Despite Expansion To 600 Districts, Study Flags Stark Gaps In Palliative Care Access

Even as the government recently informed Parliament that palliative-care services have now expanded to 600 districts under the National Programme for Palliative Care (NPPC), a new study has flagged that large sections of the population continue to remain far from both access and timely care.

The WHO defines palliative care (PC) as ‘an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.’

According to the analysis by the Association for Socially Applicable Research (ASAR), Pune, nearly 7–10 million people require palliative care (PC) in India, with less than 4% having access to it. And with the rising burden of the NCDs, the demand for palliative care is set to increase.

The study further noted that only 23.6% of Indians live within a 30-minute travel distance of a palliative-care facility, and just 71% within two hours—figures that can improve substantially when services are integrated across all levels of the existing public-health system.

Union Health Minister JP Nadda, responding to questions in the Rajya Sabha, said the palliative-care network has widened steadily over the past decade, marking significant progress in ensuring dignified care for people with chronic and life-limiting illnesses, including cancer, AIDS and neurological conditions.

“Six hundred districts have been covered under the NPPC till October 2025,” he said, noting that states such as Madhya Pradesh, Gujarat and Rajasthan have emerged as early leaders in creating functional centres.

Madhya Pradesh currently has 51 palliative-care centres, followed by Rajasthan with 42 and Gujarat with 41. These facilities offer outpatient services, inpatient support and home-based care. Utilisation too has grown: between April and October 2025, more than 12.6 lakh patients accessed outpatient care, 19 lakh received home visits, and 3.3 lakh availed inpatient services.

“The idea is to reach patients where they are, instead of forcing them to travel long distances in pain or advanced illness,” a senior Health Ministry official said.

Palliative services are also being delivered through AIIMS institutions, government medical colleges, district hospitals and an expanding network of Ayushman Arogya Mandirs (AAMs), where palliative care is among the 12 essential services mandated at the primary-care level, he said.

To address shortages in trained professionals—one of the key gaps flagged by researchers—the government has strengthened medical and nursing curricula. Basic palliative-care training is now mandatory in the MBBS programme under the National Medical Commission’s competency-based curriculum, while a 20-hour palliative-care module has been introduced in the second year of the B.Sc. Nursing course. India also offers a three-year MD in Palliative Medicine in selected institutions.

However, experts caution that despite the government’s expansion efforts, ground-level access remains uneven. The ASAR study which assessed geographical accessibility across India, found that nearly 7–10 million people require palliative care annually, but less than 4% currently receive it.

Published in ecancermedicalscience, the study reported that in 2022 India had only 526 palliative-care centres, with a density of four per 10 million population. Rural regions faced the greatest deficits, with significant variation across states. While Kerala, Lakshadweep and Goa had the highest service density and near-universal access, states such as Madhya Pradesh, Odisha and Bihar fared poorly.

Crucially, the researchers found that accessibility improved markedly when palliative care was integrated into all levels of the public-health system—echoing the NPPC’s original vision.

Dr. Parth Sharma, the lead author of the study ‘Access to palliative care in India: situational analysis and modeling of access from public healthcare centers,’ said the findings point to deep structural gaps that continue to deny timely relief to millions.

“Our analysis shows that access to palliative care in the country remains extremely poor, forcing people living with serious pain to travel long distances for adequate relief,” he said.

“Improving access to palliative care and essential opioids for pain management does not require new infrastructure. Significant gains can be achieved simply by training more healthcare providers and integrating palliative-care services across all levels of the existing health system,” said Dr. Sharma from Department of Community Medicine, Maulana Azad Medical College and the Association for Socially Applicable Research (ASAR), Pune.

The researchers added that once the existing public-health network is equipped to deliver palliative care—including primary centres in rural areas—geographical inequalities can be substantially reduced.

The study was co-authored by a multidisciplinary team of researchers, including Harsh Thakkar, Aryan Patil, Vidhi Wadhwani, Gaurav Urs, Padmavathy Krishna and Siddhesh Zadey from ASAR. The others were Preeti Chauhan, Priya Chembon, Shalini Arora Joseph, Raj Kalady, Rontu Sangma, Rajendra Dutt Bijalwan, Sunanda Samal, Lalit Selvaraju, Syed Mohammad Askari Naqvi, Jatin Bhukal, Johnsurya John and Muttacaud Ramakrishnan Rajagopal, all from Pallium India while Smriti Rana from the WHO Collaborating Centre for Training and Policy on Access to Pain Relief, Thiruvananthapuram, Kerala.