Organization: Government of Kerala
Access to palliative and end-of-life care is severely limited for the majority of Indians. However, in Kerala, a small southern state of India, there is a community model which has transformed palliative care for people in the area. The Neighborhood Network in Palliative Care (NNPC) was set up in 2001 and is a network of volunteers which delivers services to patients who, for the most part, remain in their own homes. The NNPC focuses on social, spiritual and financial issues; it does not provide medical services. However the scheme has proved highly efficient at identifying members of the community who are most in need and at providing essential services at low overall cost with limited training.
Another thing that differentiates end-of life care in Kerala is that unlike the majority of other Indian states where the Narcotic Drugs and Psychotropic Substances Act has made all opioids illegal since 1985, morphine is available for use by palliative care providers due to relaxed narcotics regulations.
It is this combination of a successful community care model and leniency in regulation which makes Kerala a good example of effective end-of-life care provision in India. In 2005, Kerala provided two-thirds of the palliative care services in the whole of India, despite only having 3% of the total population and in April 2008, Kerala was also the first Indian state to develop a state health policy with a major emphasis on palliative care. The Kerala Community Model appears to deal successfully with many of the issues relating to the lack of trained professionals, and so allows the few medically trained palliative care specialists to concentrate on areas where they can make the greatest impact.