Palliative care programme across Maharashtra hospitals, free home-based services

Pune: The Maharashtra health department will roll out its "palliative care programme" across all state hospitals. Home-based services will also be extended under this initiative to those suffering from chronic pain due to ailments such as heart, liver, kidney, lung failure, stroke, Parkinson's, dementia, as well as for child palliative care needs, and disability support, apart from those suffering from cancer, officials said.
Earlier, home-based services in Maharashtra were limited to cancer patients and available only in a few districts, but this time, the services will be rolled out across the state. The National Programme for Palliative Care (NPPC) was launched in Maharashtra in 2014 following the National Programme for Palliative Care (NPPC) guidelines issued by the Union health ministry. Several states and union territories have also implemented structured home-based palliative care services."The incidence of cancer, heart disease, diabetes, neurological diseases, respiratory disorders and old age-related diseases is rising in the state, and many patients need long-term treatment and continuous care. The main objective of this initiative is to provide physical pain control, psycho-social support, family counselling, home delivery services to ensure dignified care at the end of life," public health and family welfare minister Prakash Abitkar said. A government resolution (GR) was issued in this regard recently. Umesh Shirodkar, joint director, health services, Maharashtra, said, "We will first conduct a door-to-door survey to identify patients needing palliative care. This survey will be conducted by ASHA workers, and then the services will be provided at the health centre level by the community health officers, who are BAMS doctors or trained nurses. After that, ANMs and chief medical officer will go home to home and provide palliative care services as and when required. The criteria for a patient requiring palliative care are defined under the central govt guidelines. This facility is available completely free of cost." The survey to identify patients in need of palliative care will end by Feb 21 after which the universal palliative care programme will be implemented across the state.For preliminary palliative care, including counselling and physiotherapy, trained healthcare providers can provide services at primary health centres, urban health centres and health extension centres. Those needing a higher level of care will be referred to sub-district, district, and rural hospitals. About 4 to 6 beds will be reserved for palliative care in district hospitals, where 24-hour nursing care, counselling, physiotherapy and essential medicines will be provided. For patients who are unable to travel, home visits will also be started.In addition to services, effective painkillers such as morphine will be made available directly at primary health centres and prescribed by trained medical officers. Earlier, these were available only at district hospitals. The palliative care services will be made available throughout the treatment period, starting from the moment a specific disease is diagnosed. According to the National Health Mission website, Govt of India's expert group on palliative care in its report, ‘Proposal of Strategies for Palliative Care in India' in Nov 2012 suggested a national palliative care programme. Kerala was the first state to develop a state-level palliative care policy, emphasising home-based care. Many other states such as Tamil Nadu, Telangana, Karnataka, Lakshadweep, Rajasthan, Assam, Delhi/NCR provide home-based palliative care services.