Access to palliative care in India: situational analysis and modeling of access from public healthcare centers

Background : Nearly 7-10 million people require palliative care in India with less than 4% having access to it. This study aimed to assess the geographical accessibility of palliative care (PC) in India and estimate changes in accessibility based on its delivery from different levels of the public health system. Methods: Pallium India’s 2022 directory provided a list of active palliative care centers (PCC-PI). We analyzed the density of PCC-PIs per ten million population, the median travel time to the nearest center using motorized vehicle and the access population coverage. Palliative care delivery scenarios combining primary, secondary, and tertiary public healthcare centers were created to evaluate changes in access. Results: In 2022, India had 526 active palliative care centers, with a density of 4 per 10 million population. The highest densities were in Lakshadweep, Goa, and Kerala. The median [IQR] travel time to the nearest PCC-PI was 118 [71,179] minutes, and 23.7%, 39.9%, and 71% of people lived within 30, 60, and 120 minutes, respectively. Rural areas had worse access than urban areas, with considerable variation across states. States like Kerala and Chandigarh had near-universal access, while Madhya Pradesh and Bihar had much lower coverage. Access improved significantly when palliative care was integrated into all levels of the healthcare system. Conclusion: Access to palliative care in India is limited, especially in rural areas. Expanding integration with the public health system could enhance access, ensuring more equitable care nationwide.