Articles
In the middle of the COVID-induced global landscape of death, on 31 January 2022, the ‘Report of the Lancet Commission on the Value of Death’ put forth the need for reassessing the future of palliative and end of life care.[1] In the UK, Cicely Saunders International, a charity promoting person-centred end of life care, revealed that the COVID-19 pandemic has amplified the demand for palliative care in England and Wales in 2020.[2] A recent policy analysis in the UK context found that palliative care was not a ‘specific priority’[3] in general healthcare policies. Even the WHO neglected palliative care in their COVID-19 response plans.[4]
High-quality palliative care training in the UK was one of the identified challenges in the Action plan for better palliative care by Cicely Saunders International, as the evidence suggests that only 1 in 10 nurses felt equipped to deliver good end of life care, according to the Royal College of Nursing’s most recent ‘End of Life Care Survey’.[5] The action plan also mentioned that ‘the average number of hours of palliative care training is around 25 hours and varies greatly between medical schools – as little as 7 hours in some cases’.[6] The action plan calls for strengthening and revitalising educational strategies for community-based actors and health professionals.
The aforementioned information is about a high-income country. India, a country from low-middle-income (LMIC) context, faces similar challenges for palliative care. The demography in India in the years 2000-2050 is predicted to see an increase of 326% in the 60-plus age category.[7] The state of Kerala has the highest ‘old age dependency ratio 19.6’ percent nationally.[8] One reason for increasing palliative demand in Kerala is cancer-related patients in the state. For example, at the Trivandrum Institute of Palliative Sciences (TIPS), a study on palliative needs revealed that 59% of the total patients had cancer during the years 2007-2016.[9] Yet, Kerala has a sustainable palliative care model to address these healthcare demands with its neighbourhood networks.[10] The backbone of this system is a point of care at home, a holistic approach to health, participation of local communities and their skill development.[11] The sustainability of palliative care was taken seriously during COVID-19 as the state government integrated palliative care advisors in the pandemic response in late March 2020.[12] One outcome of this was the ‘Palli COVID Kerala’, an e-resource toolkit on palliative care for a LMIC-context in a health emergency. Eleven countries make use of this toolkit. The Lancet Commission referred to the Kerala model of palliative movement as ‘something very close to the Commission’s realistic utopia’ as the report sees the sustainability of this approach achievable.[13] This has been attested in the Global Atlas of Palliative Care from the WHO as well.[14]
While examining the higher and lower-income examples of palliative care, what becomes clear is the need for knowledge exchange without boundaries. The Global Atlas of Palliative Care identified several educational programmes across the globe in palliative care. By bringing these programmes together and translating success stories, the pressure from the demographic transition and COVID-like health emergencies can be successfully managed and mitigated.
Views expressed by the author are personal and need not reflect or represent the views of Centre for Public Policy Research.
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End Note
[1] Sallnow L. et al. ‘Report of the Lancet Commission on the Value of Death: bringing death back into life’, Lancet, 2022; 399(10327): 837–84.
[2] Griffin S. ‘Palliative care: Experts call for major reforms as pandemic accelerates demand by 20 years’, BMJ, 2021; 372(247).
[3] Sleeman K.E. et al. ‘Priorities and opportunities for palliative and end of life care in United Kingdom health policies: a national documentary analysis’, BMC Palliative Care, 2021; 20(108).
[4] The Lancet. ‘Palliative care and the COVID-19 pandemic’, Lancet, 2020; 395(10231):1168.
[5] Cicely Saunders International. ‘You Matter Because You Are You An action plan for better palliative care’, 2021. https://csiweb.pos-pal.co.uk/csi-content/uploads/2021/01/Cicely-Saunders-Manifesto-A4-multipage_Jan2021-2.pdf , Accessed Feb 26, 2022.
[6] Cicely Saunders International.
[7] National Policy for Senior Citizens March. 2011. https://socialjustice.nic.in/writereaddata/UploadFile/dnpsc.pdf. Accessed Feb 26, 2022.
[8] Rajan S.I. et al. ‘Ageing and Elderly Care in Kerala’, China Report, 2020; 56(3): 354–373.
[9] Krishnan A. et al. ‘Palliative Care Program Development in a Low- to Middle-Income Country: Delivery of Care by a Nongovernmental Organization in India’, Journal of Global Oncology, 2018;4:1-8.
[10] Philip, R.R.et al. ‘Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers’, BMC Palliative Care, 2018;17:26.
[11] Kumar, S.K. ‘Kerala, India: A Regional Community-Based Palliative Care Model’, Journal of Pain and Symptom Management, 2007; 33(5): 623-627.
[12] Daniel, S. et al. ‘Responding to Palliative Care Training Needs in the Coronavirus Disease 2019 Era: The Context and Process of Developing and Disseminating Training Resources and Guidance for Low- and Middle-Income Countries from Kerala, South India’, Indian journal of palliative care, 2020; 26(Suppl 1), S8–S16.
[13] Sallnow L. et al.
[14]Global Atlas of Palliative Care at the End of Life. 2014. https://www.who.int/nmh/Global_Atlas_of_Palliative_Care.pdf. Accessed Feb 25, 2022.
Dr Abin Thomas is Research Fellow (Global Health) at CPPR. He is a medical anthropologist whose research focuses on global health, biomedicine, and ethics. Abin studied at the Hyderabad Central University, the Delhi University, and obtained his PhD at the King’s College London. He was a research fellow at the Global Academy of Agriculture and Food Security at University of Edinburgh.
