NEW DELHI: Nearly 7-10 million people require palliative care (PC) in India, but less than four per cent have access to it, said a latest study, which found that only Kerala, Delhi and Chandigarh provide better accessibility to these centres as compared to states like Madhya Pradesh, Odisha and Bihar.
The study, published in the ecancermedicalscience journal, said that the demand for palliative care in India is going to rise manifold as four in ten people are estimated to have at least one chronic disease, and the burden is expected to rise to address serious health-related suffering, which is commonly associated with end-stage chronic diseases like cancer.
It said there are various barriers to the poor delivery of palliative care in India, including an inequitable distribution of services and poor geographic access to health centres.
Speaking with this paper, Dr Parth Sharma, the lead author of the study, “Our analysis shows that access to palliative care in the country remains extremely poor, forcing people living with serious pain to travel long distances for adequate relief.”
“Yet improving access to palliative care and essential opioids for pain management does not require new infrastructure. Significant gains can be achieved simply by training more healthcare providers in palliative care and integrating these services across all levels of the existing health system,” said Dr Sharma from the Association for Socially Applicable Research (ASAR), Pune.
The study, which assessed the geographical accessibility of palliative care in India, said that in 2022, India had 526 palliative care centres -Pallium India (PCC-PI), with a density of four per 10 million population.
It found that Chandigarh, Delhi, Kerala, and Goa had good access to PCs, while most other states/UTs, especially in the north and northeastern parts of the country, need to improve PC accessibility in their regions.
The other states with better accessibility are Puducherry, Haryana, Punjab, Dadra and Nagar Haveli and Daman and Diu.
While Chandigarh had the shortest median travel time of just three to four minutes, Ladakh had the longest time of 350 minutes to reach these centres.
Rural areas had worse access than urban areas, with considerable variation across states.
Dr Sharma further said that their analysis assumes that people own vehicles and that road conditions are good, with no traffic delays during travel. “Even under these favourable assumptions, our findings show that access to palliative care remains extremely poor in most regions of the country.”
The study found that nationally, only 23.7% of the population resided within 30 minutes, 39.9% within 60 minutes and 71% within 120 minutes of the nearest PCC-PI.
The coverage of PCC-PIs was worse in rural areas with only 11.8% of the population within 30 minutes, 29.3% within 60 minutes and 65.2% within 120 minutes as compared to the urban areas. In urban areas 55.6% of the population was within 30 minutes, 68.3% within 60 minutes and 86.2% within 120 minutes of the nearest PCC-PI.
However, it found that access improved significantly when PCs were integrated into all levels of the healthcare system.
Added Siddhesh Zadey, the corresponding author of the study, “Geography is often ignored in talks around universal health coverage, although it's an important determinant. Where you are placed can change your life, including your health access.”
“The longer it takes someone to reach their nearest palliative care centre, the more unlikely it is that they are receiving regular and affordable care,” said Zadey, co-director from ASAR, a non-profit company that works to advance research, awareness, and action on social issues.
He said the study is part of the larger work on timely access to healthcare within its flagship IndoHealMap project, under which they are building access-to-care maps for around 3,00,000 healthcare facilities.
The study also pointed out that the “limited training courses and limited awareness of PC in India also make establishing PC departments in public hospitals at all service delivery levels – primary, secondary and tertiary – challenging.”
This is also because, as per the guidelines of the National Medical Commission (NMC), it is not mandatory to establish a department for PC.
The World Health Organisation (WHO) defines palliative care as ‘an approach that improves the quality of life of patients - adults as well as children - and their families who are facing problems associated with life-threatening illness.’
Recognising the impact of PC on patients' and caregivers' quality of life, in 2014, the WHO passed a resolution urging member states to provide PC services as part of comprehensive care.
PC is most commonly needed for patients suffering from cardiovascular diseases, chronic respiratory diseases, cancer and neurological illnesses, among others. Researchers said patients with last-stage cancer account for nearly one-third of all PC needs.