Access to palliative care is very low in the country despite positive moves by the government to improve access to pain relief solutions, said Dr. M.R Rajagopal, Chairman, Pallium India and Director, Trivandrum Institute of Palliative Sciences, a WHO Collaborating Centre for Training and Policy on Access to Pain Relief.
Less than 2% of the needy has access to palliative care in India. Considering that palliative care came first to India in the form of Shanti Avedna Sadan in Mumbai in 1986, we must admit that the progress has been too slow, he added.
However there have been several positive changes in the last few years. In 2010, the Medical Council of India accepted Palliative Medicine as a specialty and announced postgraduate course (MD) in it. In 2012, the Ministry of Health and Family Welfare introduced the National Program for Palliative Care (NPPC). In 2014, the Narcotic Drugs and Psychotropic Substances (NDPS) Act of India was amended to improve access to opioids for pain relief when the state governments have implemented them. When translated to action it will have the potential to take away much of the needless health-related suffering in India, said Dr. Rajagopal.
Currently the new palliative drugs are not necessarily the best. Fortunately, the mainstay of cancer pain relief, Morphine, is inexpensive. It is manufactured by government Opium and Alkaloid Works, out of poppy grown legally in India. Unfortunately, there is a tendency among doctors and hospitals to go for expensive alternatives. International agencies together have pointed out this fact in the 'Morphine Manifesto' and urged all institutions to ensure access to the inexpensive morphine, he said.
The new NDPS Act has emphasized the importance of opioid access for pain management. Now with the guidelines published in May 2015 for stocking and dispensing the Essential Narcotics Drugs from the state government to the central Government ensures uniformity in the rules across the country. This amendment needs no modification.
Nevertheless, there are problems with the current rules, and need several modifications. We, the palliative care fraternity, have already submitted the required changes to the Department of Revenue of Government of India and we are hoping for expedited action on the matter. Once the rules are suitably modified, it will become easier for state government authorities to follow them, said Dr. Rajagopal.
Therefore, access to palliative care being particularly poor in India, it does not compare very well at all with rest of the world. Access to opioid, the globally accepted index of access to palliative care, is abysmally poor in our country, coming to about one in 250 of what is considered ideal as in a Western European country and even coming about one in 60th of the global average. Obviously, we have a long way to go, he said.
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