Context

In India, millions suffer needless physical and emotional pain, especially during the final phases of life, due to the limited availability of palliative care. Despite its critical role in easing pain and improving quality of life for patients with chronic or terminal illnesses, palliative care remains severely underfunded and underutilized. As non-communicable diseases surge and the healthcare system faces mounting pressure, integrating palliative care into mainstream health policy and practice has become both essential and urgent.

Importance of Palliative Care

Palliative care is a specialized medical discipline that attends to the physical, emotional, social, and spiritual needs of patients confronting serious illnesses. Unlike treatments aimed at curing diseases, palliative care emphasizes enhancing patient comfort, alleviating suffering, and preserving dignity throughout the illness trajectory, including at life’s end. The World Health Organization (WHO) estimates that approximately 40 million people globally require palliative care annually, with 78% living in low- and middle-income countries. However, only 14% of those in need receive such care. In India, where 7 to 10 million people need palliative services each year, access is available to only about 1–2%, underscoring significant systemic deficiencies.

Challenges Within India’s Healthcare System

• Implementation Issues: The rising prevalence of non-communicable diseases such as cancer, diabetes, and chronic respiratory illnesses intensifies the demand for palliative care. However, India’s healthcare infrastructure struggles to meet these needs. Although the 2017 National Health Policy recognized palliative care’s importance, its execution remains inconsistent, particularly in rural and poorer areas.
• Shortage of Trained Personnel: India has a doctor-to-population ratio of 1:834, surpassing the WHO recommendation of 1:1000. Yet, very few healthcare professionals receive specialized training in palliative care. Most doctors have limited education on pain management or end-of-life care, leading to variable quality and availability of services.
• Financial and Infrastructure Limitations: Insufficient funding and infrastructure gaps hinder the expansion of palliative care programs. While some integration exists in primary health care, palliative care is largely missing from tertiary health facilities.
• Lack of Public Awareness: Misconceptions persist, with many patients seeking palliative care only during the terminal stages, when interventions often have limited effectiveness.

Strategies for Overcoming Challenges

• Enhancing Medical Education and Allied Health Roles: Addressing systemic gaps requires a fundamental change in medical training. Incorporating palliative care into the MBBS curriculum would prepare future doctors with necessary clinical skills and empathy for end-of-life care. Initiatives by institutions like the Indian Council of Medical Research and AIIMS show promising progress. Moreover, task-shifting—delegating responsibilities to trained non-physician health workers—is a practical solution given India’s extensive nursing and allied health workforce. Targeted training and empowerment of these professionals can vastly improve community-based holistic care.
• Policy and Financial Reforms: Long-term commitment through policy reforms is crucial to build palliative care infrastructure and training programs. Expanding insurance schemes such as Ayushman Bharat to cover palliative services will make them more affordable. Allocating dedicated funds to establish palliative units in both public and private sectors is vital. Collaborations with NGOs and private institutions can broaden reach and enhance service quality. India can adapt global best practices—like the US hospice care model backed by insurance and funding—to develop cost-effective, dignified care tailored to local socioeconomic realities.
• Raising Public Awareness: Many people remain unaware that palliative care is not solely for end-of-life situations but also encompasses pain relief, psychological support, and improved quality of life throughout serious illnesses. Public education campaigns are needed to dispel myths, encourage earlier care-seeking, and build community support networks for patients and caregivers.

Conclusion

Integrating palliative care into India’s healthcare system is imperative from moral, medical, and social perspectives. A comprehensive strategy involving policy reform, curriculum changes, task-shifting, infrastructure investment, and public education is essential to ensure equitable access to palliative care. These efforts will improve patient outcomes and ease the financial and emotional burdens on families and the health system alike.