Palliative Care Status Update in India: South Zone
The States of Andhra Pradesh, Karnataka, Kerala, Lakshadweep, Puducherry, Tamil Nadu and Telangana contribute towards the South Zone as per the constitution of the IAPC. We thank all the contributors for their support in furnishing the required information.
Background / Context
Palliative Care services in the state were initiated in 2012 by the Sneha Sandhya Age Care Foundation (SSACF), through home and hospice care provision.
In June 2014, the Homi Bhabha Cancer Hospital and Research Centre (HBCHRC), in Visakhapatnam, was established as a unit of Tata Memorial Centre (Mumbai) under the aegis of the Department of Atomic Energy (Government of India) to provide comprehensive cancer care. A dedicated Palliative Medicine Department with full-day out-patient services began functioning at HBCHRC (Vishakapatnam) from February 2015.
Palliative care services are now also being offered at the Government General Hospital (GGH) in Kurnool since May 2019.
HBCHRC (Visakhapatnam) and GGH Kurnool have been recently (2021) accredited by ESMO as Designated Centres for Integrated Oncology and Palliative Care.
The Sri Venkateswara Institute of Cancer Care and Advanced Research (SVICCAR) in Tirupati is planning to initiate palliative care service provision shortly and The Government Hospital in Kakinada has designated days for pain clinics and dispensing morphine.
The bifurcation of the state of Andhra Pradesh in 2014, has unfortunately resulted in the absence of a State Cancer Registry, which has made data collection difficult.
Policy
Though Andhra Pradesh does not currently have a State Palliative Care policy, efforts in that direction have been ongoing through SSACF and through HBCHRC over the past few years. Efforts include having several meetings with government officials and conducting opioid availability workshops despite the evolution of the state policy.
Of the 13 districts in the State, dedicated palliative care services are available in two districts (Visakhapatnam and Kurnool) of the state.
Drugs Availability
SSACF was one of the first NGOs in Andhra Pradesh to get the RMI in 2018. Methadone is available at SSACF.
Drugs have been available at HBCHRC since 2015 through the NDPS licence.
The Government General Hospital at Kurnool acquired the RMI in 2019.
The oncology department at the King George Hospital (Government Hospital in Visakhapatnam) acquired their RMI status in 2019 and now have access to END’s.
The Government Hospital in Kakinada has designated days for pain clinics and dispense morphine in very limited quantities.
Patients being treated at a few of the private oncology centres in Visakhapatnam and Vijayawada, now have access to narcotic drugs.
Education: Training and Awareness
SSACF and HBCHRC have been leading advocacy activities across Visakhapatnam and the surrounding districts since 2012.
Project Hamraahi with the Australasian Palliative Link International and Pallium India partnered with the SSACF for advocacy and training in palliative care across the city and surrounding districts between 2018 and 2020.
The IAPC’s CCEPC has been held regularly since 2017 with HBCHRC as the coordinating centre for training nurses and doctors in palliative care.
Doctors and nurses working at SSACF, Kurnool and Tirupathi have undergone the six week training program offered by the MNJ Cancer Centre in Telengana.
Staff at HBCHRC have also been trained through IPM Calicut and TMH, Mumbai.
HBCRC has been involved in research and Quality Improvement programmes in palliative care nationally and internationally.
Current Challenges towards implementing PC within the state
- The lack of availability of palliative care services and END’s across most districts which force patients to travel from all over the state and also from the neighbouring districts of Orissa and Chhatisgarh.
- The lack of the State’s initiative or training has resulted in a lack of awareness towards palliative care and it not yet being entrenched in the medical curriculum.
Future Plans to expand PC throughout the state
Evidence based palliative care service provision needs to penetrate all the districts in the state urgently for which it is imperative to have an action plan, a timeline, the provision for resources, improved drug availability and increased healthcare training.
There is also an urgent need to establish a comprehensive cancer registry program to concurrently capture the availability of or the need for palliative care services across the state. Such robust mechanisms will create the oppurtunity for accurate data capturing, which is extremely crucial for effective advocacy, policy making and policy implementation.
