The central challenge for palliative care in Uttar Pradesh is no longer only whether services exist, but whether they can reach people who are too frail, bedridden or seriously ill to travel to a hospital. A comparison with Kerala, where community organisations, local governments, nurses and volunteers have built an extensive home-based network, shows how sharply the question of access changes when care moves from institutions to neighbourhoods and homes.
The issue has gained attention as World Hospice and Palliative Care Day is observed on October 10. For people living with cancer, advanced heart or lung disease, neurological disorders, frailty and age-related illnesses, treatment may not always remove suffering. Palliative care addresses pain and other symptoms while also supporting psychological, social and spiritual needs. It can be provided alongside disease-directed treatment and does not necessarily mean that curative or life-prolonging treatment has ended.
That distinction matters because a hospital-centric system can measure the presence of a facility without establishing whether the service is usable for the people who need it. A patient who is bedridden may be unable to make repeated journeys to a district hospital. A family caring for an older person with dementia or multiple chronic illnesses may need advice at home, not only a prescription issued during an outpatient visit. The practical test of palliative care is therefore not simply the number of units created, but the continuity between those units and the patient’s living environment.
Kerala’s experience illustrates this shift. The state’s palliative-care initiatives began with voluntary efforts in 1993, and Kerala became the first Indian state to announce a comprehensive palliative-care policy in 2008. The programme later developed through the participation of healthcare institutions and local self-government bodies. Kerala currently reports 1,141 primary palliative-care units covering gram panchayats, municipalities and corporations. It also has 113 secondary-level units in major hospitals and 231 units at community health centres.
More than 500 organisations in the NGO and community sectors provide home-based medical and nursing services in the state. Bedridden patients are connected with trained volunteers in their neighbourhoods, while nurses and healthcare teams conduct home visits. The Kerala Care palliative-care grid, launched in March 2025, is intended to connect government institutions and voluntary organisations. According to the Kerala Health Department, the grid includes more than 1,300 government institutions and more than 1,000 voluntary organisations, with information on over 158,000 bedridden patients.
The significance of this arrangement lies in its institutional design. Care is not treated as the responsibility of hospitals alone. Local bodies, community organisations, frontline workers, nurses and families form part of a connected system. Research cited in the report has found that home visits are central to the way government and non-government palliative-care providers operate in Kerala. The model has also involved more than one lakh volunteers in palliative-care activities, according to the state.
The contrast with Uttar Pradesh is visible in government data on home-based services. In 2024–25, Kerala recorded 9,77,879 patients visited at home for palliative care, while Uttar Pradesh recorded 33,832. Kerala recorded 13,47,566 patients availing palliative outpatient services, compared with 3,68,834 in Uttar Pradesh. These figures are not a simple ranking of the two health systems. The states differ in population, geography, infrastructure and the way services are organised and reported. They do, however, point to a substantial difference in the scale of home-based palliative-care delivery.
Uttar Pradesh’s challenge is also shaped by its geographical spread and large rural and semi-urban population. A patient living far from a district hospital may technically be covered by a programme but remain practically outside its reach. This creates a distinction between nominal availability and effective access. For palliative care, the distinction is especially important because patients may have limited mobility, reduced strength or symptoms that make travel difficult.
Uttar Pradesh began implementing the National Programme for Palliative Care in 2016–17. The state health department lists the availability and accessibility of palliative services, the development of facilities at different levels of the healthcare system and greater community participation among the programme’s objectives. As of October 2025, government data showed functional NPPC services in 23 districts of Uttar Pradesh, compared with all 14 districts of Kerala.
The numbers indicate that Uttar Pradesh has a programme framework, but a framework is not the same as a functioning last-mile network. Expanding hospital-based facilities can improve diagnosis, treatment and referral, yet it may not solve the needs of patients who cannot travel. The next organisational question is how palliative care can be integrated into primary healthcare and community-level services so that patients are identified earlier, families receive guidance and complex cases are referred to specialist teams.
This would require palliative-care capabilities to become part of routine healthcare rather than a separate service that families must discover only after serious illness has advanced. Community-level health workers can help identify patients, support home visits and maintain continuity of care, while higher levels of the system handle cases requiring specialist intervention. The report does not establish that Uttar Pradesh has implemented such a network at the scale of Kerala, but it identifies integration as the key direction for expanding access.
The clinical meaning of palliative care also extends beyond the reduction of a pain score. Dr Abhishek Shukla of Aastha Centre of Geriatric Medicine, Palliative Care & Hospice said pain management should consider what pain prevents a patient from doing, whether that is sleeping, eating, walking to the dining room, spending time with family or carrying out a meaningful daily activity. Patients with similar illnesses may experience pain differently because of previous experiences, anxiety, fear, emotional circumstances and social conditions.
For older adults, including those living with dementia or communication difficulties, pain may not be expressed verbally. Agitation, withdrawal, disturbed sleep, loss of appetite, reduced mobility or a change in behaviour may indicate suffering. Assessment therefore requires listening and observation, not only a numerical pain rating. The cause may be the disease itself, nerve involvement, inflammation, pressure, injury, constipation, immobility or another treatable condition.
Treatment can include appropriate analgesic medicines, physiotherapy, positioning, mobility interventions, psychological support and relaxation techniques. Opioids may be clinically important for moderate to severe pain in advanced illness, but their use requires assessment, careful prescribing and regular monitoring. At the same time, fear of these medicines should not prevent legitimate pain relief. The treatment goal is shaped by the patient’s priorities: one person may value being pain-free, another may prioritise alertness, and someone else may want to walk or eat independently for as long as possible.
This patient-centred approach has direct implications for how services are organised. Families often administer medicines, assist with movement and feeding, manage wounds and observe changes between professional visits. They need to know how to recognise changes in pain, appetite, sleep, mobility and behaviour, as well as when to seek professional help. In a home-based system, caregiver education is therefore not an optional addition; it is part of the care infrastructure.
Kerala’s model offers lessons, but not a template that Uttar Pradesh can reproduce without adaptation. The two states have different population sizes, geographies and healthcare systems. The relevant lesson is the principle of a connected chain of care: primary-care integration, trained nurses, local-government participation, community organisations, volunteers and referral links to hospitals. For Uttar Pradesh, the scale of the task makes it difficult for specialist teams alone to provide continuous support.
The larger urban and regional question is whether public services are designed around institutions or around the actual conditions of residents. A hospital may provide high-quality care to patients who can reach it, but the same system can remain inaccessible to those whose illness prevents travel. Home visits, community workers and local organisations bridge that gap by bringing professional support closer to where people live.
The evidence confirms that Uttar Pradesh has a policy framework and functional palliative-care services in 23 districts, but it also shows a wide difference from Kerala in reported home visits and geographical coverage. It does not establish that one model can be transferred unchanged, nor does it quantify the full unmet need in Uttar Pradesh. The developments to monitor are the expansion of functional services beyond the current districts, the integration of palliative care with primary healthcare, and the creation of reliable home-based support for patients and caregivers.
