Ten Years Since the Resolution: How Are We Doing?
What Resolution Are We Talking About?
In 2014, the World Health Assembly—the decision-making body of the World Health Organization—passed a landmark resolution:
“Strengthen Palliative Care as a Component of Comprehensive Care Throughout the Life Course.” This was a global call urging countries to integrate palliative care into their national health systems. Ten years on, it’s time to ask: have we done enough?
Where Does India Stand?
India has indeed made notable strides. The turning point came in 1994 with the formation of the Indian Association of Palliative Care (IAPC). This organization has played a key role in advocating for and shaping palliative care in the country.
Palliative care is a holistic approach that goes beyond just treating physical symptoms. It addresses the emotional, social, and spiritual suffering of patients with serious and chronic illnesses like cancer, neurological disorders, and more. The sole aim of this care is to improve the quality of life in patients and their families. Contrary to popular belief, it’s not just for end-of-life care—it’s beneficial throughout the disease journey.
Education: The Missing Link
One of the early challenges we faced was a lack of education. Treating chronic symptoms like pain or breathlessness, and handling emotionally difficult conversations, were never part of the standard MBBS curriculum.
Thankfully, the IAPC stepped in. With help from international experts, India began offering training courses for doctors and nurses. Today, there are several short- and long-term programs in palliative care, including MD and DNB degrees in the specialty.
But here’s the catch: these courses are still voluntary. Only those who opt in receive this training, which severely limits the number of professionals equipped to deliver palliative care.
A Startling Disparity
According to the World Hospice and Palliative Care Alliance (WHPCA), over 50% of palliative care needs are met in high-income countries. In low- and middle-income countries, including India, that figure drops to just 4%. That’s not just a gap—it’s a crisis!
To build an effective palliative care system, 3 mandatory requisites have to be met with:
- Simplified drug policies
- Access to essential medicines like oral morphine
- Education and training
India has made good progress on the first two in most states including Tamil Nadu. But without making palliative care education mandatory, we’ll continue to fall short.
The Way Forward
The most effective way to develop palliative care is to embed its core principles into the undergraduate medical and nursing curriculum. If every graduating doctor understands how to manage suffering competently and compassionately, we can finally begin to meet the vast, unmet needs across the country.
Encouragingly, in 2019, the National Medical Commission (NMC) began the process of introducing palliative care into the MBBS curriculum. The momentum is there—but now, we need every medical college to implement this comprehensively and urgently.
A Call to Action
Let’s urge our health systems to do more, and do better. Palliative care must be recognized not as optional, but as essential—an integral part of health care for people of all ages, at every stage of illness. The tools are in our hands. The knowledge is available. Now it’s time for bold, systemic action to end unnecessary suffering.
Dr. Mallika Tiruvadanan