Chairman emeritus of Pallium India M.R. Rajagopal and its CEO Binod Hariharan have written to the World Health Organization (WHO) and other international agencies in palliative care – including the Worldwide Hospice Palliative Care Alliance and the International Association for Hospice and Palliative Care – that the Global South, or the low and middle income nations, need a separate palliative care strategy.
On the occasion of the World Hospice and Palliative Care Day on October 11, Saturday, the low and middle income countries, including India, are nowhere near the goal that was envisioned in 2030, that of Universal Health Coverage, including palliative care, they point out.
Integrating palliative care into healthcare systems is at the core of Universal Health Coverage and it is important that palliative care is included across the continuum of care at all levels of the healthcare system. Yet this has not been happening.
“Achieving the Promise – Universal Access to Palliative Care” is the theme of World Hospice and Palliative Care Day 2025. But how is this possible, when in 2025, 84% of the population in low and middle-income countries account for just 6% of the consumption of global opioids for pain relief? Forty years after palliative care came to India, less than 4% of our citizens have access to even basic pain relief, forget the other aspects of palliative care,” points out Dr. Rajagopal
This denial of pain relief is a passive violence that is being inflicted on people by the healthcare system, he says. This is apart from people’s suffering due to the rise in catastrophic health expenditure and the inappropriate end-of-life care that is inflicted on people, about which nothing is being done.
“About 93.5% of all palliative care research happens in the Global North or the high income countries. We don’t even know the elements of suffering in low and middle income countries. What exactly are people enduring? What is the nature of their social suffering? How do families access care? How do you provide emotional support to a family without food to eat?” asks Dr. Rajagopal
All international efforts, guidelines, and recommendations formulated for palliative care are directed towards the high income countries, while it is just scattered local initiatives in poor nations. These guidelines and recommendations hold no meaning for nations which have no machinery or health system capacity to implement these directives.
Guidelines designed for the Global North have failed 84% of the world’s population. “Which is why we are appealing to the WHO and other international agencies in the area of palliative care, that a separate palliative care strategy, one that accounts for the realities of the low and middle income countries, be formulated for the Global South,” says Dr. Rajagopal
The recent WHO publication, Left Behind in Pain, called for regional manufacturing and supply chains for opioids. Something should be done about this and international agencies should be able to help in the development of regional strategies for effective palliative care and facilitate its implementation, Pallium India has appealed.
Published – October 10, 2025 09:04 pm IST
