The Government’s revised non-communicable diseases guidelines were criticised for the lack of focus on palliative care.
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.
It aims to identify patients at risk of over-medicalisation at the expense of quality of life and financial burden on the family.
It is an approach to care that addresses the person as a whole, not just their disease
Palliative care is available at any time, regardless of the stage of the illness or life expectancy whereas Hospice care is available only at the end of life.
Prevalence of NCD
As per World Health Organization (WHO),
Global Scenario - There is one death from non-communicable diseases (NCDs) every 2 seconds.
NCDs, along with mental illnesses, kill 41 million people each year across all age groups.
Of all NCD deaths, 77% are in low- income and middle-income countries (LMICs).
Indian Scenario - 66% of all deaths can be attributed to NCDs, with cardiovascular diseases accounting for 28% of these deaths and chronic respiratory diseases 12%.
In 2019, the report showed that India had one of the highest death rates from chronic respiratory diseases.
Why is palliative care so significant?
Symptom managementPalliative care specialists may help people with symptom and pain management.
Improved quality of life- As per a report, amongst the Parkinson’s disorder affected people, those who received palliative care scored three points higher in the quality of life.
Reduced risk of depression-Early palliative care is associated with a lower risk of depression in people newly diagnosed with advanced cancer.
Longer survival- Palliative care increases the survival of people with advanced cancer as there is a link between mortality and depression.
Emotional Support -Palliative care can include instructional guidance and emotional support for family members caring for a loved one with a serious illness.
What steps were taken to promote Palliative care?
Policy - Only three states have implemented the palliative care policy - Kerala, Karnataka, and Maharashtra.
Among them, Kerala is the only state with a policy which integrates palliative care with the public health system and it is decentralized down to the primary health care.
National Program for Palliative Care- It was launched in 2012 in line with 2014 World Health Assembly Resolution for achieving universal access to palliative care as part of Universal Health Coverage (UHC).
NP-NCD & NCD Guidelines- In 2023, the revised operational guidelines of National Programme for Prevention of Non-Communicable Diseases for 2023 to 2030 was released.
75/25 initiative- It is an initiative in which 75 million people with hypertension and diabetes is put on Standard Care by 2025, through the primary health care centres.
Shashakt Portal-It was launched for training of 40,000 primary health care medical officers on standard treatment workflow.
Other programs that has Palliative care as a component includes
National Program for Prevention and Control of Cancer, Cardiovascular Disease, Diabetes, and Stroke
National Program for Health Care of the Elderly
National AIDS Control Program
National Health Mission
What are the gaps in the revised NCD guidelines?
Accessibility- Palliative care is accessible to only 1-2% of the estimated 7-10 million people who require it in the country.
Misconceptions- As per Global Atlas of Palliative Care, in 2020, the need for palliative care was higher for non-cancer illnesses.
However, the revised NCD operational guidelines, released in 2023, mentions palliative care is in synonym with cancer only.
Infrastructure deficit – As per revised guidelines, generally palliative care service starts in district hospitals and there is no mention on home based care.
Lack of dedicated budget- There is no specific budget dedicated for the palliative care.
Lack of awareness- It is due to lack of awareness among policy-makers, health professionals and the public about the palliative care and its benefits it can offer to patients and health systems.
Indicator to assess the programme’s impact- Including an indicator to assess morphine access is a welcome move, but an indicator focusing only on patients with cancer might lead to an inaccurate assessment of coverage of services.
What lies ahead?
The 67th World Health Assembly in 2014 called for palliative care to be integrated into health systems at all levels.
It is high time to realise the ongoing pandemic of non-communicable diseases in India and to strengthen our palliative care services.