About the Author: Dr. Vidya Viswanath is a Consultant in Palliative Medicine at the Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam. Her goal is to make evidence based palliative care accessible, accountable and penetrative in the society and among the medical fraternity.
Background / Context
Palliative care in the State began with Dr S Vijayaram’s (an anesthetist from Kidwai Memorial Institute of Oncology, Bengaluru) initiative to bring morphine to the State. Over time, other hospitals such as Bangalore Baptist Hospital and Karunashraya began provisioning palliative care in the State.
Of Karnataka’s approx. 64 million population, and a reported crude death rate of 7.1 (Reference: SRS 2013) around 448,000 people are dying. It is estimated that around 60% of the people who are dying would benefit from palliative care into their management plan.
The State palliative care policy reports that over 1.8 lakhs of people are diagnosed with cancer, 2 lakhs people with HIV and a larger unknown number of people with other incurable illnesses are currently in pain and suffering. Of the 1.8 lakh cancer patients registered for treatment, around 60,000 new patients are diagnosed each year and in advanced stages of the disease. Additionally, the elderly and patients suffering from other chronic illnesses like HIV, chronic kidney, heart, neurological or hepatic diseases also require Palliative Care. It is estimated that less than 2% of these patients receive palliative care.
Palliative Care in the State is provided by several hospitals and NGOs; some of which include the Kidwai Memorial Institute of Oncology (KMIO), Bangalore Hospice Trust – Karunashraya, Bangalore Baptist Hospital, St Johns Medical College and Hospital, Aster CMI hospital, HCG, Swami Vivekananda Youth Movement, Kasturba Medical College etc.
The services available in the State include OP, IP, Home care and hospice care.
Policy
The State of Karnataka was the third State in the country to launch a State palliative care policy in 2016.
Health professionals (Doctors, nurses, counselors and pharmacists) from the 31 districts of the State are being sensitized and trained in a phased manner to being provisioning palliative care services across the State.
A few of those trained have begun offering such services at their centers.
Drugs Availability
The necessary opioids and other pain medication are available at all the above mentioned private institutions and NGOs.
The State Government has also taken the necessary steps to implement the amended NDPS Act and has included the necessary medications into the State’s Essential List of medicines.
Education: Training and Awareness
The State Government has partnered with two centers of excellence, KMIO and Karunashraya to conduct training and sensitization programs for the different health cadres working in the State’s public health care system. The COVID 19 pandemic has however deterred the continued implementation of these activities.
The IAPC’s CCEPC course is currently being offered at 5 centers in the State.
Sensitization programs have been conducted by the two institutes to train doctors, nurses, counselors and pharmacists from the district level health centers.
A few doctors and nurses from a few districts have also completed the 10 days fundamentals in Palliative Care course offered at Karunashraya.
Several have also completed the Fellowship program in Palliative Medicine, offered by KMIO.
Kasturba Medical College, Manipal, will soon offer MD in Palliative Medicine.
Aster CMI Hospital, Bengaluru, will soon offer DNB in Palliative Medicine.
Current Challenges towards implementing PC within the state
- The onset of the COVID 19 pandemic has definitely hindered the active and effective implementation efforts to provision palliative care across the State.
- The lack of adequately trained health care professionals to cater to the palliative care needs at the grassroot levels in the State.
Future Plans to expand PC throughout the state
Continue implementing the various components of the State palliative care policy and ensure that palliative care services are integrated in the State’s public health care delivery system.
About the Author: Dr. Nagesh Simha is the Founder Medical Director at Bangalore Hospice Trust- Karunashraya. He now supports the State Government to effectively implement the State palliative care policy. Dr Simha was also the past president of IAPC.
Background / Context
In 1993, a non-government organization, the Pain and Palliative Care Society, was established in the Calicut Medical College. This grew to a network of palliative care centers, to the Neighbourhood Network in Palliative Care (NNPC) and to the Institute of Palliative Medicine (IPM).
