Context: Kerala is evolved as a unique model in the service delivery of palliative care through the community-based approach.  This article discusses various dimensions of Kerala’s successful palliative care model.

About Palliative Care

• Palliative care is a specialised approach to healthcare that focuses on improving the quality of life for individuals facing serious illnesses or conditions. 

• It aims to provide relief from pain, symptoms, and psychological distress, while also addressing the emotional, social, and spiritual needs of patients and their families.

• Palliative care is not limited to end-of-life situations and can be provided alongside curative treatments. It is appropriate for individuals with chronic illnesses, such as cancer, heart disease, or neurological disorders, as well as those with life-threatening conditions.

• Palliative care can be provided in various settings, including hospitals, hospices, long-term care facilities, and even in a person’s own home.

• More than 80% of individuals who experienced serious health-related suffering in 2015 were from low- and middle-income countries. 

• India’s capacity to address significant health-related suffering on a large scale is inadequate due to limited coverage of palliative care, which stands at approximately 4% and is concentrated primarily in major cities. 

• This poses a challenge considering the country’s middle-income status, ageing population, and increasing burden of non-communicable diseases.

Kerala Model

• Kerala stands out as a global example of a comprehensive and inclusive palliative care model. The model’s success extends beyond healthcare, demonstrating broader social and public innovations. 

• Kerala boasts one of the largest palliative care networks in the world, with over 841 palliative care sites out of India’s total of 908, as reported by The Lancet in 2018.

• The state has established a network of palliative care centres, community-based clinics, and home care services that work in coordination with hospitals and healthcare professionals. 

• Kerala’s model emphasises community involvement and participation in palliative care. Local volunteers, known as palliative care workers, play a crucial role in identifying patients, providing basic care, and supporting families. 

• For example, the Pain and Palliative Care Society in Calicut has been instrumental in delivering palliative care services to patients in need, reaching over 7,000 patients in 2020 alone.

• The volunteers went beyond traditional boundaries by extending their support to patients with unconventional conditions like spinal injuries, HIV/AIDS, and geriatric cases. They also recognized the social challenges faced by families in their communities when dealing with these conditions.

• Recognizing that a significant portion of a patient’s suffering is non-medical, the community-based model in Kerala emphasised holistic care. 

• This approach involved community ownership and provided comprehensive support, including medical, social, financial, bereavement, and rehabilitative assistance to patients and their families. 

• Kerala’s model differed greatly from hospital-based approaches prevalent elsewhere in the world.

• The need for the State’s involvement in palliative care was recognized by community organisers in Kerala by 2004. This led to the initiation of the Pariraksha project in Malappuram panchayats, which eventually paved the way for a landmark palliative care policy in 2008. 

• This policy mandated palliative care provision at primary, community, and tertiary levels across all 14 districts of Kerala.

Significance

• This model addresses the limited access and affordability of hospitals and hospices that are prevalent worldwide. 

• While only 14% of patients globally receive palliative care, Kerala’s model covers over 60% of patients in need.

• Kerala’s successful integration of palliative care into public health systems challenges prevailing myths about the “impossibility of public health infrastructure in India” or the belief that “the State cannot deliver healthcare.” 

• This model demonstrates that public health palliative care integration is not only feasible but also essential. By effectively integrating palliative care into the public health framework, Kerala showcases the potential of government-led initiatives in providing comprehensive healthcare services.

• The Kerala model highlights the role of community organisations in this regard. The formation of such inclusive and collaborative networks showcases the power of solidarity in building a resilient and effective palliative care system that caters to the diverse needs of the population.

Road Ahead

• Kerala’s community palliative care model, driven by volunteers and nurses, is considered a global exemplar in inclusive care infrastructure. The success of the model highlights the possibilities of public health integration and demonstrates how diverse groups can come together to create effective care infrastructure.