World Palliative Care Day 2025: Why Compassionate Care Is Every Indian’s Right, Not A Privilege

Every year, on the second Saturday of October, the global community observes World Hospice and Palliative Care Day (WHPCD)—a day dedicated to raising awareness, mobilising support, and reaffirming our commitment to alleviating suffering for individuals with life-limiting illnesses. In 2025, this observance will occur on October 11.

In India, where rising rates of chronic diseases, an ageing population, and inequities in health access present significant challenges, the observance of Palliative Care Day is not merely symbolic. It serves as a clarion call to address the glaring gaps between need and access - ensuring that dignity, comfort, and holistic care are recognised as rights for all, rather than privileges.

Understanding Palliative Care: More than End-of-Life Care

Palliative care is frequently misunderstood as synonymous with “giving up” or “only for the dying.” In reality, it is a holistic approach designed to enhance the quality of life for patients and their families facing serious illnesses, including cancer, heart disease, lung disease, kidney failure, neurological disorders, or advanced chronic illness. This care addresses not only physical symptoms such as pain, breathlessness, and fatigue, but also psychosocial distress, spiritual concerns, and support for caregivers.

Importantly, palliative care can be initiated early in the disease trajectory alongside life-prolonging or curative treatments, with the focus shifting or scaling as patient needs and goals change.

In the context of India - characterised by resource constraints, large rural populations, and stark inequalities - palliative care also involves bringing services into communities, integrating them with primary health services, strengthening home-based programs, and ensuring access to essential medications, including pain relief.

The Reality: Enormous Need, Limited Reach

The scale of need

A 2023 meta-analysis estimated that across India, 6.21 individuals per 1,000 population require palliative care. Other sources suggest that the annual need ranges from 5.4 million to 7–10 million people requiring palliative care. Among older adults (60 years and older), 12.2 percent exhibit at least 2 indicators of need for supportive and palliative care. Specifically for cancer patients, estimates indicate a need for palliative services at a rate of 70–140 per 100,000 population. These figures reflect not only the needs for terminal care but also the significant
suffering associated with advanced chronic illnesses and symptom burden across various disease trajectories.

The Access Gap

Despite the considerable scale of need, access to palliative care remains distressingly low. Less than 4 percent of Indians who require palliative care can access it. Some sources even claim that fewer than 1 percent of the population has access to pain relief and palliative care services. As of late 2022, India had 847 palliative care centers, of which only 526 (62 percent) were actively operating—a modest density of approximately four centers per 10 million people nationwide. In surveys of cancer-care centers, about 68 percent reported offering palliative care services; however, only 50 percent had inpatient palliative care units.

Several barriers contribute to this access gap: regulatory restrictions on opioid prescriptions, inadequate training for health professionals in pain management, a lack of public awareness, weak policy support, inconsistent funding, and fragmented health systems. A notable assessment states. Only 4 percent of Indians have access to palliative care. Medical doctors do not learn about pain relief." This educational gap highlights a significant obstacle to scaling humane care.

India’s Palliative Care Journey: Milestones and Lessons

Early Pioneers and Kerala’s Model

Some of the earliest palliative care efforts in India emerged as grassroots, community-led initiatives, particularly in Kerala. This state, which comprises only about 3 percent of India’s population, is recognized globally for its significant advances in palliative care.

The model developed in Kerala relied on community volunteers, home visits, decentralized services, strong leadership from non-governmental organizations (NGOs), and integration with local governance structures (Panchayati Raj). Over time, these efforts garnered government-level support and facilitated policy integration.

National Program for Palliative Care (NPPC)

In 2012, the Indian government launched the National Program for Palliative Care (NPPC) to promote state-level implementation, training, and integration into district health systems.
A significant reform occurred in 2014 when Parliament amended the Narcotic Drugs and Psychotropic

Substances Act to improve access to opioids such as morphine, thereby removing longstanding legal barriers that had hindered pain relief efforts.

