Policy and advocacy

2015; Volume 16, No 6, June

Policy and advocacy

Modeling Palliative Care for the Rural Poor

IAHPC Board Member, Dr. Eric Krakauer, Director of the International Program at the Harvard Medical School Center for Palliative Care, U.S, and IAHPC Board Member, recently visited Kerala in southwest India at the invitation of Dr. M.R. Rajagopal and Dr. Suresh Kumar.

Dr Eric Krakauer

In 2008, the government of the India’s southwestern state of Kerala issued a palliative care policy stating that palliative care should be integrated into routine healthcare. In 2010, the state government took the additional step of ordering that every local government or “panchayat” must implement palliative care as a condition of receiving funding from the state government. These remarkable actions, at once humanitarian and practical, were the result of years of advocacy, both at grassroots and governmental levels, by numerous palliative care activists led by Lifetime IAHPC Board Member and Founding Chairman of the Pain and Palliative Care Society in Calicut and of Pallium India, Dr M.R. Rajagopal, and his colleague as Director of the Institute of Palliative Medicine, Dr. Suresh Kumar.

Lifetime IAHPC Board Member Dr. M.R. Rajagopal
collaborates with a nurse from a local
NGO’s palliative care team to care for a
patient at home in her tarpaulin shack near
Thiruvananthapuram, Kerala State, India.

Each panchayat operates a primary health center, and as a result of the governmental order, every primary health center in the state hired a nurse to provide palliative care full time. After three months of palliative care training, the nurses visit all bed-bound patients within their catchment area in their homes. The state palliative care policy also envisaged each panchayat partnering with one or more local non-government organizations (NGOs) to provide more intensive palliative home care free of charge for anyone in need, including the rural poor. To date, local public/private palliative care partnerships have been created only in a minority of communities across the state. But in those that exist, the healthcare system has been strengthened because the community assumes part of the responsibility to care for its own. While formal cost-effectiveness data is not yet available, the partnerships appear to improve patient outcomes while reducing costs both for families and for the healthcare system by averting hospital admissions.

In the wake of the momentous World Health Assembly Resolution on Palliative Care and Long Term Care of 2014, which states that palliative care is “an ethical responsibility of health systems,” there is great need for promising, cost-effective models of palliative home care. The Kerala model that unites government policy with community initiative is just such a model. Recently, IAHPC Board Member Dr. Eric Krakauer, who also serves on the World Health Organization Ad Hoc Technical Advisory Group on Palliative Care, visited Kerala at the invitation of Dr. Rajagopal and Dr. Kumar. These photos are from his visit.



In rural Kerala, nurses and volunteers from the Jeeva Karunnya Palliative Home Care Program, a collaboration between
local government and a local NGO, visit a paraplegic patient at home.
IAHPC Board Member Dr. Eric Krakauer (right), meeting with the Chairperson of the panchayat or local government,
her staff, and officials of the Jeeva Karunnya Palliative Home Care Program in Kodiyathur, Kerala.

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