Over 56.8 million people need palliative care each year: WHO

By 2060, the need for palliative care at the end of life is expected to nearly double

By Madhumita Paul
Published: Wednesday 06 October 2021

It is estimated over 56.8 million people are in need of palliative care, of whom 78 per cent live in low- and middle-income countries, according to a new report from World Health Organization (WHO).

Worldwide, only 12 per cent of palliative care need is being met and the global need will continue to grow as a result of ageing population and the rising burden of non-communicable disease. 

WHO defines palliative care as an approach that improves the quality of life of patients and their families facing problems associated with life-threatening illness or serious health-related sufferings.  

The availability of palliative care services remains limited for patients with non-communicable diseases (NCD) globally, with only 39 per cent of countries reporting general availability, according to the 2019 WHO NCD Country Capacity Survey. 

By 2060, the need for palliative care at the end of life is expected to nearly double.

WHO conducts a periodic assessment of national capacity for NCD prevention and control through the use of a global survey to all member states known as the NCD Country Capacity Survey. 

Palliative care is generally available to patients in need at primary health care (PHC) facilities in 50 per cent of the countries, where funding is specifically allocated as compared to 15 per cent of the countries, where there is no dedicated funding for palliative care, according to the WHO.

Urgent action is needed as this unmet need continues to grow as a result of ageing populations and the rising burden on non-communicable diseases.

To address this need, WHO released two new resources: Technical report and technical brief, to support countries in assessing the development of palliative care and improving the quality of services. 

The technical report with indicators can be used by countries to monitor the provision of services. The goal is to create a global consensus on indicators, providing data that supports decision-making.  

The technical brief includes practical approaches and resources to support policy, strategy and practice. The brief guides action at the national- and district- level, and point of care. 

The two resources were released in advance of the World Hospice and Palliative Care Day, marked on October 9, 2021. The theme this year is: Leave no-one behind  — equity in access to palliative care. 

There is a substantial gap in funding and availability of palliative care among country groups by income, as well as an urgent need to scale up palliative care services in low- and middle-income countries (LMIC) through policies, resources and services in primary care. 

This gap in paediatric palliative care provision is especially under-reported and almost 2.5 million children die with serious health-related sufferings every year. Around 98 per cent of these children live in LMICs.

The greatest number of children in need of palliative care died from congenital anomalies, followed by neonatal conditions, protein energy malnutrition, meningitis, HIV / AIDS and cardiovascular diseases

The novel coronavirus disease (COVID-19) highlighted the need for palliative care in all places and settings to relieve suffering at the end of life such as the physical suffering caused by breathlessness or the mental pain.

The pandemic also reminded of the need for all health professionals to have some training in a palliative care approach.

Palliative care is required for a wide range of diseases. The majority of adults in need of palliative care have chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, AIDS and diabetes. 

Many other conditions that may require palliative care are:

  • Kidney failure
  • Chronic liver disease
  • Multiple sclerosis
  • Parkinson’s disease
  • Rheumatoid arthritis
  • Neurological disease
  • Dementia
  • Congenital anomalies and
  • Drug-resistant tuberculosis. 

Optimal palliative care in countries requires a supportive policy environment, empowered communities, palliative care research, access to essential palliative care medicines, strong education and training systems for palliative care workers and professionals, and attention to the quality of palliative care services, the report said.

In 2014, the first ever global resolution on palliative care, World Health Assembly resolution WHA67.19, called upon WHO and Member States to improve access to palliative care as a core component of health systems, with an emphasis on primary health care and community / home-based care.  

WHO develops evidence-based guidelines and tools on palliative care, including pain management options in adults and children and guidance for the availability and accessibility of controlled medicines. Palliative care medicines, including those for pain relief, are included in WHO’s list of essential medicines for adults and children.

According to the report, actions that can be taken at a national level for quality palliative care:

  • Incorporate quality considerations into all levels of palliative care planning, including policy, strategy and service delivery plans.
  • Align national palliative care planning with a clearly articulated national strategic direction on quality.
  • Integrate palliative care across the health system, embedding it in a PHC approach.
  • Utilise existing quality assurance mechanisms such as licensing, registration and quality standards to assure quality palliative care services. 

Palliative care is highlighted as a central component in the global drive for Universal Health Coverage (UHC) and without prioritising quality palliative care, the achievement of UHC is at risk.

This report can guide countries in the selection of palliative care indicators 

and integrate them within the monitoring frameworks of national strategies, policies and plans.

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