Despite these established frameworks, palliative care implementation across states has been inconsistent. Some states, including Kerala, Tamil Nadu, Karnataka, and Maharashtra, have adopted supportive policies, while others continue to lag in implementation.

World Palliative Care Day (Image Credits: Canva)

Recent and Emerging Initiatives

In Kerala, the government introduced the Kerala Care Universal Palliative Service Scheme in 2025, facilitating volunteer registration and integrating services across existing networks.

In Rajasthan’s Sikar district, mobile home-based health units have begun offering palliative care services in rural and underserved areas.

In Karnataka, a partnership between the state health university and Pallium India aims to incorporate structured palliative care training into the MBBS curriculum, starting in 2025.

Throughout India, World Hospice and Palliative Care Day

(WHPCD) celebrations often include participation from hospitals, NGOs, medical colleges, volunteers, public programs, awareness rallies, training camps, and more.

These developments are encouraging. However, the ongoing challenge remains to scale, sustain, and equalize care across different regions, particularly in rural and marginalized communities.

Why Palliative Care Matters—Beyond Medicine

Dignity and Compassion in Suffering

At its core, palliative care acknowledges that even when a cure is unattainable, providing relief, respect, comfort, and meaning is vital. No one should have to endure preventable pain, loneliness, or indignity during life's final Stages.

Financial Protection

In India, a significant portion of healthcare expenses is paid out of pocket, which can drive families into poverty when faced with chronic illness. Community-based and home-based palliative care models can help minimise hospitalizations and costly medical interventions,
alleviating financial strain.

Caregiver Support and Bereavement

The emotional toll on families caring for individuals with chronic illnesses is substantial. Palliative care addresses this by offering caregiver training, counseling, respite, and bereavement support, thereby ensuring caregivers well-being.

Integration into Primary Health

Incorporating palliative care into primary healthcare, district hospitals, and public health systems facilitates early identification of needs, continuity of care, and equitable access, particularly in areas beyond urban centers.

Ethical and Cultural Values

India's diverse and pluralistic society requires healthcare that is sensitive to cultural, religious, and personal values. Palliative care provides a platform for discussions in spiritual and psychosocial areas that purely biomedical models often overlook.

Challenges: What’s Holding India Back?

Despite progress, the palliative care movement in India faces numerous obstacles:

Workforce Gaps: A limited number of physicians, nurses, and community health workers have received formal training in palliative care or pain management.

Regulation and Pharmaceutical Policy: Although reforms have improved access to morphine, issues with procurement, licensing, and distribution remain inconsistent across different states.

Poor Awareness: Patients, families, and even some healthcare professionals often underestimate the concept and advantages of palliative care.

Funding Fragmentation: Many palliative services depend heavily on NGOs, philanthropy, and grant cycles instead of stable government funding.

Inequitable Geography: Urban or better-resourced areas concentrate most palliative care services, leaving rural, remote, and tribal regions underserved.

Lack of Measurement and Quality Standards: There is a lack of systematic data on outcomes, quality, and accountability in palliative care services.

Cultural Barriers: Misunderstandings that equate palliative care with “giving up” or religious taboos surrounding death can hinder its acceptance. Addressing these challenges requires coordinated efforts across multiple sectors, including health ministries, education, social welfare, civil society, professional organizations, and local communities.

A Vision for the Future: Bridging the Divide

As we observe Palliative Care Day in India, the path forward demands bold action and significant systemic change. Below is a roadmap to promote universal, compassionate, and effective palliative care:

1. Universal Access as a Health Right

India should reaffirm that universal access to palliative care is a fundamental healthcare right and incorporate it into Ayushman Bharat, the National Health Mission, and state health frameworks.

2. State-Level Policies Accountability

Each state should implement a palliative care policy, complete with clear timelines, funding, and accountability—drawing on the successes of states like Kerala, Tamil Nadu, and Karnataka.

