Palliative Care In India

Physicians and other types of providers such as nurse practitioners and register nurses are scarce in rural India. For every 10,000 people living in rural areas, there is only one license, qualify physician. But in such low-resource areas, community health workers (CHWs); may provide a workforce that could potentially help to fill the critical gap in health services.

CHWs are defined as “health workers who receive standardize training outside the formal nursing or medical curricula; but to deliver a range of basic health, promotional, educational, and outreach services; and who have a defined role within the community system and larger health system.”

Rural communities

A common, untrained CHW workforce in India is unlicensed rural medical practitioners (RMPs); that deliver health-care services in rural communities. But RMPs do not have formal medical training but offer rural patients’ basic health-care services; for health problems such as pneumonia, diarrhea, and gynecological issues.

Informal RMPs represent a well-establish workforce that tends to be trust in their communities. Since this workforce is already providing basic care for colds, coughs, fevers, aches, and pains; it may be feasible to train and utilize this workforce to increase the reach of scarce palliative care services; given the lack of trained providers in rural areas.

Community health workers

But in India, the need for rural palliative care is increasing with the rising number of people diagnosed; with late-stage cancers. Rural areas also have a shortage of trained medical personnel to deliver palliative care. But address these needs, a home-based palliative care program using community health workers (CHWs); to facilitate care delivery was developed to extend the reach of a cancer center’s palliative careservices outside of Kolkata, India. The research question guiding this qualitative study was, how feasible, useful, and acceptable was this program; from the perspectives of the clinical team and CHWs who delivered the intervention?

This qualitative descriptive study used a grounded theory approach; and the iterative constant comparative method to collect and analyze data from the key stakeholder interviews. But ten qualitative interviews took place at the Saroj Gupta Cancer Center and Research Institute and were conduct with the CHWs; who delivered the home-based palliative care intervention (n = 3) and the clinical team who provided them with training, support, and supervision (n = 7).

Three major themes emerged

(a) CHWs’ desire and need for more training,

(b) the need for tailoring of existing intervention protocols and modifying expectations of stakeholders, and

(c) the need for considerations for ensuring program sustainability. The study provided evidence that the utilization of CHWs to facilitate delivery of palliative care is a feasible model worthy of consideration and further research testing in low-resource settings.