THIRUVANANTHAPURAM: India may not be one of the nicest places to die of a chronic disease, lagging behind even Uganda in providing endoflife healthcare, but Kerala sure is, according to a white paper on the Quality of Death, released by the Economist on Wednesday afternoon in Singapore.
The report from 'The Economist' has ranked 40 countries across the world on endoflife care facilities on the basis of 24 indicators on healthcare environment and availability, cost and quality of care.
In the overall score, India with a score of 1.9 out of 10 ranked the 40th, behind countries such as Slovakia, Malaysia, Turkey, Brazil and even Uganda.
UK topped the list followed by Australia and New Zealand.
However, the report has projected the community model healthcare system from Kerala as a beacon of hope.
"While India ranks at the bottom of the index in overall score and performs badly on many indicators, Kerala if measured on the same points, would buck the trend. With only 3 percent of India's population, the tiny state provides twothirds of India's palliative care services," said the report.
Kerala, which extended palliative care to even the mentallyincapacitated, is also one of the first Indian states to relax narcotics regulations to permit the use of morphine by palliative care providers. Even Italy was ranked unexpectedly low at position 24 because of the poor access to opioid medication for pain management until recently.
Kerala's formal palliative care policy, the only state with such a policy, the communitybased Neighbourhood Network in Palliative Care (NNPC) Project that employs an army of volunteers and the Government funding for these local communitybased care units, almost 260 in number, has earned it many an accolade.
Twenty nine out of the 40 countries studied have no formal palliative care strategy, revealed the report. Only seven Australia, Mexico, New Zealand, Poland, Switzerland, Turkey and UK have national policies, while four others Austria, Canada, Ireland and Italy are in the process of drafting one.
Kerala had long ago recognised the importance of palliative care as can be seen from the growth of communitybased care units.
"The State's communityoperated care system is funded largely through local microdonations of as little as Rs 10 (21 US cents) per month.
The volunteers in these units, after training can provide psychological, social and spiritual support. It is this that marks the NNPC out from more medicaloriented and expensive systems in use elsewhere," said the report.
Studying Kerala's combination of Government support and civic involvement in endoflife care, a number of similar models are being tried out in Ethiopia, Bangladesh, Seychelles and even in Switzerland.
"Kerala provides a useful lesson for other countries, particularly as ageing population puts increasing pressures on existing healthcare services," said the report.
While countries such as Taiwan and Hungary have managed to get on the top 15 of the index, one possible reason cited for the poor show by India and China is their large population, with the care coverage reaching only a fraction of those in need.