Of Kerala’s 36 million population, at least 1.5 lakhs of people are estimated to be in need of palliative care at any given point in time.
The government network of 1,295 hospitals and over 345 non-government agencies including private hospitals and at least 200 non-government organisations, most of them Community Based Organisations (CBOs), deliver palliative care across the state.1
Policy
A State palliative care policy was adopted by the State of Kerala in 2008 and all of Kerala’s 14 districts provide palliative care.
More than 900 primary health centers have one fulltime palliative care nurse visiting every bed bound patient at home once a month. The policy envisaged palliative care provision in tertiary, secondary and primary hospitals; nevertheless, implementation in medical college hospitals did not happen by and large, except for scattered and inadequate provision.
Though the policy included a provision for government and non-governmental organisations to work together, no clear scheme for its implementation was included and such provision has also been scattered.
Noting these deficiencies in 2019, Kerala came out with a revised palliative policy which includes provision for the establishment of palliative divisions in medical colleges as well as guidelines for the government and non-governmental collaboration.2 However, the COVID-19 pandemic has prevented implementation of these new provisions.
Drugs Availability
Most provisions of the amended NDPS Act of 2014 have been implemented within the State and in 2020 the Drugs Controller of Kerala approved of a virtual education as adequate qualification for a doctor in charge of a Recognised Medical Institution (RMIs).
57% of government palliative care providers and 55% of non-government palliative care providers could have uninterrupted access to oral morphine for their patients.1
The per capita consumption of morphine in Kerala was 1.56 mg in 2015, which is roughly one fourth the global mean consumption of 6.27 mg and about 1/150 of what is considered ideal. Nevertheless, the consumption in Kerala is 14 times more than the national consumption of about 1.1 mg.3
Education: Training and Awareness
In addition to IAPC certificate course at 4 centers, several physical and virtual courses are offered in 7 palliative care training institutions in the state. They offer fellowship, six-week certificate course and ten-day foundation course for doctors, nurses and other professionals. They also conduct volunteer training programs.
The Institute of Palliative Medicine, Calicut, also a WHO collaboration centre for community participation in palliative care and long term care, offers the one year National Fellowship in Palliative Medicine (NFPM), the one year National Fellowship in Palliative Nursing (NFPN) in collaboration with Christian Medical Association of India and the International Fellowship Program in Palliative Care for program Managers.
The government also conducts training programs.
Current Challenges towards implementing PC within the state
- A major challenge deterring access to palliative care in Kerala is the lack of integration of palliative care into medical colleges resulting in lack of education of medical students on the subject.
- An inadequate collaboration between the government and non-government organisations in the field is the other challenge.
Future Plans to expand PC throughout the state
Both the above issues are addressed in the revised palliative care policy of 2019. A significant improvement in the situation is expected to happen thereafter.
About the Author: Dr. M. R. Rajagopal is currently the Chairman at Pallium India and the Director at Trivandrum Institute of Palliative Sciences, a WHO Collaborating Centre for Training and Policy on Access to Pain Relief at Trivandrum.
1Lijimol A S et al. Ind J Palliat Care Oct-Dec 2020;26(4):500-505. https://pubmed.ncbi.nlm.nih.gov/33623312/
2https://palliumindia.org/wp-content/uploads/2020/05/Kerala-State-Palliative-Care-Policy-2019.pdf
3Krishnan A et al. J Glob Oncol. 2018; 4: Palliative Care Program Development in a Low- to Middle-Income Country: Delivery of Care by a Nongovernmental Organization in India. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223464/
Background / Context
The Union Territory of Lakshadweep consists of 10 inhabited islands with an approx. population of 64,000 who are scattered across the different islands. The population in each island varies between 300 and 12,000. Lakshadweep currently has several patients with cancer, stroke and heart failure spread across all of it’s islands.
