Dr Nandini Vallath, Coordinator of the expert committee that worked with the Ministry of Health and Family Welfare to develop policies on pain relief and palliative care for India, and Consultant, Pallium India; Dr MR Rajagopal, Director, Trivandrum Institute of Palliative Sciences – the WHO Collaborating Centre for Training and Policies on Access to Pain Relief, Pallium India.
In India, palliative care (PC) activists are celebrating the unprecedented changes in policies recently initiated by the Government of India. So what’s to celebrate and what led to policy changes?
The Ministry of Health and Family Welfare (MoHFW), India, has implemented national programs on prevention, care and support for people with chronic diseases, through its five year plans.1 However, the initiatives had not recognized access and availability of PC. Things changed when Sri. Keshav Desiraju (MoHFW) heard Dr. Rajagopal speak at the PC side event at the World Health Assembly, 2012. He initiated the formation of a consultative expert committee, which worked with MoHFW to address the lack of services in the country. 2 The deliberations, coordinated by Dr. Nandini Vallath, led to the ‘National Strategy Document on Palliative Care’, which was eventually adapted to the National Program of Palliative Care for India 2012 - 2017.
The goal of NPPC is “availability and accessibility of rational, quality pain relief and PC to the needy, as an integral part of Health Care at all levels, in alignment with the community requirements”. The program aims to facilitate PC service delivery through government and private health delivery systems; refine regulations to ensure safe access to opioids; shift attitudes of professionals towards PC; foster community-owned initiatives; develop national standards for services. A workshop on ‘Implementation framework’ followed, to make the strategies functional and budgeted for.
The implementation workshop January 2014. Attended by representatives of MoHFW, Ministry of Finance, WHO regional Office, Medical Council of India, Nursing Council of India, National Accreditation Board for Health Services, Indian Association of Palliative Care and other NGOs, members of the national faculty in palliative care and consultants from regional cancer centers.
Another leap forward was the amendment to the ‘Narcotic Drugs and Psychotropic Substance (NDPS) Act – 1985’ in 2014. The amendment expands the scope of law to support medical and scientific usage of notified ‘Essential Narcotic Drugs’, disentangling several regulatory barriers, simplifying licensing procedures and improving access and availability of opioids for needy patients. Education-wise, PC content for undergraduate medical and nursing students, developed through a national workshop (May 2013), is now being integrated into the curriculum. 3 Workshops at state level are under way to support the effective implementation of the NPPC and the amended Act.
India can leverage on the recent World Health Assembly resolution on ‘Strengthening of palliative care as a component of integrated treatment within the continuum of care’ and fortify its public health policies on service delivery, drug availability and education; thus acknowledging and respecting care of the person, along with management of disease.
The future looks promising, with commitment from the government and a vibrant palliative care community to translate the policies into tangible outcomes for the needy in the country.
1 Example: National Programme for Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) and National Programme for the Health Care of the Elderly (NPHCE), the National AIDS Control Program; and the National Rural Health Mission.
2 The expert working committee had representation from the MoHFW, the Drug Controller General, the Directorate of Narcotic Control, under Ministry of Finance, the Prime Minister’s Office, WHO regional Office, legal experts on policies related to opioids and selected experts from the field of Palliative Care.
3 Organized by TIPS (Trivandrum Institute of Palliative Sciences), Pallium India and the Indian Association of Palliative Care.