Community based palliative care: It is urgent need for Sri Lanka


Most of the developing countries are witnessing protracted epidemiological transition with the worst of infectious and chronic diseases existing side by side(Bray et al., 2012). Overall global burden of disease was estimated to be 1.5 billion DALY’s. Communicable diseases (CD), NCDs and accidents contribute to 41%, 47% and 12%, respectively (Murray et al.). One of society’s achievements in 20th century is the dramatic increase in average life expectancy. An increasing proportion of older people living with varying severities of comorbidities are needed proper care to have good quality of care (Bhatnagar and Gupta). Life with an incurable and debilitating disease is often associated with a lot of suffering. In addition to physical problems, people also suffer from social, emotional, financial and spritual issues caused by the diseases.

Modern principles of palliative care can take care of the suffering in patients with incurable diseases and provide considerable support for the patients and family members. Palliative care is aimed at improving quality of life, by employing what is called “active total care”(Bakitas et al., 2009). Palliative care has been defined by the World Health Organization as: “an approach that improves the quality of life of patients and their families facing the problems associated with life threatening illness through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual”(Organization, 2002).

Different Models of Palliative care:

Palliative care services are appropriate and should be available for all patients from the time of diagnosis with a life-threatening or debilitating condition. These services should be integrated into all healthcare settings. This will ensure that there is a continuum of care from the diagnosis of a disease through the terminal phase. However, there is no model that fits every organization or institution. Thus palliative care delivery must be individually integrated into specific care settings (eg., hospital, home, assisted living, homecare) with attention to the culture of the organization. Different countries have adopted different models to provide palliative care services. Among the models, Kerala model of developing palliative care could be the most suitable and replicable to our context. It adopted the WHO designated bottom approach. The clinics were run at village level with the support of committed doctors and volunteers. Unique feature of the Kerala model is home care. Also The services were covered not only for the cancer and HIV aids, but also for stable chronic disorders such as posttraumatic paraplegia, fluctuating chronic disorders, such as filarial lymph oedema and sickle cell disease, slowly progressive diseases such as peripheral vascular diseases and end stage progressive diseases such as renal failure and chronic obstructive pulmonary diseases with respiratory failure. Trained volunteers take on much of the psychosocial support and like some relatives often undertake nursing tasks (including changing wound dressing) and simple lymph oedema massage (Watson et al.,2009).


Dr. R. Surenthirakumaran
Department of Community and Family Medicine,
Faculty of Medicine, University of Jaffna.

In the absence of a state social security system, palliative care teams have provided financial assistance to enable some patients to travel to the outpatient clinic and rehabilitation of families. Latter services were integrated with the main stream of the health. Kerala state government has accepted its role and policy document was prepared and accepted. Now most of these clinics are integrated with the state primary care services.

The Kerala experience demonstrate that palliative care should be integrated with and not separated from, the main stream of the health. WHO suggested public health approach mean that model which is adopted should be scientifically valid as well as acceptable, sustainable and affordable at the community level. It must be a comprehensive generic plan for development of a palliative care programme for cancer, AIDS, other end stage disease and the care of older people (Hanks et al.,2011).

Success story of the model, is a guide for us to develop more sustainable and community integrated model. Palliative care association will work out with all the relevant stakeholders and develop a comprehensive model of palliative care which should consider the following key aspects.

Patients’ need should come first

– Palliative care delivery system should be realistic and sustainable – A partnership in care needs to be established with the family – A partnership in care also needs to be established with patient – The family’s finances need to be considered before recommending treatment – Make use of existing resources – Deficiencies in existing facilities need to be supplemented by NGOs. – Volunteers can be the backbone of the palliative care services – Advocacy is essential – Public education – Professional education (Hanks et al., 2011) We all get together and develop a world class palliative care in Sri Lanka.

The true sign of intelligence is not knowledge but imagination
Albert Einstein