It was Mr K Abdul Hameed Moulana, the Chair and Founder of Thanal Charitable Organization, who recognized the need for palliative care services in the Union Territory of Lakshadweep. The Thanal Charitable Organization operates in an isolated area which had no home based services and where the complexity of the needs of patients’ were quite varied. Mr Moulana then took initiatives to send a doctor and a nurse team to Pallium India, to get trained in palliative care under the direction of Dr MR Rajagopal. Dr.Ali Azher and Mr Ahammed Khafi then underwent a 6 week palliative care training at the Trivandrum Institute of Palliative Sciences (TIPS), Pallium India Trust, Trivandrum.
Provision of palliative care services in Lakshadweep officially began in March 2013 with the inauguration of the Lakshadweep Institute of Palliative Medicine, an organ of the Thanal Charitable Organisation, on a day which coincided with the budding of corals in the islands. This institute operates with a team of doctors, nurses, a patient care quality officer and social workers led by Mr Moulana. The team provides medicines, equipments, ration, physical and psychosocial care, bathing, nail cutting, hair dressing services, funeral services and bereavement support to the family. Bereavement support visits are made on the 3rd and 7th day of death to help families address their grief and loss. Over the past few years, the institute has been able to provision care to over 450 patients per year.
The Lakshadweep Institute of Palliative Medicine is currently the only care provider of palliative care services in Lakshadweep.
Policy
There is no palliative care policy in Lakshadweep; however efforts are being made to improve the quality of life of patients and allow for a natural death at home with adequate end of life care services.
The Lakshadweep Institute of Palliative Medicine currently delivers palliative care in eight islands with consultation services in two islands. The services are purely home based with the Government extending support with the necessary medications. At the moment, the Government system is not yet fully prepared to deliver palliative care in Lakshadweep.
Drugs Availability
The Thanal Charitable Organization is the Recognized Medical Institution for possession and supply of Oral Morphine with proper documentation, demand and dispensing as per amended NDPS Act.
Education: Training and Awareness
Dr Ali Azher, Ahammed Khafi and Mansoor Ali Khan have been trained at TIPS, Pallium India with successful completion of their 6 weeks training program. Dr. Nezeeda and Sabeena were trained at the Regional Cancer Center at Trivandrum.
8 of our volunteers have been trained from Thrissur Palliative Care. Our volunteers spread across the islands are regularly trained by our trained doctors and nurses. An approx. of 150 palliative care volunteers have been trained by our doctor-nurse team in all islands.
A team from Australia, as part of Project Hamrahi, visited the institute between 2013 and 2016 for a mutual exchange of knowledge and advocacy. They also engaged in organizing and delivering awareness programs and seminars in all islands.
The Institute also broadcasts programs, training sessions and talks to all islands with the help of Akashvani Kavaratti. Interestingly, our program on death and dying was well appreciated by the community.
Current Challenges towards implementing PC within the state
- The lack of a full time available nurse due to frequent transfers
- Limitation in accessing the peripheral islands during monsoon seasons (transportation challenges)
- The lack of a dedicated physiotherapy unit
- The inadequate supply of funds to access pain medications and other medical equipments and rehabilitation aids.
Future Plans to expand PC throughout the state
We plan to establish a hospice at Kavaratti island.
We plan to also offer a dedicated geriatric clinic with recreational activities and a open library at Kavaratti.
We plant to hold a death café to talk on death & dying.
About the Author: Dr. Ali Azher is a native of Lakshadweep, who is currently working as the Specialist Doctor-Oncology at Government Indira Gandhi Hospital, Kavaratti. He also holds the charge of RMI and is the Executive Director of Thanal Charitable Organization.
Dr. Ali has completed his MD in Radiation Oncology from GCRI, BJ Medical College, Ahmedabad. He has successfully completed his 6 weeks certificate course in Pain and Palliative Medicine from TIPS, Pallium India.
Background / Context
The Union Territory of Puducherry consists of three regions, (Mahe, Puducherry and Karaikal) which are geographically separate from each other.
- Mahe, sharing its border with Kerala, began developing civil society organization supported community based palliative care services by 2010.
