While an estimated 14% of patients receive palliative care globally, such facilities are available for only less than 4% patients in India. At least one in five suicides in the country is committed by a person living with an advanced, chronic or life-limiting condition. The financial devastation a family faces is far greater at the time of illness due to lack of basic social security.
A recent study by Pune-based Association for Socially Applicable Research (ASAR) and Pallium India, Thiruvananthapuram, estimated that seven to 10 million Indians require palliative care every year and nearly 96% of people with serious health-related suffering are left without structured support. What is more worrying than the low number is the extreme geographical imbalance in the distribution of services and unavailability of such facilities for non-cancer patients in many states.
According to the analysis, Kerala stands out as a clear outlier, accounting for nearly 45% (234) of all palliative care centres in the country.
The state’s community-based model, strong civil society involvement and early policy support have made palliative care a routine part of healthcare delivery.
In contrast, many large and populous states with high disease burden remain critically underserved.
States like Uttar Pradesh, Bihar, Odisha, Jharkhand, West Bengal, Rajasthan and Madhya Pradesh together have fewer than 70 centres.
“This is because palliative care in India is dominated by care of cancer patients in the form of hospice care or end of life care. There is little awareness of the need for such care to improve the quality of life of non-cancer patients who live many more years than those with cancer,” said Dr Digvijay Kakde, an occupational therapist.
For every one patient with cancer that needs palliative care, there are 15-20 patients who do not have cancer but need similar care. These patients can lead productive lives because they are not terminally ill, unlike those who are referred to palliative care with cancer afflictions who often need end of life care.
“The government should integrate palliative care including non-cancer care into national health programmes and medical curricula to expand access across India. Policymakers must support workforce training, funding mechanisms and referral pathways,” Dr Borges added.