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Joint advocacy for palliative care in Delhi

Author: Dr Mary Ann Mukaden (IAPC), Prof. Julia Downing (ICPCN), Dr Stephen Connor (WHPCA), Dr Veronic Dinand (IAP)
17 March 2017

Following the recent successful Indian Association of Palliative Care Conference (IAPCON) in Coimbatore, a team from the Indian Association of Palliative Care (IAPC), the Worldwide Hospice Palliative Care Alliance (WHPCA), the International Children’s Palliative Care Network (ICPCN) and the Indian Association of Paediatrics (IAP), took the opportunity to advocate for palliative care with key Government of India personnel within the Ministry of Health, the World Health Organization, the Indian Council of Medical Research and the Medical Council of India.

Focusing their advocacy in Delhi, the team started by meeting with Alok Mather and Dr Arum Panda from the Ministry of Health and Family Welfare, key people in the Ministry responsible for palliative care development.

Stressing the importance of palliative care for both adults and children and its place within Universal Health Coverage, the team also reminded the Ministry of the 2014 WHA resolution and the need for integration of palliative care into the existing health care system.

The team from the Ministry are very supportive of palliative care and the need to extend its provision throughout India.

Discussions were held about the responsibilities of the national and state governments, and the importance of recommendations from the national level to the states about palliative care development.

The need for ongoing advocacy for palliative care at the state level was evident, although the support for palliative care at the national level was clearly seen.

Following on from this, the team met with Malik Parmar from the WHO Multi Drug Resistant TB programme, situated within the Ministry of Health and Family Welfare, this programme is crucial for the ongoing treatment and prevention of MDX-TB.

The need for palliative care to be integrated into MDX-TB programmes has been realised for many years, and it was encouraging to note the inclusion of some palliative care within the MDX-TB manual.

This could be strengthened, and it was agreed that we would share some existing guidelines for the team to adapt where appropriate.

One of the issues within India is to really understand the need for palliative care, both for children and for adults, map existing services and understand the gap so that we can advocate for the inclusion of palliative care through the demonstration of actual need.

Discussions were held with regards to this with Dr Swaminathan, the Director of the Indian Council for Medical Research (ICMR).

Dr Swaminathan was very supportive of the need for research on palliative care, in particular measurement of the capacity to deliver palliative care in India and the unmet need.

We were able to share some previous research with her and look forward to submitting the protocol to the ICMR shortly.

The team visited the WHO country officers and were able to meet with Atreyl Ganguli, Kasonde Mwinga, and Firku Tullu, team leader of the NCD program for India.

The team have been working with the IAPC and other organisations to provide training and building capacity for the delivery of palliative care both for adults and children, and we were able to discuss with them the way forward and future strategies.

It was encouraging to see that the country office had a strategy for palliative care and that this was cross-cutting across different teams within the country office, e.g.: NCDs and maternal and child health.

Finally, the team visited the Medical Council of India (MCI), advocating for the inclusion of palliative care in post graduate medical training, and discussing the options for recognising palliative care as a speciality and sub speciality and the conditions that need to be met in order for this to happen, e.g.: number of inpatient beds.

The availability of home care was stressed. The MCI were keen to show us where palliative care has already been integrated into different curricula along with pain management, and discussions were held as to how this could be strengthened.

Our few days in Delhi were well spent in terms of advocacy. India is such an important country for global palliative care development, and the IAPC is stepping up in engaging with the government to advance palliative care throughout the sub-continent.

Advocacy is an ongoing process, and having the opportunity to meet with key stakeholders is essential as we continue to strive towards the integration of palliative care within services in India.
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