- JIPMER, the tertiary care teaching institution by Government of India in Puducherry region, also had a basic pain relief unit for cancer patients by that time. Further progress in this area happened following the establishment of Sanjeevan, a community-based program in palliative care jointly by the Institute of Palliative Medicine in Kerala and Sri Aurobindo Society in Puducherry.
- The third region, Karaikkal, is yet to have any developments in Palliative Care
The UT of Puducherry with a population of 1.7 million, is estimated to have around 7000 patients in need of palliative care. Around 3000 of the needy are now covered by existing palliative care services, the majority being covered by Sanjeevan (over 2600 patients).
JIPMER provides OP, IP and weekly home care services. Two of the private medical colleges in the region also offer palliative care services. Out Patient and home care services by Sri Manakula Vinayaka Medical College and inpatient services (nonfunctional since the beginning of the COVID 19 pandemic) by Mahatma Gandhi Medical College & Research Institute. Mahe region has a fully functional palliative home care unit run by an NGO.
Policy
The UT of Puducherry currently does not have a State palliative care policy. A draft document has however been prepared by Sanjeevan and is now being circulated among the legislators.
Two among three regions mentioned above have access to palliative care services.
Drugs Availability
Oral Morphine is available in three Institutions in Puducherry region. The machinery for implementation of amended NDPS Act has not been established yet.
Education: Training and Awareness
The following courses are available for Doctors and nurses in the region
- 2-day CCEPC by IAPC (Common course for Doctors & Nurses): Around 25 doctors and 35 nurses have so far undergone training
- 3-day Foundation Course in Palliative Care by Sanjeevan (Separate courses for Doctors and Nurses): 68 doctors and 80 nurses have undergone training so far
- Six week Basic Certificate Course in Palliative Medicine by IPM: 12 doctors have completed training
- Six Week Basic Certificate Course in Palliative Nursing by IPM: 12 nurses have completed training
- Three-month Community Nurse Training by Sanjeevan: 80 community nurses have completed training
- 16 hour volunteer training by Sanjeevan: 400 volunteers, 135 ASHA and 230 Anganwadi workers have completed the training
- 3-hour volunteer sensitization program: 1200 volunteers have completed
Current Challenges towards implementing PC within the state
- The inadequate development of the Primary Health Care system in the region, particularly in rural areas.
- The absence of a palliative care policy or a strategy document or an action plan by the government
- The limited formal collaboration that exists between the NGO and the Government sector
Future Plans to expand PC throughout the state
Improve capacity building in various sectors (both professional and non-professional) on palliative care
Escalate the advocacy efforts with the Government of Puducherry
Continue engaging with the policy makers to discuss the Policy document
About the Authors
Dr. Suresh Kumar is the Director at the Sanjeevan Palliative Care Program, Puducherry.
Dr. S. Adinarayanan is the Professor of Anaesthesiology and Critical Care and the in charge of the Palliative Care Unit at JIPMER.Background / Context
Tamil Nadu’s population is estimated to be 7.88 Crores. With an annual incidence of approximately 78,641 new cancer patients, along with the existing non-cancer population, it can be estimated that an approximate 5 to 6 lakh patients are in need of palliative care services per year within the state. Though the exact coverage cannot be said without a statistic assessment, we can assume that less than 4% of patients are only covered, currenlty.
Palliative Care was born in Tamil Nadu in 1990, with the birth of the ‘Jeevodaya’ Hospice. Soon after, many NGOs like Lakshmi Pain and Palliative Care Trust (LPAPCT), followed suit in Chennai and other places.
All the various NGOs and the Institutions practicing Palliative Care in Tamil Nadu, have now come under one common umbrella – the Tamil Nadu Palliative Care Society (TNPCS).
A few of the key palliative care providers in Tamil Nadu includes the LPAPCT, Jeevodhaya, Dean Foundation, RMD Center, Cancer Institute Adyar, Chennai Pain and Palliative Care, Soul Palliative Care, Sharon Palliative Care, Nethravathy Palliative Care, Annai Adhuragamand and Golden Butterflies Children’s Palliative Care Foundation. Please contact TNPCS at tnpcc2017@gmail.com to access details of all the palliative care providers in the state. Alternatively, you could also reach out to Dr. Mohanasundaram at 9345116599 or Dr. Republica at 9381016588 for the same.
