Integrating Palliative Care: A Vital Yet Overlooked Pillar of India’s Healthcare System
By Arunima Rajan
In a candid conversation with Arunima Rajan, Neeraj Lal, COO & Unit Head, Apollo Hospitals, Gujarat, sheds light on the pressing challenges of integrating palliative care into India’s healthcare ecosystem and offers pragmatic solutions to bridge the gap.
Despite increasing awareness about palliative care, it remains underutilised in many tertiary hospitals across India. What do you see as the biggest barriers to integrating palliative care into mainstream healthcare?
The underutilisation of palliative care in tertiary hospitals in India stems from multiple complex factors. At the institutional level, there is often a lack of dedicated infrastructure and trained personnel. Many hospitals don’t have specialised palliative care units or integrated systems to identify patients who could benefit from such care. The medical curriculum in India traditionally emphasises curative treatment, leading to knowledge gaps among healthcare providers about palliative care principles. Cultural barriers also play a significant role, since there is often resistance to discussing end-of-life care, and many families prefer aggressive treatment until the end. Financial constraints further complicate the situation, since insurance schemes do not cover palliative care services, making it difficult for hospitals to justify dedicated resources.
Neeraj Lal, COO & Unit Head, Apollo Hospitals, Gujarat,
Palliative care is often misunderstood as end-of-life care. How can the medical community and hospitals work together to redefine its scope and emphasise its importance in improving the quality of life for patients with serious illnesses?
The medical community needs to undertake a comprehensive approach to change the perception of palliative care. This should begin with educational initiatives targeting both healthcare providers and the public. Hospitals can organise regular CME programmes highlighting how palliative care improves the quality of life across illnesses, not just terminal conditions. Case studies demonstrating the impact of early integration of palliative care in conditions like heart failure, COPD and neurological disorders can help change perspectives. Hospitals should also develop clear clinical pathways that trigger palliative care consultations based on specific disease markers rather than just end-of-life situations. Measuring and publishing quality-of-life outcomes for patients receiving early palliative care can provide concrete evidence of its broader benefits.
There is a significant shortage of doctors and nurses trained in palliative care in India. What strategies can be adopted to scale up training programmes and encourage healthcare professionals to specialise in this field?
India needs a multi-faceted approach to address the shortage of trained professionals. Medical colleges should integrate mandatory palliative care rotations into UG and PG curricula. Establishing more fellowship programmes in palliative medicine, supported by experienced mentors, can create a pipeline of specialists. Online learning platforms can provide basic training to healthcare workers in remote areas. Partnerships with international organisations can facilitate knowledge exchange and training opportunities. Financial incentives, career advancement opportunities and research funding in palliative care can make the specialisation more attractive to young professionals. Workshops and training sessions can help healthcare workers develop palliative care skills.
Access to pain relief, such as oral morphine, remains a critical gap in palliative care. What steps can be taken to improve the availability and proper usage of pain management solutions, especially in rural and underserved areas?
Enhancing access to pain relief requires systematic changes. The regulatory framework for opioid prescription needs simplification. This includes streamlining the licensing process for hospitals and pharmacies to stock oral morphine. Training programmes for physicians should emphasise proper pain assessment and management techniques. Regional pain medicine centres can serve as hubs for distribution and training. In rural areas, partnerships with primary health centres and pharmacies can improve last-mile delivery. Regular audits of pain management practices and outcomes can help identify and address gaps in service delivery.
Many healthcare systems in India are not equipped to handle the emotional and psychological aspects of palliative care. How can hospitals integrate mental health and spiritual support into their palliative care programmes?
A comprehensive palliative care programme must address psychological and spiritual needs. Hospitals should develop multidisciplinary teams including psychiatrists, psychologists, social workers and spiritual counsellors. Regular screening for depression, anxiety and other psychological issues should be standardised. Staff training should include communication skills, cultural competency and basic counselling techniques. Support groups for patients and families can provide additional emotional support. Partnerships with religious organisations and community leaders can help address spiritual needs.
Funding is often cited as a major constraint in expanding palliative care services. How can the public and private sectors collaborate to ensure sustainable funding models and broader access to these essential services?
Creating sustainable funding requires innovative approaches. Public-private partnerships can help share costs and risks. Insurance companies should be engaged to include palliative care coverage in their policies, supported by data showing potential cost savings. CSR funds can be channelled into palliative care programmes. Schemes like Ayushman Bharat should expand coverage for palliative services. Community funding models, where local organisations contribute to care delivery, can help sustain services in underserved areas.
Coordination between government facilities, private hospitals and NGOs is often lacking in delivering seamless palliative care. What kind of frameworks or policies could foster better collaboration and resource sharing?
Better collaboration requires structured frameworks. A centralised digital platform can facilitate referrals and information sharing between different providers. Regular meetings between government facilities, private hospitals and NGOs can help coordinate services and share resources. Standard operating procedures for patient transfers and shared care can ensure continuity. Joint training programmes and resource pooling can improve efficiency. Creating regional palliative care networks can help optimise resource utilisation.
Technology has transformed many aspects of healthcare. How can innovations like AI, telemedicine and mobile health solutions enhance the delivery of palliative care, especially in remote areas?
Technology can significantly enhance palliative care delivery. Telemedicine platforms can connect specialists with remote areas for consultations. Mobile apps can help patients track symptoms and communicate with healthcare providers. AI algorithms can help identify patients who might benefit from palliative care early in their disease course. Remote monitoring systems can help track the condition of patients.
With an increasing focus on preventive and holistic healthcare, how can palliative care be positioned as an essential part of patient treatment plans, rather than an afterthought?
Integrating palliative care into mainstream healthcare requires systematic changes. Treatment protocols for chronic diseases should include early palliative care referrals. Quality metrics should incorporate palliative care outcomes. Economic analyses demonstrating cost-effectiveness can help justify resource allocation. Patient and family feedback systems can document the impact on quality of life. Regular communication with healthcare administrators and policymakers can help maintain focus on palliative care development.
Looking ahead, what specific steps can hospitals like Apollo take to lead the way in making palliative care an integral part of India’s healthcare system, and how can this influence other healthcare providers nationwide?
Leading hospitals can set examples by establishing comprehensive palliative care programmes. This includes dedicated inpatient units, outpatient clinics and home care services. Developing standardised protocols and quality metrics can help track progress. Training programmes for staff at all levels ensure consistent care delivery. Community outreach programmes can raise awareness and build support networks. Regular evaluation and improvement cycles can help refine services based on experience and feedback.