3. Workforce Capacity Building

Palliative care modules should be integrated early into the curricula for MBBS, nursing, allied health, and community health. Ongoing training and incentives for rural deployment are essential. The Karnataka initiative to include palliative care training in MBBS serves as an exemplary model.

4. Strengthening Home Community Models

We should expand community-based home-visit programs, which receive support from local volunteers, ASHA workers, primary care teams, and hospice-home networks. These models are cost-effective and have a broader reach.

5. Ensuring Access to Essential Medicines

Robust logistics, licensing, and equitable drug policies are necessary to ensure the reliable availability of opioids and analgesics across all districts and address deficiencies in
state policies.

6. Financing Sustainability

Dedicated budget lines in both national and state health budgets are crucial. Public–private partnerships, insurance models, and reimbursement schemes can enhance the sustainability of services.

7. Data, Research, and Quality Assurance

Improved metrics are needed to measure coverage, quality, outcomes, equity, and the impact on suffering. National registries and standardized protocols will facilitate ongoing improvement.

8. Public Awareness Cultural Readiness

Campaigns through media, schools, and community and religious forums should aim to demystify palliative care, normalize discussions about suffering and death, and reduce stigma.

9. Advocacy Civil Society

NGOs, faith-based organizations, and networks such as Pallium India, IAHPC, and the Indian Association of Palliative Care (IAPC) must continue to mobilize, innovate, and hold governments accountable.

Amplifying Voices: Stories from the Field

A few real-life reflections illustrate what palliative care can enable—and what is missed without it:

In rural North India, a study found that cancer patients in need of palliative support often lack referrals and awareness; families face challenges with out-of-pocket costs and emotional isolation.

Surveys of patients in palliative care centers reveal a complex symptom burden: common issues include pain, fatigue, depression, dyspnea, nausea, and spiritual distress. Anecdotal accounts, such as opinion pieces, describe families opting to withdraw from aggressive hospital interventions and caring for loved ones at home when they could access compassionate palliative support. These voices remind us that palliative care does not merely treat
disease; it supports life, dignity, connection, and closure.

Call to Action: What Can Each Stakeholder Do?

Stakeholder What They Can Do Central & State Governments

Allocate dedicated funds, integrate palliative care into health schemes, and ensure access to essential medicines.

Medical Colleges & Training Institutes

Embed palliative care into curricula, establish training fellowships, and promote research initiatives.

Hospitals & Clinicians

Create inpatient and outpatient palliative care units, refer patients early, and collaborate with community care models.

Primary Health Community Workers

Screen for palliative needs, provide home care, and coordinate with specialist teams.

NGOs, Civil Society Volunteers

Support care delivery, raise awareness, and offer counseling and bereavement support.

Patients Families

Advocate for their rights, engage in awareness campaigns, and participate in shared decision-making.

In Conclusion: A Day with Purpose, a Decade of Commitment

On Palliative Care Day, we honor the dignity of life, even during its most difficult moments. However, this commemoration must evolve into a commitment to expand compassionate care across India’s diverse landscape.

By 2030, envision a nation where no one experiences the end of life alone in pain, where care is gentle, personalized, and accessible even in the most remote villages. This vision is not utopian; it is an attainable goal if we—government, clinicians, communities, and patients—unite in determination.

India, with its rich traditions of caregiving, strong familial ties, and diverse cultural values, holds both a moral responsibility and significant potential to become a leader in palliative care within the global south. On this October 11, let us reaffirm our commitment to alleviate suffering, maintain dignity, and accompany those on life’s final journey—ensuring they not only live longer but also live better.

(Note: Dr (Prof) Sadhana Kala is a USA-trained robotic & laparoscopic surgeon, Uppsala University, Sweden, trained fertility specialist, Icon Endoscopic Surgeon of North India, and National Icon Endoscopic Surgeon of India. She is rated as India's Best Gynecologist by Google.)

(Disclaimer: The views expressed in this article are the personal opinions of the author.)