Ten Years Since the Resolution – How is Bangladesh Faring?

World Hospice and Palliative Care Day (WHPCD) is a globally recognised annual event dedicated to raising awareness about the importance of palliative care for individuals living with life-threatening illnesses, and the profound impact it has on their quality of life. Observed on the second Saturday of October each year, WHPCD serves as a crucial platform for advocacy, education, and action, calling on governments, healthcare providers, and civil society to prioritise palliative care as an integral part of comprehensive healthcare. This year, WHPCD on October 12, 2024, carries special significance as it marks not just one but two major milestones: the 19th anniversary of the day itself and the 10th anniversary of the landmark World Health Assembly (WHA) resolution that called for the full integration of palliative care into healthcare systems worldwide. The 2014 WHA resolution was a pivotal moment for the global health community, officially recognising palliative care as a critical component of healthcare that must be accessible to everyone, regardless of geography, socio-economic status, or medical condition.

The theme for WHPCD 2024, “Ten Years Since the Resolution: How are we doing?” invites the global community to engage in a deep and honest reflection on the progress made in advancing palliative care over the past decade. It urges stakeholders to celebrate the achievements while also critically assessing the persistent gaps that prevent millions from accessing the care they need.

A Global Perspective: How Far Have We Come?

Since the WHA resolution was passed in 2014, calling on member states to “strengthen palliative care as a component of comprehensive care,” the field of palliative care has made remarkable strides, but significant disparities persist. In the years following the resolution, there has been an increase in palliative care services across the globe, with the number of services rising from 16,000 in 2011 to 25,000 by 2017. However, this only meets 12% of the global need, which leaves an overwhelming majority of people—especially those in low- and middle-income countries (LMICs)—without adequate access to care.

This inequality is a pressing concern for 2024. Despite ongoing advocacy and the establishment of palliative care programmes worldwide, only a fraction of people in LMICs, where over 80% of the global need resides, receive the care they require. Estimates suggest that in high-income countries, over half of the need for palliative care is met, while in LMICs only 4% is addressed. This “Access Abyss” underscores the challenge facing the global health community: ensuring equitable access to palliative care services for all, regardless of geographical or economic barriers.

The Bangladesh Context: Struggling to Meet the Demand

Bangladesh, like many other LMICs, faces a daunting challenge in integrating palliative care into its healthcare system. The country has made some efforts to establish palliative care services, but progress has been slow. Currently, there are only six comprehensive palliative care programmes available, all based in Dhaka. This centralisation highlights a glaring inequity, as most of the country’s population resides in rural areas, far removed from these essential services.

Moreover, awareness about palliative care among healthcare providers remains alarmingly low. Many physicians and healthcare professionals are unfamiliar with the concept, let alone equipped to provide the necessary care. The country’s healthcare system, burdened with other pressing challenges, has yet to prioritise palliative care integration on a national scale, despite the growing demand.

Under the 4th Health, Population, and Nutrition Sector Program (HPNSP), the government has recognised the need to address palliative care. Initiatives are underway to build awareness and capacity among medical professionals, particularly in the areas of pain management and end-of-life care. These efforts include developing national policies, strategies, and action plans aimed at integrating palliative care into primary healthcare and ensuring comprehensive pain management services are available. Yet, progress has been slow, and the country has a long way to go to meet its obligations under the 2014 WHA resolution.

Access to Pain Relief: A Crucial Gap

One of the most urgent issues in palliative care is access to pain relief. In Bangladesh, access to essential pain management drugs, including morphine, remains limited. The WHO has long emphasised that pain management is a critical component of palliative care, yet the availability of pain relief medicines in many LMICs is inadequate. This disparity results in needless suffering for millions of people, particularly those in the terminal stages of life.

In Bangladesh, there has been some progress, with both government and non-governmental organizations working to procure necessary drugs for pain management. However, logistical challenges, regulatory barriers, and lack of education among healthcare professionals have impeded broader access to these medications.

Palliative Care in Universal Health Coverage (UHC): The Road Ahead

Palliative care is an essential health service and should be a key component of Universal Health Coverage (UHC). The 2014 WHA resolution and subsequent global health policies have underscored the importance of integrating palliative care across all levels of the healthcare system. For Bangladesh, this means not only building capacity among healthcare providers but also ensuring that palliative care services are accessible at the primary care level and within communities.

The government’s recent focus on palliative care through HPNSP is a step in the right direction, but there is much more to be done. The integration of palliative care into UHC frameworks must be prioritised, with efforts focused on building awareness, developing infrastructure, and ensuring that pain relief medicines are available and affordable.

The Role of Advocacy: Moving Forward

As we commemorate WHPCD 2024, it is imperative that advocates for palliative care in Bangladesh and globally continue to hold policymakers accountable. The theme of this year—”Ten Years Since the Resolution: How are we doing?”—serves as a call to action. Stakeholders across the health sector must work to close the access gap and ensure that palliative care services are available to all who need them.

Efforts at the community level must also be scaled up. NGOs, local health groups, and religious leaders can play a crucial role in raising awareness and advocating for better access to palliative care. Engaging these groups in dialogue about palliative care’s importance in improving quality of life will be essential to overcoming cultural and logistical barriers.

A Long Way to Go

While the world has made significant progress in palliative care over the past decade, the journey is far from over. Bangladesh, in particular, faces significant challenges in ensuring that all people living with palliative care needs have access to the care and support they deserve. As we mark WHPCD 2024, let us take stock of how far we have come, but more importantly, recognise the work that remains to be done to close the gap and ensure equitable access to palliative care for all.