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Improving palliative care in India

Dec 04, 2009

Unbearable pain, a Human Rights Watch publication, draws attention towards the poor state of cancer treatment and inadequate health services in India. It urges government agencies and healthcare units to develop action plans for ensuring better access to palliative care.

Unbearable pain

Publisher: Human Rights Watch, October 2009

In India stories of suffering due to cancer and other disease are too common. Leading palliative care experts in India estimate that more than one million people in India suffer from moderate to severe pain every year due to advanced cancer.

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That number rises considerably once people with non-advanced cancer, HIV and AIDS, and a variety of other progressive, incurable or otherwise life-limiting health conditions are included. The experts believe that more than seven million people may suffer from pain and other symptoms due to such illnesses and conditions annually.

Only a small fraction of these people have access to adequate palliative health services. In 2008 India used an amount of morphine that was sufficient to adequately treat during that year only about 40,000 patients suffering from moderate to severe pain due to advanced cancer, about 4%of those requiring it.

Morphine, the key medication for treating moderate to severe pain, is inexpensive, highly effective, and generally not complicated to administer.

Palliative care, a field of medicine that does not seek to cure but to improve the quality of life of patients with life-limiting illnesses can be delivered at limited cost both in the community through home-based care and at healthcare centres. It includes treatment of pain and of other problems, whether physical, psychosocial, or spiritual.

The World Health Organisation (WHO) has recognised palliative care as an integral and essential part of comprehensive care for cancer, HIV, and other health conditions. It has urged countries to take action in three areas – policy making, education, and drug availability. It has observed that these measures cost little but can have significant effect. In India major challenges exist in all three areas.

The document underlines that government authorities in India, both at the central and state level, have done too little to make sure that palliative care and pain management services are available, or to facilitate their provision by the private sector or nongovernmental organisations.

In fact, many state governments continue to enact complex narcotics regulations that actively impede the availability of morphine, despite a key recommendation by the central government to simplify them.

Under the International Covenant on Economic, Social and Cultural Rights, the Indian government has an obligation to take steps “to the maximum of its available resources” to achieve progressively all the rights in that covenant, including the right to health. Therefore the government should ensure that patients who require palliative care and pain treatment can get access to these health services.

While developing palliative care services and integrating them into the healthcare system is a significant challenge, India has a considerable advantage compared to most other countries in the region.

The southern state of Kerala is home to one of the most effective community-based palliative care networks in the world. Outside Kerala there are a number of strong palliative care programs, based both in the community and at healthcare institutions.

Nongovernmental organisations, such as the Indian Association of Palliative Care, the Institute of Palliative Medicine, and Pallium India, among others, have developed palliative care courses for healthcare workers and have extensive experience providing such training.

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