World Hospice and Palliative Care Day 2024: A decade of striving for compassionate care

On October 12, 2024, the global community observes World Hospice and Palliative Care Day, a unified day of action to celebrate support and promote the provision of appropriate care for people living and dying with health-related suffering.

This annual event, held on the second Saturday of October, highlights the vital importance of providing appropriate care for those living with serious illnesses and those nearing the end of life.

This year's theme -- Ten Years Since the Resolution: How Are We Doing? -- encourages reflection on the progress made and the ongoing challenges in implementing palliative care worldwide.

The WHO resolution: A call for action

In 2014, the World Health Assembly (WHA) in Geneva passed the first-ever global resolution on palliative care, known as WHA67.19.

This resolution urged WHO and its member states to integrate palliative care as a core component of health systems.

Emphasising the moral responsibility of health systems, it called for palliative care to be provided at all levels, particularly in primary healthcare and community-based settings.

The resolution also advocated for ensuring access to essential pain-relief medications, such as oral morphine, to alleviate suffering.

Despite this significant step, the reality remains concerning ten years later.

Although the resolution has been adopted, palliative care services have not expanded at the scale required to meet the demand.

The theme for 2024 reflects the disappointment that, despite tremendous medical advancements, the world continues to fall short in providing basic compassionate care to those who need it most.

Since its inception in 2005, World Hospice and Palliative Care Day has brought attention to the need for care for the dying with yearly themes highlighting context-specific challenges.

Though the themes change, the underlying message remains the same: access to palliative care is a universal right.

With more than 85 percent of deaths preceded by significant suffering, it is crucial that all health professionals -- doctors, nurses, and paramedics -- are trained in palliative care.

Furthermore, the engagement of communities through volunteer training and awareness is essential to support families and individuals during this difficult phase of life.

WHO and various organisations have developed training programmes to build this capacity across different healthcare systems.

The global gap in palliative care

Despite global efforts, only a fraction of the world's population in need of palliative care is receiving it.

The World Hospice and Palliative Care Alliance, in collaboration with WHO, reports that over 60 million patients and their families require palliative care annually.

However, less than 15 percent of this need is being met, with stark disparities between high-income countries (HICs) and low- and middle-income countries (LMICs).

While 50 percent of the demand is met in HICs, only 4 percent is being addressed in LMICs.

Alarmingly, since 2014, the availability and consumption of opioids -- critical for pain relief -- have declined, further limiting the ability to manage suffering effectively.

Currently, 56 countries recognise palliative care as a specialty, with the UK first acknowledging it in 1987.

Global service provision has increased slightly, from 16,000 to 25,000 services, but this still only covers around 3 to 7 million patients out of the 60 million who need it annually.

Bangladesh's progress: A long road ahead

In Bangladesh, the government has made notable progress by recognising the need for palliative care and incorporating it into mainstream medical practice since 2016.

The country is a signatory to the WHA67.19 resolution and has included palliative care within its Non-Communicable Disease Control Programme.

Around 10 to 12 non-governmental organisations currently provide palliative care services, though most are based in urban areas, with only a few offering community-level care.

Despite these steps, the situation remains dire.

The National Institute of Population Research and Training (NIPORT) estimates that approximately 700,000 people in Bangladesh are in need of palliative care, including 40,000 children.

However, current services can only meet less than 1 percent of this need, leaving a vast majority of patients without adequate care.

The rise in dementia, cancer, end-stage renal disease, and other chronic illnesses further highlights the urgency for expanded palliative care services in the country.

Learning from the Kerala Model

Amidst these challenges, there are examples of success in LMICs, particularly in Kerala, India, where a compassionate community model has been developed.

Known as the Kerala Model, it has mobilised local communities to provide palliative care to those with incurable diseases, offering a safety net of support when curative treatments are no longer possible.

This model has garnered global attention, even from high-income countries, as a replicable approach to community-based palliative care.

Campaign key messages for strengthening palliative care

To tackle current challenges, we must develop and implement palliative care policies that enhance health systems.

Governments should prioritise integrating palliative care into national healthcare frameworks, making it a core component for patients with severe illnesses.

This requires multi-sectoral partnerships between government and non-government actors to address the significant unmet needs in palliative care services.

There is also an urgent need to review and update legislation regarding controlled medicines, such as opioids for pain relief, in accordance with WHO guidelines.

This will ensure that patients have access to essential medications for effective pain management.

Key Ask

Palliative care progress must not stall. Governments and healthcare systems must ensure the effective implementation of the palliative care resolution over the next decade.

We need to advocate for the inclusion of palliative care and relief of suffering in universal health coverage plans, ensuring compassionate care for all who need it.

The author is the Founder Chairman, Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University