Implementing the WHA resolution on palliative care – India

In India, health is administered at the state level. Though individuals have championed palliative care for decades, there is not yet a national palliative care policy. Though this has been drafted and handed over to central administration, it has not yet been implemented.

Only two states, Kerala and Maharashtra, have documented palliative care policies. In Kerala, there is dedicated funding to cover the whole state, in Maharashtra there is intermittent funding to cover 25% of the districts.

Education

Efforts have been ongoing for decades for palliative care to have comprehensive exposure in the undergraduate medical and nursing curricula.

In some universities all over the country, there have been certain levels of success. For example, the Maharashtra University of Health Sciences have allocated three hours teaching in 3rd year. However, implementation is poor.

There is palliative care content included in the Masters level nursing curriculum. A proposal to include palliative care in undergraduate nurses’ training has be submitted to Nursing Council of India. This is yet to be implemented.

A Diploma in Palliative Nursisng in in the nascent stage.

There is a one-year distance learning palliative care fellowship programme through Medical University – which is MD Palliative Medicine, as well as three years’ full time post graduate course in two medical colleges and possibly in two more this year.

Medication availability

Morphine, which belongs to India and WHO’s essential medication list, is not available in many parts of the country.

The issue is complex, and even after the amendment of the national policy on Narcotic Drugs and Psychotropic Substances.

There remain issues of affordability, access, as well as training of healthcare workers. Other strong opioids such as oxycodone and methadone are not available

Civil society have produced a report detailing progress on implementing the WHA Palliative Care resolution including case studies from India and other countries. You can download this from the Worldwide Hospice Palliative Care Alliance website.