Palliative and End of Life Care in India - Current Scenario and the Way Forward

India, being home to one -sixth of the world's population has a huge burden of suffering from life limiting diseases. It is estimated that in India the total no. of people who need palliative care (PC)is likely to be 5.4 million people a year. Though PC was introduced nearly 30 years ago, it is still in its infancy with less than 1% of patients having access to PC. India ranks at the bottom of the Quality Of Death Index in overall score. Obstacles are too many and not only include factors like population density, poverty, geographical density, restrictive policies regarding opioid prescription, workforce development at base level but also limited national PC policy and lack of institutional interest in palliative care. However there has been a steady progress in the past few years through community owned PC services. South Indian state of Kerala which has 3% of Indian population, stands out in terms of achieving coverage of palliative care. On the national level recent years saw several palpable changes including the creation of a National Programme for Palliative care and also the Parliament amended India's cumbersome Narcotic Drugs and Psychotropic Substances Act (NDPS) thus overcoming many of the legal barriers to opioid access. Initially WHO and now the IAPC has taken over the responsibility of spreading the message of palliative care in India, but we still have a long way to go. Education of the professionals and sensitization of the public through awareness campaigns are vitals for improving access to PC in India. Process of implementing PC plan into action requires strong Advocacy, political support and integration across all levels of care.