Palliative care is a crucial aspect of healthcare that addresses suffering beyond just physical symptoms. It adopts a team-based approach to support patients and their families, tackling practical needs and offering bereavement counseling. The goal is to enable patients to live as actively as possible until their death, providing a comprehensive support system during challenging times.
Recognized as a human right, palliative care should be delivered through patient-centered, integrated health services. These services must be tailored to the unique needs and preferences of each individual, ensuring dignity and respect throughout the care process.
The necessity for palliative care spans a wide array of illnesses. Chronic conditions are the most prevalent, including cardiovascular diseases (38.5%), cancer (34%), chronic respiratory diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Beyond these, conditions like kidney failure, liver disease, multiple sclerosis, Parkinson’s, rheumatoid arthritis, dementia, congenital anomalies, and drug-resistant tuberculosis also frequently require palliative support.
Pain and breathing difficulties are common and severe symptoms for those needing palliative care. Notably, a significant percentage of patients with AIDS or cancer (80%), and those with cardiovascular disease or chronic obstructive pulmonary disease (67%) experience moderate to severe pain at the end of life. Opioids play a vital role in managing this pain, alongside alleviating breathlessness and other distressing physical symptoms. Early and effective symptom control is not only ethically sound but also essential for relieving suffering and upholding a person’s dignity.
Children receiving palliative care, highlighting the global need and WHO's focus on expanding access, especially in resource-limited settings.
The Global Palliative Care Gap
Annually, an estimated 56.8 million people require palliative care, with the majority residing in low- and middle-income countries. For children, the disparity is starker: 98% of children needing palliative care live in these resource-limited nations, with nearly half in Africa.
Several significant obstacles hinder access to palliative care worldwide:
- Lack of National Integration: Palliative care is frequently absent from national health policies and systems.
- Limited Professional Training: Healthcare professionals often receive inadequate or no training in palliative care.
- Opioid Access Restrictions: Access to opioid pain relief is insufficient, failing to meet international standards for essential medicines.
A 2019 WHO survey across 194 Member States revealed that while 68% of countries had funding for palliative care, only 40% reported that services reached at least half of those in need.
The International Narcotics Control Board highlighted in 2018 that 79% of the global population, primarily in low- and middle-income countries, consumed a mere 13% of morphine used for pain management. This represents just 1% of the 388 tons of morphine manufactured globally. Although an improvement from 2014, the gap in access to narcotic drugs for palliative care between high-income and low- and middle-income countries remains a critical concern.
Further barriers to palliative care include:
- Limited Awareness: Lack of understanding among policymakers, health professionals, and the public about palliative care and its benefits.
- Cultural and Social Factors: Cultural and social beliefs surrounding death and dying can impede acceptance and access.
- Misconceptions: False beliefs that palliative care is solely for cancer patients or only relevant in the final weeks of life.
- Opioid Concerns: Misguided fears that improved opioid access will lead to increased substance abuse.
Building Palliative Care into National Health Systems
National health systems bear the responsibility of integrating palliative care into the continuum of care for individuals facing chronic and life-threatening conditions. This integration should link palliative care with prevention, early detection, and treatment programs. At a minimum, this integration requires several key components:
- Integrated Health Policies: National health policies must incorporate palliative care services into the structure and financing of healthcare systems at all levels.
- Human Resource Development: Policies to strengthen and expand the palliative care workforce are essential. This includes training current health professionals, integrating palliative care into the core curricula for new professionals, and educating volunteers and the public.
- Essential Medicines Availability: A robust medicines policy is needed to ensure the availability of essential medicines for symptom management, particularly opioid analgesics for pain and respiratory distress.
Early integration of palliative care, considered from the initial stages of illness, is most effective. This proactive approach not only enhances patients’ quality of life but also reduces unnecessary hospitalizations and healthcare service utilization.
Palliative care delivery must adhere to the principles of universal health coverage. Access to a nationally-determined set of basic health services, including palliative care, should be available to all, regardless of income, disease, or age. Financial and social protection systems need to uphold the human right to palliative care, especially for vulnerable and marginalized populations.
Nurses, as part of multidisciplinary teams, require specialized training in palliative care skills, particularly those working with seriously ill patients.
While specialist palliative care is a component of service delivery, a sustainable and accessible system necessitates integration into primary health care, community-based and home-based care. Support for informal caregivers, such as family and community volunteers, is also crucial. Providing palliative care should be recognized as an ethical imperative for all healthcare professionals.
WHO’s Global Response to Enhance Palliative Care
Palliative care medicines, including pain relief medications, are included in both the WHO Essential Medicines List and the WHO Essential Medicines List for Children. Palliative care is a recognized element within key global strategies on universal health coverage, noncommunicable diseases, and patient-centered care. The WHO also released guidelines in 2019 for managing cancer pain in adults and adolescents.
In 2014, the World Health Assembly adopted the first global resolution on palliative care (WHA67.19), urging WHO and Member States to improve access to palliative care as a core component of health systems, with a focus on primary and community/home-based care. WHO’s efforts to strengthen palliative care concentrate on:
- Integrating palliative care into global disease control and health system plans.
- Assessing the development of palliative care services worldwide.
- Creating guidelines and tools for integrated palliative care across various diseases and care levels, addressing ethical considerations.
- Supporting Member States in improving access to palliative care medicines through better regulations and delivery systems.
- Specializing in palliative care for people living with HIV, including guideline development.
- Promoting increased access to palliative care for children, in partnership with UNICEF.
- Monitoring global palliative care access and program progress.
- Developing indicators to evaluate palliative care services.
- Advocating for adequate resources for palliative care programs and research, particularly in resource-constrained settings.
- Building evidence for effective palliative care models in low- and middle-income countries.
These comprehensive efforts by WHO and national health systems are vital to ensuring that palliative care becomes an accessible and integral part of healthcare for all who need it, reflecting a commitment to both human rights and compassionate care.
