PALLIATIVE CARE
1. Context
India is home to nearly 20% of the world’s population, two-thirds of which reside in rural areas. Apart from a rising population, India has experienced a steep rise in the burden of lifestyle related noncommunicable diseases. Nearly 1.4 million people are diagnosed with cancer in India every year while diabetes, hypertension, and respiratory diseases are also on the rise. All these diseases need palliative care sooner or later in the disease trajectory.
2. Palliative care
- Focuses on improving quality of life and preventing suffering for those with life-limiting illnesses.
- Aims to identify patients at risk of over-medicalization, considering the impact on quality of life and financial burden on the family.
- Often misinterpreted as end-of-life care but aims to address physical, psychological, spiritual, and social domains for various diseases.
- Provides support for affected families, considering the person as a whole and not just the disease.
- Includes bereavement support for caregivers after the patient's death.
3. Palliative care in India
- Palliative care is mainly available in urban areas and tertiary healthcare facilities, leaving only 1-2% of the 7-10 million people who need it with access.
- According to Aju Mathew, a medical oncologist, 7 out of 10 patients he sees daily require palliative care.
- Post-independence, India has implemented a three-tier health system, national health programs, and the Ayushman Bharat Health Insurance Scheme to enhance healthcare coverage.
- Despite efforts, 55 million people in India fall below the poverty line each year due to health-related expenses.
- Overuse of medical interventions contributes significantly to the financial burden on individuals and families.
4. Non-Communicable Diseases
Non-communicable diseases (NCDs) are medical conditions that are typically chronic in nature and cannot be transmitted from person to person. These diseases are often long-lasting and progress slowly over time. Common examples of non-communicable diseases include:
- Cardiovascular diseases: Such as heart disease, stroke, and hypertension.
- Cancer: Including various forms of cancer such as lung, breast, colorectal, and prostate cancer.
- Chronic respiratory diseases: Such as chronic obstructive pulmonary disease (COPD) and asthma.
- Diabetes: A metabolic disorder characterized by high blood sugar levels.
- Neurological diseases: Including Alzheimer's disease, Parkinson's disease, and multiple sclerosis.
- Kidney diseases: Such as chronic kidney disease and kidney failure.
- Mental health disorders: Including depression, anxiety disorders, and schizophrenia.
- Musculoskeletal disorders: Such as osteoarthritis and rheumatoid arthritis.
- Obesity: Excessive body weight that increases the risk of various other diseases.
- Metabolic syndrome: A cluster of conditions including high blood pressure, high blood sugar, abnormal cholesterol levels, and excess abdominal fat.
5. Palliative Care at Global Level
- At the global level, the World Health Assembly Resolution 67.19 on Strengthening of palliative care as a Component of comprehensive care throughout the life course, adopted in 2014, called upon WHO and Member States to improve access to palliative care as a core component of health systems, with an emphasis on primary health care and community/home-based care.
- Furthermore, WHO explicitly recognizes that palliative care is part of the comprehensive services required for noncommunicable diseases (NCDs) through the Global Action Plan for the Prevention and Control of NCDs 2013–2020, and fundamental to improving the quality of life, well-being, comfort, and human dignity for individuals, as an effective person-centered health service.
- Additionally, palliative care is encompassed in the definition of universal health coverage and the WHO global strategy on people-centered and integrated health services which offers a framework for strengthening palliative care programs across diseases.
6. Palliative care at Regional Level
- At the regional level, improved access to essential palliative care services is one of the regional strategic health care interventions included in the Framework for Action on cancer prevention and control in the Eastern Mediterranean Region.
- Every year an estimated 40 million people are in need of palliative care, 78% of whom live in low- and middle-income countries.
- Access to palliative care services is a major challenge in the Eastern Mediterranean Region, where only an estimated 5% of adults who are in need of palliative care actually receive it. A number of significant barriers explain these unmet needs for palliative care.
- National health policies and systems do not often include palliative care at all.
- Training on palliative care for health professionals is often limited or non-existent.
- Lack of awareness among policy-makers, health professionals, and the public about what palliative care is, and the benefits it can offer patients and health systems.
- Misconceptions about palliative care, such as that it is only for patients with cancer, or for the last weeks of life.
- Cultural and social barriers, such as beliefs about death and dying.
- Population access to opioid pain relief is inadequate and fails to meet international conventions on access to essential medicines.
- Misconceptions that improving access to opioid analgesia will lead to increased substance abuse.
- Palliative care in most of the Eastern Mediterranean Region remains at an early stage of development, with insufficient strategic planning by governments for palliative care services.
- The situation is further compounded by complicated political situations and weak health care systems coupled with conflicts affecting some countries in the Region, weakening health services and further increasing the demand for palliative care services.
7. National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD):
- Evolution: The NP-NCD was previously known as the National Programme for Prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS). It was launched in 2010 to address the growing burden of non-communicable diseases (NCDs) in India.
- The program encompasses chronic diseases that contribute significantly to health-related expenses and aims to provide promotive, preventive, and curative care across all levels of healthcare, from primary to tertiary institutes.
- In an ideal scenario, as these chronic diseases progress, palliative care should transition from curative care. Palliative care is intended to improve the quality of life and alleviate suffering for patients with life-limiting illnesses.
- The NP-NCD's revised operational guidelines were expected to strengthen the program. However, these guidelines have not adequately addressed the gaps in palliative care services in India, limiting its impact on patients in need.
- The guidelines fail to encompass a broader range of non-communicable diseases beyond cancer and neglect the importance of home-based palliative care services. This results in a limited scope and accessibility of palliative care for patients.
- Despite the program's objectives, there is still a considerable gap in addressing palliative care in India's healthcare system. Additional efforts are required to ensure comprehensive palliative care services are integrated into the NP-NCD framework.
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For Prelims: Palliative care, Non-communicable diseases (NCDs), Ayushman Bharat Health Insurance Scheme, chronic obstructive pulmonary disease (COPD), Eastern Mediterranean Region, National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD).
For Mains: 1. Discuss the importance of collaboration between the government, healthcare providers, NGOs, and community organizations in improving palliative care services and ensuring holistic support for patients and caregivers. (250 Words).
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Source: The Hindu
