the rise of NCDs and ageing populations, the demand for palliative services is surging. Conditions such as:

• Cancer
• Cardiovascular diseases
• Chronic respiratory disorders
• End-stage renal disease 

Policy Support (2017 Onward)

The National Health Policy (2017) formally recognised palliative care, advocating its inclusion in primary healthcare services. Since then:

• The Indian Council of Medical Research (ICMR) and AIIMS have launched research and pilot projects on pain management.
• Community-based models in Kerala and Karnataka have gained prominence.

Yet, implementation remains uneven, and national-level integration is lacking.

Innovative Practices

Dr. Naresh Shetty’s Niram-RIMH Centre, supported by the Ajit Isaac Foundation, is an example of community-integrated palliative models offering:

• Home-based support
• End-of-life counselling
• Psychosocial therapies
• Family education and bereavement support

Challenges in Implementing Palliative Care in India

Severe Shortage of Trained Workforce

• While India has a doctor-population ratio of 1:834, palliative care specialists are extremely limited.
• Most doctors, nurses, and paramedics receive little or no training in pain relief or psychosocial support.
• Even medical graduates are often unaware of ethical frameworks or communication protocols required in end-of-life situations.

Urban-Rural Divide

• Urban hospitals offer sporadic palliative units.
  
• In rural India, where 70% of the population lives, such services are virtually non-existent.
• The few existing NGOs or hospices lack resources, personnel, and sustainable funding.

Lack of Public Awareness

• The general population often misunderstands palliative care as only applicable for the dying or terminally ill.
• Many patients approach care only during the last stages of illness, losing valuable time for relief.

Funding and Infrastructure Gaps

• Palliative care is not a priority in government or private health budgets.
• It receives negligible insurance coverage, despite the growing evidence of its cost-effectiveness in reducing hospitalisation and medical expenditure.

Legal and Regulatory Uncertainty

• India has no national palliative care law.
• The Narcotic Drugs and Psychotropic Substances (NDPS) Act complicates access to essential pain-relief medications like morphine due to overregulation and fear of misuse.
• Ethical dilemmas around life-support, DNR (Do Not Resuscitate), and euthanasia further muddy clinical practice.

Way Forward: Building a Compassionate Health System

Integrate Palliative Care into Medical Education

• Introduce mandatory palliative care modules in MBBS, nursing, and paramedical courses.
• Promote interdisciplinary training involving oncologists, psychologists, geriatricians, and community health workers.

Task-Shifting and Workforce Expansion

• Empower India’s 34.33 lakh registered nurses and 13 lakh allied health professionals through short-term certification courses in palliative support.
• Adopt the “task-shifting” model, wherein trained nurses or community workers provide frontline care under physician supervision.

Expand Ayushman Bharat and Insurance Coverage

• Include palliative and end-of-life care under PM-JAY (Ayushman Bharat) and the Employee State Insurance (ESI) schemes.
• Develop a public-private palliative care model where both sectors are incentivised to offer community-level services.

Fund Community-Based Palliative Centres

• Encourage state-level palliative care missions, especially in high NCD-burden states like Kerala, Punjab, Karnataka, and Maharashtra.
• Provide funding support for setting up mobile palliative units, day-care hospices, and helplines.

Raise Public Awareness and Destigmatise End-of-Life Care

• Use mass media, social platforms, and National Health Mission campaigns to sensitise people to:
  • The benefits of early palliative intervention
  • Advance care planning
  • Legal rights of terminal patients
  • Bereavement and caregiver support

Reform Legal and Regulatory Framework

• Simplify the licensing of opioids for medical use under the NDPS Act.
• Enact a National Palliative Care Act to:
  • Define rights and responsibilities
  • Standardise service delivery
  • Clarify medico-legal issues (e.g., informed consent, DNR orders)
  • Promote ethical end-of-life decision-making

Learn from Global Best Practices

• United States: Strong hospice models funded by Medicare and private insurance.
• Australia: Community-led palliative models with GP partnerships.
• Kerala (India): Community volunteers and local governance provide home-based care, reducing patient suffering at scale.

Conclusion

A truly humane health system must not just cure but also care. In a country as populous and diverse as India, millions endure silent suffering, not because their diseases are untreatable, but because the system fails to support them with dignity and compassion in their final journey.

MAINS PRACTICE QUESTION

Question: How can India strengthen its palliative care delivery through integration in medical education and task-shifting to allied health professionals? Illustrate with examples.

PRELIMS PRACTICE QUESTION