14-05-2025
On palliative care, India has the blueprint for success — it must implement it
Written by N M Mujeeb Rahman
The Human Development Index 2025 (HDI) report ranked India 130th out of 193 countries, underscoring persistent inequalities in health, education, and income. While national life expectancy has improved, the report highlights how access to healthcare — especially quality care for vulnerable groups — remains deeply unequal. One of the most overlooked examples of this inequality is end-of-life care.
According to the United Nations World Population Prospects, India's elderly population — those aged 60 years and above — is projected to increase from around 149 million in 2022 to over 300 million by 2050. At the same time, non-communicable diseases like cancer, heart disease, stroke, and dementia now account for more than two-thirds of all deaths in the country, according to the Ministry of Health and Family Welfare. Yet millions who live — and die — with chronic, life-limiting illnesses receive little to no palliative care.
The scale of suffering is staggering.
The Lancet Commission on Global Access to Palliative Care and Pain Relief estimates that more than 60 per cent of India's 10 million annual deaths involve serious health-related suffering that could be relieved with appropriate care. Yet less than 2 per cent of India's population has access to any form of palliative support. Meanwhile, data from the National Crime Records Bureau (NCRB) shows that over 31,000 people died by suicide in 2022 due to illness and disability — a stark reflection of how untreated pain and despair can become fatal.
Despite these grim realities, palliative care remains largely absent from India's public health priorities. In much of India, healthcare continues to focus exclusively on curing disease. When a cure is no longer possible, patients are often sent home — in pain, isolated, and unsupported.
Kerala: A different story
Today, nearly 70 per cent of Kerala's population has access to some form of palliative care — a remarkable contrast to the rest of the country. Across towns and villages, it is not unusual to see trained volunteers, often accompanied by doctors, nurses or physiotherapists, visiting bedridden elders and those with chronic illnesses in their homes. They offer not just medications and wound care, but something far more valuable: Conversation, human presence, and dignity.
The state's approach is community-driven, professionally supported, and publicly funded.
Many local self-governments — panchayats and municipalities — run palliative care clinics, employing trained healthcare workers while relying heavily on networks of community volunteers. Rather than treating palliative care as a luxury or a specialist domain, Kerala has made it a basic public health service, accessible and available to all. The roots of this model go back more than two decades to the Neighbourhood Network in Palliative Care (NNPC), an initiative started in Kozhikode. It championed a simple but transformative idea: That with proper training, ordinary citizens could provide critical support to those suffering from serious illnesses. The NNPC promoted decentralisation, local ownership, and a focus on strengthening human connections alongside clinical care. And it worked.
Why the rest of India has struggled
However, replicating Kerala's success across the country has proved challenging. Most Indian states still lack a coherent palliative care policy. Budgetary allocations are either absent or insufficient. Where palliative services exist, they are often driven by isolated NGOs or passionate individuals rather than systemic government support. Moreover, local self-governments outside Kerala are rarely empowered or resourced to lead healthcare initiatives in the way Kerala's panchayats have been.
There is also a deeper issue: A conceptual gap in understanding palliative care itself. It continues to be seen narrowly as an end-of-life service for cancer patients, rather than as a comprehensive support system for anyone living with a serious chronic illness — whether that is advanced heart failure, stroke, dementia, or long-term neurological conditions.
What must change
If India is to truly address the needs of its aging, chronically ill population, four steps are urgently needed:
One, India must strengthen and fully implement the existing National Programme for Palliative Care (NPPC), ensuring it has adequate budget allocations and clear accountability mechanisms. Two, it must integrate palliative services into the primary healthcare system, ensuring every Primary Health Centre (PHC) and district hospital provides basic palliative support. Three, empower and resource local self-governments to lead community-based palliative care initiatives, following Kerala's example.
Four, the national narrative must be changed — palliative care has to be seen as a human right, not a specialist privilege, and must be embedded into mainstream medical education and public health programmes.
India already holds the blueprint for success. Kerala's experience demonstrates that compassion can be organised, suffering can be alleviated, and dignity can be made a public health goal. But achieving this nationally will require political will, civil society engagement, and a public commitment to making invisible suffering visible — and addressable.
The choice before us is clear.
We can either continue to neglect millions at their most vulnerable, or we can build a healthcare system that truly values not just life, but the quality and dignity of life, until its very end.
The writer is co-founder, Global Palliative Doctors Network