Policy
To achieve widespread coverage of palliative care services, we have been interacting with our Health Department since 2003. Subsequently, the Tamil Nadu State Palliative Care Policy was launched in June 2019.
All the 32 District HQ Hospitals have trained their doctors and nurses and have begun provisioning OP services along with oral morphine being available at these centers. The available NGOs are scattered over a few districts.
Drugs Availability
The Tamil Nadu Narcotic Policy was simplified in 2002 following a Workshop organized by Dean Foundation, but was unfortunately not implemented for years. With repeated interactions and engagements with the Drug Control office and the Health Department, an SOP was made in 2007, as a first in the country towards easing the availability of Oral Morphine.
Oral Morphine has been made available in all the District Head Quarters Hospitals where training was given to the concerned doctors and nurses. Oral Morphine and other essential drugs are currently available in all the key PC Centers and most of the other NGOs within the State.
Oral Morphine is also available in Chennai’s 3 Govt. Hospitals; however the effective usage of the same is doubtful. (Note: Govt. Hospitals do not need license to store)
Though the amended NDPS Act yet to be implemented within the state, NGOs can procure oral morphine easily with their existing RMI status. Even the Injectables can be procured directly from the dealer through the quota allotted by the Central Govt. to the RMPs.
Education: Training and Awareness
LPAPCT has been training doctors and nurses since 2005, while the IAPC has been training professionals in the State since 2008.
The NHM, Tamil Nadu, along with LPAPCT trained doctors and nurses from the 32 districts of our State since 2017, in batches. OP centres for Palliative Care have therefore been functioning in these district hospitals with funding from NHM. This has taken Palliative care to a much wider population.
“Makkalai Thedi Maruthuvam” is a recent government project (2021) to “take health care to the patients’ door steps”. TNPCS has joined hands and begun training for more than 200 nurses in batches, since August 2021.
An approximate 60 doctors and 350 nurses have been trained in the Govt. sector till date. Further training activities are in progress.
Current Challenges towards implementing PC within the state
- Unavailability of trained health professionals is the primary challenge since Oral Morphine is freely available and the Narcotic Policies are in place.
The IAPC has been leading the training of health professionals in the private sector. To make training of professionals within the govt. sector effective, it is critical to include the principles of palliative care into the UG medical curriculum and conduct a training of trainers workshop within the govt. institutions. Efforts by the NGOs would then be more effective as palliative care would then truly be integrated within the health system.
Future Plans to expand PC throughout the state
We hope that with continued support from the Tamil Nadu Government, and NHM, Tamil Nadu, we will be able to soon realise our vision of making palliative care easily available for every needy patient within the state.
The Inclusion of Palliative Care in the UG curriculum will ideally facilitate this vision for the entire country.
Until then, NGO’s will continue to channelize their support towards both the govt. and private sector.
About the Author: Dr. Mallika Tiruvadanan founded the Lakshmi Pain and Palliative Care Trust in 2000. She then completed her Dip. in Palliative Medicine in 2003. Dr. Tiruvadanan along with her team has conducted numerous public awareness and education programs for doctors, nurses, social workers and volunteers throughout the State. She was an Adjunct Prof. in the Tamil Nadu Dr. MGR Medical University for 5 years and has been actively involved in academics. Dr. Tiruvadanan is also proud to be a National Faculty for the IAPC since 2008.
Background / Context
Telangana was formed in 2014 and is one of India’s youngest states. The state has a population of 3,50,03,674 and 33 administrative districts. Figures from the 2016 data denote that non-communicable diseases and injuries together constituted for over 70% of total disease burden causing death and disability in the state.1
With a commitment to give dignity and respect to people in the terminal stage of their life, the Department of Health and Family Welfare, Government of Telangana, designed and is implementing a program aimed to make palliative care accessible to Telangana’s entire population, including the poorest and the remotest areas of the state.
