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Palliative care in India

GS Paper 2

 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.