Across the world, millions of people continue to live and die with preventable suffering. In 2021 alone, an estimated 73.5 million people experienced serious health-related suffering (SHS)—a term that encompasses pain, distress, and the severe limitations caused by life-threatening or life-limiting conditions.
Alarmingly, 80% of these individuals reside in low- and middle-income countries (LMICs), where access to palliative care remains scarce or inconsistent.
Recognizing this urgent need, the Lancet Commission on Global Access to Palliative Care and Pain Relief (2018) introduced the concept of SHS and proposed an initial Essential Package for palliative care and pain relief (PCPR). While that package represented a milestone in defining minimum standards, its application across countries was limited and it did not adequately address complex or specialized needs.
To bridge this gap, a team of global experts led by Dr. Tania Pastrana and colleagues conducted a comprehensive Delphi study, published in the Journal of Pain and Symptom Management (2025). This research—“Global Consensus-Based Essential and Expanded Packages for Palliative Care and Pain Relief for Adults and Children”—marks a major advancement toward achieving equitable and universal access to palliative care.
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Key Findings: A Global Consensus on what’s Essential
The study used a multistage, modified Delphi method involving palliative care professionals from over 75 countries, representing diverse regions and income levels. Two separate expert panels—one for adults and another for children—participated in two rounds of review, followed by an external validation by global experts.
Through this rigorous process, consensus was achieved on updated Essential Packages for both adults and children, ensuring they remain evidence-based yet adaptable to varied healthcare contexts. The Essential Adult Package now includes 19 medications, 10 essential equipment items, and 10 core professional roles. The Essential Pediatric Package consists of 22 medications, 13 equipment items, and 7 professional roles.
Several important updates were made:
– New essential items such as paracetamol suppositories were added to ensure flexible administration routes.
– Basic supplies like wound dressings, oral care kits, thermometers, gloves, and antiseptic solutions were incorporated, reflecting the real-world needs of clinicians in low-resource settings.
– Human resources were expanded to include spiritual care providers, pharmacists, and physical therapists, acknowledging the multidisciplinary nature of quality palliative care.
Beyond these, the study introduced Expanded Packages for both adults and children, designed to address complex or specialized care needs. The Expanded Adult Package includes 39 medications, 18 equipment items, and 10 professional categories, while the Expanded Pediatric Package encompasses 44 medications, 53 equipment items, and 15 professional roles. These expanded sets allow countries with greater resources—or those progressing toward advanced palliative services—to provide a fuller range of interventions.
Global Implications: A Framework for Universal Health Coverage
The significance of these consensus-driven packages extends beyond clinical care—they represent a practical, adaptable framework for integrating palliative care into health systems worldwide.
Aligned with the World Health Assembly Resolution WHA67.19, the packages embody the principle that palliative care is a public health responsibility and a core component of Universal Health Coverage (UHC). By outlining the minimum medicines, equipment, and workforce requirements, they provide a road map for governments and health systems to systematically expand access, even within limited budgets.
Importantly, the packages are intentionally low-cost, scalable, and designed for use across all levels of healthcare, especially at the primary care level. In practice, this means that basic symptom relief—such as pain control, wound care, and psychosocial support—can be delivered closer to where patients live, reducing the burden on tertiary hospitals and enabling compassionate end-of-life care at home or in the community.
For countries striving toward UHC, the packages offer measurable guidance for planning, budgeting, and monitoring. They can be directly incorporated into national essential health service lists, benefit packages, and training curricula, ensuring palliative care is no longer viewed as optional but as integral to quality healthcare delivery.
Challenges and Barriers: Persistent Inequities
Despite this encouraging progress, the study underscores ongoing challenges that threaten equitable access to palliative care globally.
Medication availability remains deeply unequal. None of the medicines listed in the essential packages were reported as universally available. For instance, injectable diphenhydramine was unavailable in nearly one-quarter of countries surveyed, and oral morphine—a cornerstone of pain management—was missing in over 20% of low- and middle-income countries. Shortages also extended to basic items such as lactulose and petroleum jelly in the poorest nations.
These disparities highlight the combined effects of restrictive opioid regulations, weak supply chains, and insufficient government prioritization of palliative care. Without systemic reforms, millions will continue to suffer needlessly from untreated pain and distress.
Another key finding was the limited awareness among healthcare professionals. Over 40% of participants were unfamiliar with the Lancet Essential Package or WHO’s pediatric equivalent. This gap reflects the broader marginalization of palliative care education and training in medical and nursing curricula, even as global health frameworks increasingly emphasize UHC.
Recommendations: Turning Consensus into Action
To translate this research into tangible impact, the study proposes several actionable strategies for governments, health systems, and global partners:
- Integrate the Packages into National Health Policy
Ministries of Health should formally adopt the Essential and Expanded Packages as part of their national health benefit schemes or palliative care guidelines. This policy alignment ensures that essential medicines and human resources become part of publicly financed healthcare.
- Strengthen Supply Chains and Regulation
Governments must work with international agencies to ensure the consistent availability of key medications, especially opioids like morphine. Simplifying regulatory processes, improving procurement systems, and training pharmacists in safe opioid handling are critical steps.
- Invest in Workforce Training and Education
Health professional curricula should incorporate the safe prescribing and use of palliative care medications and equipment. Training community health workers can further extend services to rural and underserved areas, fulfilling the principle of “palliative care for all.”
- Raise Awareness and Build Advocacy Networks
Greater dissemination of these packages through professional associations, civil society, and global platforms like eHospice can build momentum for policy change. Highlighting patient stories and community impact can humanize the data and mobilize public support.
5. Monitor Implementation and Evaluate Outcomes
Establishing systems to track availability, utilization, and patient outcomes will enable countries to measure progress and identify gaps. Linking the packages to local cost and burden data can further strengthen advocacy for sustainable funding.
A Shared Vision for Compassionate Care
The Essential and Expanded Packages for Palliative Care and Pain Relief represent more than clinical guidelines—they symbolize a collective global commitment to alleviating preventable suffering. By defining what every health system should provide at minimum, they transform compassion into a measurable standard of care.
If adopted widely, these packages could help realize the vision of “no one left to suffer without relief”—a cornerstone of Universal Health Coverage and human dignity. For policymakers, practitioners, and advocates alike, they provide both a framework and a moral imperative: to ensure that comfort, care, and dignity are within reach for every person, in every country, at every stage of life.
As the global community continues to confront rising rates of serious illness, this consensus-driven effort offers a hopeful pathway forward—one where science, compassion, and justice converge to redefine what it truly means to care.
Disclaimer: This article was produced with the support of AI.
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Author Bio: Sumit Banik is a public health activist, writer, and trainer from Bangladesh, known for his dedicated work in advancing palliative care services nationwide. He has played a key role in promoting awareness and advocacy for equitable access to compassionate end-of-life care. Through his initiatives, Mr. Banik strives to strengthen Bangladesh’s healthcare system by fostering empathy, dignity, and inclusiveness in care delivery. His professional mission focuses on crafting narratives that inform, inspire, and drive meaningful social change in the field of public health. You can reach the author via E-mail: sumitbd.writer@gmail.com
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