Oncology-Based Palliative Care Development: The Approach, Challenges, and Solutions From North-East Region of India, a Model for Low- and Middle-Income Countries

Abstract

BACKGROUND Access to palliative care within healthcare systems of low- and middle-income countries (LMICs) has never been more pronounced than in current times. The Lancet Commission Report (2018) estimates that 80% of global serious health-related suffering (SHS), which demands access to palliative care for its relief, are in LMICs. Cancer is a major contributor to SHS and a rapidly growing burden in LMICs. Similar to many LMICs, cancer is a leading cause of death in India. The North-East Region (NER) of India has a high prevalence of cancer and paucity of services for cancer and palliative care. OBJECTIVES To describe the strategies used to initiate and strengthen palliative care services integrated with the comprehensive cancer care initiatives in the state of Assam in NER. METHODS After an initial assessment of the status of palliative care in the NER, a multipronged strategy was adopted that aligned with the WHO framework recommended for initiating palliative care services. A core team working with a government and private collaborative strategized and activated supportive policies, education, and training and improved access and availability to essential drugs, while implementing the components synchronously within the state. SIGNIFICANCE This project demonstrates an informed regional adaptation of the WHO model. It highlights the strengths of integrating palliative care within cancer care program right from its inception. It emphasizes the sustainability of services activated across public healthcare systems, as compared with the donor- or champion-driven initiatives. The outcome of this project underlines the relevance of this model for LMIC regions with similar health systems and sociocultural and economic contexts.

Socially, Culturally and Spiritually Sensitive Public Health Palliative Care Models in the Lower-income Countries: An Integrative Literature Review

“…Twenty-eight were narrative descriptions, three quantitative studies, one qualitative study, four mixed method studies and one commentary. The selected articles were from Bolivia, [24] China, [25,26] India, [27][28][29][30][31][32] Kenya, [33,34] Malawi, [35,36] Nepal, [37,38] Rwanda, [39,40] Tajikistan, [41] Tanzania, [42,43] Uganda, [44][45][46][47][48][49] Vietnam [50,51] and Zambia. [52] Eight articles [13,[53][54][55][56][57][58][59] described PC services in more than 1 country.…”

“…Fourteen articles specified PC as a fundamental human right. [13,28,[30][31][32][33]40,42,48,50,[53][54][55]57] Two main themes, (1) WHOrecommended public health framework and (2) sociocultural and spiritual support in PC were deductively derived and further categorised into five subthemes: (i) suitable PC policies; (ii) availability and accessibility of essential PC medicines; (iii) PC education for health professionals, policy makers and the public; (iv) implementation of PC at all levels of healthcare and (v) sociocultural and spiritual components. These characteristics are summarised in [Table 1].…”

“…Although not all articles specifically mentioned 'WHO public health' , they did describe services based on its strategies (policy, education, drugs and implementation). While 14 articles [25,28,29,[31][32][33]36,[39][40][41][42]47,49,53] described that all four strategies were in place, others [24,26,30,34,35,37,38,[45][46][47][48][50][51][52]54,56,59] identified the need and/or discussed efforts being made towards achieving all four strategies.…”

Improving symptom assessment and management in the community through capacity building of primary palliative care: A study protocol of exploratory research

“…It highlights the supportable public health care services present in comparison with the funded initiatives. This WHO model emphasizes the usefulness of this for LMIC countries with similar health and socio-cultural contexts (Vallath et al, 2021). In this regard, India requires the development of clinical guidelines according to the local needs for palliative home care ensured quality and uniform delivery of clinical services (Jeba et al, 2020).…”

Cancer Groundshot: Building a Robust Cancer Control Platform in Addition To Launching the Cancer Moonshot

“…[22][23][24][25][26][27][28][29] Additionally, WHO estimates that nearly 78% of patients who need palliative-care services each year live in low-income countries, but only 14% receive these services. 30,31 This reflects the omission of palliative care from the national health policies of many countries, the lack of trained staff, and inadequate access to affordable pain medications that are on the WHO Model List of Essential Medicines. 31,32 According to the Lancet commission, 99% of people in low-income countries do not have…”