Progress in palliative care in India

India is experiencing an epidemiological transition with non-communicable and chronic diseases becoming the leading causes of death. There are at least 1.5-2 million cancer cases; two-thirds of them are in an incurable stage of disease. The adult HIV prevalence is approximately 2.5 million. The development of palliative care has been patchy. Vast majority of India does not have access to palliative care but in a state like Kerala, effective coverage and involvement led to designation of centers such as Institute of Palliative Medicine (IPM), Calicut and Trivandrum Institute of Palliative Sciences (TIPS), Pallium India as the Collaborating Centers of WHO for Community Participation in Palliative Care and for Training and Policy on Access to Pain Relief, respectively. A lack of health policy, lack of training and awareness, and opioid availability are barriers to palliative care. India does not have a national policy on palliative care. The National Cancer and AIDS Control Programme mentions palliative care but with ineffective implementation. Kerala is the first state to introduce a state health policy. Andhra Pradesh includes palliative care for cancer in its state health insurance scheme. The major barriers to opioids availability include stringent regulatory issues, attitude, and knowledge. Efforts led to 14 states simplifying the regulations. Lack of training and awareness is a challenge. The Medical Council of India recently approved palliative medicine as a specialty. The Indian Journal of Palliative Care has become an indexed journal. Many International organizations such as the International Network in Cancer Treatment and Research (INCTR) and the International Association for Hospice and Palliative Care (IAHPC) are playing roles in bringing changes. Recognition of non-communicable diseases as a priority and palliative care as a specialty is expected to bring major change in palliative care scenario in India.