In India, millions endure unnecessary suffering, making it imperative to integrate palliative care into its health-care system. Palliative care plays a crucial role in providing comfort and ensuring dignity to those navigating terminal conditions. Despite its proven impact, palliative care remains critically underfunded and underutilised in India, leaving millions without the support that they desperately need.
Palliative care, which is a form of specialised care addressing a person’s physical, emotional, social and spiritual needs, remains a critical, yet underappreciated, component of health care. Unlike curative treatment that is aimed at eradicating disease, palliative care focuses on alleviating pain, reducing suffering, and improving quality of life — for patients and their families.
According to the World Health Organization (WHO), an estimated 40 million people globally require palliative care each year, with 78% of them living in low and middle-income countries. However, only 14% of those in need receive such care. In India, where an estimated seven million to 10 million people require palliative care annually, only 1%-2% have access to it. This gap underscores the urgency for systemic intervention and policy prioritisation.
The demand for palliative care is increasing constantly due to the global rise in non-communicable diseases such as cancer, diabetes and chronic respiratory conditions. India’s health-care system, which is already strained, faces increasing pressure, making it essential to integrate palliative care to reduce unnecessary hospitalisations and ease the emotional and financial burden on families.
The challenges in India
The inclusion of palliative care in the National Health Policy of 2017 in India marked a pivotal step in addressing the gap. Subsequent efforts in capacity building, community outreach and collaboration with global organisations have fostered growth in this field. However, even today, access remains uneven, especially in rural areas, and primarily among economically disadvantaged populations. Each year, approximately 7.2 million Indians need palliative care, yet systemic inefficiencies hinder its effective delivery.
One of the primary barriers is the shortage of trained professionals. Many doctors lack specialised training in palliative care, limiting their ability to provide comprehensive pain management and end-of-life care. While India’s doctor-population ratio of 1:834, surpasses the WHO recommended norm of 1:1000, the availability of medical practitioners specialising in palliative care is disproportionately low.
Limited funding and lack of proper infrastructure further exacerbate the challenges. While palliative care is included in the primary health sector, its integration into tertiary care remains incomplete. Additionally, public awareness of palliative care remains limited, leading to misconceptions and late-stage access to these critical services.
Linking it with medical education
Strengthening the capacity of doctors to deliver this care, particularly in underserved regions, is imperative. In order to equip medical professionals with the skills and the empathy required to address end-of-life care, integrating palliative care into the core MBBS curriculum is crucial. The projects on pain and palliative care by the Indian Council of Medical Research and the All India Institute of Medical Sciences exemplify gradual progress in this area.
Given the limited availability of palliative care specialists, task-shifting (delegating responsibilities to trained allied health-care workers) emerges as a viable solution.
India has a huge base of 34.33 lakh registered nursing personnel and 13 lakh allied health-care professionals. Empowering this workforce through targeted training can help bridge the gap, ensuring holistic care, particularly in rural areas and underserved regions.
Policymakers must recognise the long-term benefits of investing in palliative care, from improving patient outcomes to reducing the overall burden on the health-care system. Governments should allocate dedicated funding for palliative care programmes, ensuring that public and private health-care facilities are equipped with the necessary infrastructure.
Insurance schemes such as Ayushman Bharat should expand coverage to include palliative care, making these services more financially accessible to patients and families. Partnerships with non-governmental organisations and private institutions can also accelerate the expansion of these facilities.
Raising public awareness
Public awareness campaigns can demystify palliative care and encourage early access to services. Many patients and families are unaware that palliative care extends beyond end-of-life support and includes pain management, psychological support, and improved quality of life at any stage of a serious illness. Educating communities about these benefits can drive demand and policy changes.
The United States has a well-established palliative care system that is driven by robust funding mechanisms, insurance coverage, and hospice care models. Most importantly, in the U.S., there is an emphasis on end-of-life care, which involves substantial and progressively rising health-care expenditures — an indication of how robust funding and insurance systems support comprehensive, patient-centered care, offering a model that India can learn from while balancing costs and dignity.
India can study and adapt these practices while considering its unique cultural, demographic and economic context. Continuous research and the adoption of evidence-based practices are essential for improving care delivery and patient outcomes.
Integrating palliative care into India’s health-care framework has become inevitable. A multi-pronged approach of prioritising capacity building, embedding palliative care in medical education, empowering allied health professionals, and addressing systemic challenges can transform the landscape of end-of-life care in the country.
Dr. Naresh Shetty is an Orthopaedic Surgeon, Hospital Administrator and Project Director, Niram-RIMH Palliative Care Centre in Tumkur, Karnataka, supported by the Ajit Isaac Foundation (AIF). Dr. Avani Prabhakar is an Assistant Professor of Medicine at The Johns Hopkins University School of Medicine
Published – July 03, 2025 12:08 am IST
