Why the palliative healthcare model of Kerala needs to be extended to other states

Palliative care is the total care of patients suffering from incurable diseases. “Palliative care responds to physical, psychological, social and spiritual needs of the patients and their families and extends if necessary to support the family in bereavement. It is patient centered, and not disease-focused,” reads the website of Institute of Palliative Medicine in Kerala. Nationally, there are around 50 lakh people who need palliative care but only 2% of them get it.

The anomalous case of Kerala

The situation nationally is pretty grim but Kerala has been able to combat this issue. Out of the 1.25 lakh people needing palliative care in the state, 50% of them have access to palliative healthcare owing to efforts of organizations like the Institute of Palliative Medicine. There are different facets like Outpatient care, inpatient care, home care and rehabilitation which the institute looks into and in its two decades of existence, has been able to setup a framework that can solve the problem in India.

“There are close to a 1000 palliative care clinics in India and 80% of them are in Kerala. These are either run by NGOs or are established at the Panchayat level,” says Dr. Suresh Kumar, an Ashoka Fellow and a founding member of the IPM. Also another one of those Pareto problems- 80% of the patients needing palliative care are in the developing world while only 20% of the services are available here.

Why Kerala has been able to do this:

The ‘Kerala Community Model’ of healthcare has been lauded widely and has worked because of the following reasons:

· One of the first of India’s states to relax narcotics regulations to permit use of morphine by palliative care providers.
· Kerala has also extended the definition of palliative care to include the long-term chronically ill and even the mentally incapacitated.
· Kerala's formal palliative care policy, the only state with such a policy, the community-based Neighborhood Network in Palliative Care (NNPC) Project that employs an army of volunteers and the Government funding for these local community-based care units, almost 260 in number, has earned it many an accolade.

The need to grow beyond Kerala:

The Economist had conducted a survey on the ‘Quality of Death’- ranking end-of-life care across the world in 40 countries and India stood last in the survey behind countries like Uganda. But within India, Kerala bucked the trend. The State’s community-operated care system is funded largely through local micro-donations of as little as Rs 10 (21 US cents) per month and has worked well. Studying Kerala's combination of Government support and civic involvement in end-of-life care, a number of similar models are being tried out in Ethiopia, Bangladesh, Seychelles and even in Switzerland.

But beyond this, there is a serious need for the other states in the nation to wake up to this problem and address it.

These and more issues will be discussed at the Ashoka Future Forum which is being organized from the June 27-29th in Pune.


By Jubin Mehta