The MNJ Institute of Oncology (MNJIO) is a Regional Cancer Center and a Government Tertiary Referral Hospital for patients with cancer from the State of Telangana and Andhra Pradesh. A formal department of palliative medicine was established in the center in 2011. Today, it is one of the largest centers in the region for palliative care services, research and training and education.
There are a few other Non Governmental Organizations doing commendable work in the field in Hyderabad.
Policy
Despite the absence of an official State Palliative Care Policy, there is immense work already being done to integrate palliative care in the state health care system. The State Government is also currently working towards developing an official State palliative care policy.
The State sponsored health insurance included palliative care for cancer way back in 2008, making every patient receiving cancer treatment at the empanelled hospitals eligible for free palliative care services for life. Efforts to integrate palliative care in the state health care system at all levels of care is described below:
Dedicated palliative care centres have been set up in all of Telangana’s 33 districts. The centers are located in the District/Area Hospitals, many of them in separate buildings within the campus. Each centre has an inpatient facility of 8-10 beds and also offers out-patient service and home care program in the community with the help of a dedicated palliative care team consisting of 1 doctor, 5 nurses, 1 physiotherapist and other supporting staff. All the team members are recruited after having undergone an intense one month training in palliative care.
Over a period of 3 years (2018 – 2021), 33 palliative care units have begun functioning in all districts from the most remote tribal areas to the large metropolitan cities and towns. This has successfully created 330 palliative care beds spread across the State with an average, 330 households being touched by palliative care home care team every day.
These centres work in close coordination with the District Medical and Health Department to synergize its activity at all levels of care. This integration ensures that those requiring palliative care are easily identified by the ASHA workers in the community and other health workers at primary, secondary and tertiary level of care.
To establish this program, the Department of Health and Family Welfare collaborated with the Department of Palliative Medicine, MNJ Institute of Oncology and a local NGO called the Pain Relief and Palliative Care Society to avail of their expertise in planning, training, execution, mentoring and quality assurance. For opioid availability, they liaised with the state drug controller office.
Drugs Availability
MNJ Institute of Oncology is one of the centers in the country with the largest opioid consumption. Each district palliative care center being a government establishment has got a deemed RMI status and they stock and dispense opioid medications to all patients in their respective districts.
Education: Training and Awareness
MNJ Institute of Oncology is the official center of excellence for training and education. The center runs several training programs like Post doctoral courses in adult and pediatric palliative care, ECHO based training, one month certificate course and IAPC CCEPC.
All the team members; 1 doctor, 5 nurses and 1 physiotherapist at each district palliative care center are recruited after having undergone an intense one month training in palliative care at MNJIO.
All the health and wellness center and PHC staff, ASHA workers, district program officers have undergone 2 hours of sensitization training in pc.
Massive sensitization and awareness programs, survey and health profiling of the households have resulted in adequate patient identification and referrals.
Current Challenges towards implementing PC within the state
- Lack of awareness among both the health workers and in the community, limits the timely identification and referral of patients requiring palliative care.
Future Plans to expand PC throughout the state
The state of Telangana has made palliative care an essential component of basic health care; made it equitable and accessible to all, no matter where they live, what their age or their background.
The future plan is to therefore establish beds and make morphine available in every government hospital, to start a dedicated pediatric palliative care center in Niloufer Children’s hospital, a tertiary pediatric referral center for the state, and to establish and implement a formal palliative care health policy in the state.
About the Authors:
Smt. Karuna Vakati (IAS) is the Mission Director (NHM) & Commissioner, Public (H&FW), Government of Telangana.
Dr. Gayatri Palat, is a Consultant, Pain and Palliative Medicine, at MNJ Institute of Oncology and RCC. She is also the Director, PAX Asia Program, Two Worlds Cancer Collaboration, Canada and a Member of the Executive Committee, Pain Relief and Palliative Care society, Hyderabad.
Reference: