The campaign is over. The pain is not. On 10 October, the global palliative care community spoke with one voice: pain management is an essential part of palliative care. Eleven days later, the hashtags have gone quiet, the webinar recordings are filed, and the press releases have done their work.
The patient in a district hospital who was in pain on 9 October is still in pain today. If nothing changes in her ward, our campaign spoke past her.
This is the uncomfortable question every awareness day has to answer: what happens on day 11, day 90, day 300? If the honest answer is “we wait for next October”, then we have built a ritual, not a movement. This piece is an argument for using the next twelve months differently, and a practical guide to tracking whether we do.
The campaign trap
We are good at the day itself. Every October, hundreds of events across dozens of countries, thousands of posts, letters to ministers, media interviews. We count all of it, and we should.
But look at what we usually report afterwards: reach, impressions, events held, toolkits downloaded. These are outputs. They tell us we were busy. They do not tell us whether one more patient got morphine, whether one more nurse can now prescribe it, or whether one ministry moved palliative care into its budget line.
The trap works like this. A campaign generates commitments in October. Nobody writes them down in one place. By January, attention moves to the next grant cycle, the next report, the next crisis. Next, we are designing a new theme. The commitments made last year are never revisited, so the people who made them are never asked about them.
That is how a movement slowly turns into a calendar. Awareness is necessary. It has never been sufficient.
What “essential” commits us to
This year’s theme, Pain Management: An Essential Part of Palliative Care, was not a slogan. “Essential” is a claim with consequences. If pain relief is essential, then its absence is a failure of the health system, not a regrettable gap.
The evidence landed in the same week. The third edition of the Global Atlas of Palliative Care, launched in Montréal on 9 October, estimates that 73.5 million people need palliative care every year. About 14% of that need is met by specialised services. In low- and middle-income countries, it is 4% (ehospice).
On pain specifically, the Atlas finds that 75% of the world’s population has little or no access to essential controlled medicines. Among the 10.6 million children who need palliative care, 96.2% live in low- and middle-income countries (ehospice).
There is good news too. Specialised services grew from about 25,000 to 33,720 between 2017 and 2025, and patients served rose from about 7 million to over 10.4 million. Progress is possible. It is also uneven, slow, and too easy to celebrate on one day and forget on the next.
So the theme gives us a test. Twelve months from now, can more people in pain get relief than today? If we cannot answer that question with evidence, we have not finished the campaign.
What to measure
We should stop asking “how many people did we reach?” and start asking “what changed, for whom, and who made it change?” That means tracking a short set of outcomes, not a long list of activities.
The tools already exist. WHO has published actionable indicators for palliative care development, and the Atlas now gives us a fresh 2026 baseline. The International Narcotics Control Board publishes national opioid consumption every year. We do not need a new measurement system. We need to use the ones we have, together, and on a timetable.
Here is a starter set that any national association can adopt this quarter.
| Level | What to track | Where the data comes from | Change we want by October 2027 |
| Commitments | Every pledge made around WHPCD 2026, with owner and deadline | A public commitment register kept by each national association | Each pledge marked kept, in progress or broken |
| Policy | Palliative care and pain relief in the national health plan, benefits package and budget | Ministry documents, budget statements, Atlas country data | At least one concrete policy step per country |
| Medicines | Oral morphine on the national essential medicines list and in stock at district level | INCB consumption data, facility stock checks | Fewer stock-outs; consumption moving toward estimated need |
| Workforce | Nurses and clinical officers trained and authorised to prescribe or dispense opioids | Training records, regulatory changes | A rising count, reported by district |
| Services | Facilities offering pain assessment and relief, including for children | Service directories, Atlas updates | New services in under-served regions |
| Patients and families | Pain scores and family-reported experience of care | Routine use of tools such as the APCA African POS or IPOS | Reported pain controlled for more patients |
The last row is the one that matters most and the one we measure least. Until patients’ own reports of pain sit beside our policy wins, we are measuring the system around the patient, not the patient.
Two rules keep this honest. Publish the baseline before you publish the progress. And report what did not move with the same prominence as what did.
Who answers for what
Accountability fails when everyone is responsible, because then nobody is. Each actor in this system has a specific lever. Each should be asked, by name, whether they pulled it.
Governments and ministries of health. In 2014, every WHO member state endorsed World Health Assembly resolution 67.19 on palliative care. Twelve years on, the question is simple: is palliative care, including pain relief, in your national plan, your benefits package and your budget? If it is in the plan but not the budget, it is a promise, not a policy.
Regulators and pharmacy boards. Most of the barriers to morphine are not scientific. They are rules: who may prescribe, how many days’ supply, how many forms. Regulators should publish what they have reviewed this year and what they have changed.
WHO and regional offices. The indicators exist. Countries need technical support to report against them, and a regular regional moment where progress is compared openly.
Funders and development partners. Funding that ends at the campaign ends the work. We need multi-year support for the unglamorous parts: supply chains, training, data collection.
Industry and supply chains. Oral morphine is cheap to make. Its absence in many markets is a commercial and logistical choice, and those making it should be asked to explain it.
Health professional bodies and training institutions. Pain assessment should be a core competency for every nurse, doctor, and clinical officer, not an elective for enthusiasts.
National associations and civil society. We hold the register. We publish the scorecard. We go back to the minister in March, not only in October.
WHPCA, ICPCN and global networks. This includes us. If we ask others to report, we must report too: what we committed to, what we delivered, and where we fell short.
Twelve months, four checkpoints
Accountability needs a timetable, or it becomes a mood. The global calendar already gives us natural checkpoints between now and next October. We should use every one of them.
accountability calendar · Oct 2026 to Oct 2027
Each checkpoint has one job: turn the October pledges into something written down, followed up, reported and published, so WHPCD 2027 starts with evidence rather than a blank page.
Don’t wait for October
Next year’s World Hospice and Palliative Care Day should not open with a new theme. It should open with a report card on this one.
So here is what I am asking of every reader, this month, not next year:
- Write down the commitments your country, organisation or institution made around 10 October. Put an owner and a date beside each one.
- Choose three indicators from the table above. Find your baseline in the new Atlas or your national data.
- Book the follow-up meeting now. The minister, the regulator, the funder. Put it in the diary for the first quarter of 2027.
- Share your register and baseline with your regional association and with WHPCA, so we can see the global picture together.
Pain does not keep a campaign calendar. Neither should we. The people we serve will judge this campaign not by what we said on 10 October, but by what we did in the 364 days after it.
Howard Kinyua
Communications Manager
The Worldwide Hospice Palliative Care Alliance (WHPCA)
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