Palliative care models in primary health care system of India: a scoping review.

INTRODUCTION

Palliative care is essential in alleviating the suffering of patients with chronic or terminal illnesses and improving their quality of life. Despite progress, in India it reaches only 1% of the population, highlighting significant gaps in access and awareness that can be mitigated by integration into primary health care. States like Kerala have demonstrated community-based palliative care through Local Self-Government Institutions (LSGIs). This scoping review aimed to examine models and interventions for integrating palliative care into India’s Primary Health Care (PHC) system, focusing on their strengths, limitations, and policy implications.

METHODS

Following Arksey and O’Malley’s scoping review framework, a systematic search was conducted across PubMed, JSTOR, and Google Scholar for studies published between 2000 and 2024. Of 2,262 screened records, 19 articles met the inclusion criteria. Data were charted and synthesized into thematic categories: community-based care, structured existing models, and hospital-linked initiatives.

RESULTS

The review identified three main model types: community-based care, structured models, and hospital-linked initiatives. Community-driven approaches in Kerala showed high reach, cost-effectiveness, and cultural acceptability. Models like Pallium India showcased scalable volunteer-supported care, embedded within primary care. Structured models led by NGOs and public-private partnerships revealed strengths in continuity, training, and patient satisfaction, though often limited by funding fragility. Hospital-linked interventions highlighted critical gaps in implementation, while also piloting innovations such as telemedicine and digital monitoring. Across models, a common thread was the importance of community engagement, governance support, and specialist linkages. However, most studies lacked long-term outcome data, cost-effectiveness analysis, and evidence of successful replication, pointing to significant research and policy gaps.

CONCLUSION

Integration of palliative care into PHC in India is both feasible and essential. Evidence-informed, community-anchored, and governance-supported models must guide future policy, with attention to quality, sustainability, and sociocultural fit.