‘End-of-life care is everyone’s responsibility’

A pioneer of Kerala’s globally recognised community-owned palliative care model, Dr K Suresh Kumar recently received the WHO South-East Asia Regional Award 2026 for Public Health Champions. The model has helped expand palliative care coverage to nearly 60% of Kerala’s population compared with less than 2% nationally. He speaks with TOI on the Kerala model and its challenges. Excerpts:

What is the WHO award, and why is it important?

The WHO Award recognizes individuals who have made outstanding contributions to public health. By presenting it to a palliative care professional, the WHO reinforces the view palliative care should be treated as a public health priority, that suffering at the end of life is a universal public health concern.

Could you share your journey into palliative care, and how the movement has changed govt and public perception of it in Kerala?

The initiative we established in Kozhikode in 1993 was the first of its kind in South India. At the time, palliative care was largely unfamiliar in Kerala, and some of us had trained in institution-centred Western models. We soon recognised that this model, developed in high-income countries, did not reflect the holistic philosophy of palliative care and was not suited to the realities of low- and middle-income countries. So, we began experimenting with a community-based approach instead. Over the years, this work contributed to the development of community-based palliative care systems now followed in many countries across Asia, Africa and Latin America. In Kerala, this evolved into a distinctive state policy: Rather than relying mainly on healthcare institutions, the programme places local govt at the centre of planning, coordination and implementation, making palliative care part of the community and local health system.

Kerala is considered a model for community-based palliative care. What more needs to be done?

Kerala has built a comprehensive policy framework, a clear roadmap, and scaled up services considerably—it now has around 1,750 primary palliative care units, over 1,100 run by local govts, a level of provision well ahead of most low- and middle-income regions. Even so, important gaps remain. Access is still neither adequate nor equitable: People living with dementia and children needing palliative care are often underserved or excluded. Quality standards have yet to be systematically established, and stronger quality-assurance mechanisms are needed to ensure consistent care statewide.

Where does the system still fall short?

Kerala’s palliative care system faces limited access for many in need, disparities in geographical coverage, uneven quality of care, weak referral and back-referral mechanisms between primary and specialised units, and insufficient job security or career progression for palliative care professionals.

Palliative care is considered more accessible in Kerala than elsewhere, even in villages. So why can’t everyone access it?

Apart from a few private-hospital services, palliative care in Kerala is generally free, funded largely by local govt institutions and community support. But the system still faces resource constraints, and access varies across districts. Many patients also need round-the-clock support, and the current system can offer only a fraction of that.

The govt sector faces a severe staff shortage. Is there enough trained manpower—doctors, nurses, social workers, counsellors—in palliative care here?

At the grassroots level, the core workforce is community palliative care nurses employed by local govt institutions and NGOs—generally underpaid and often without job security. They’re typically supervised by doctors in govt service or general practice; many have had structured training in palliative care, but a significant proportion haven’t. Bodies like the Indian Medical Association have recently begun training more doctors in palliative care competencies. There’s also a shortage of physiotherapists, essential to the multidisciplinary care team. Trained community volunteers provide much of the psychosocial support, and both community groups and local govt institutions contribute substantially to social support at the community level.

How dependent is Kerala’s system on volunteers and charitable organisations?

Local govt institutions are the largest provider, operating more than 1,100 of the approximately 1,750 palliative care units in the state, all offering home-based care supported by community nurses, ASHA workers and volunteers. The remaining units, run by NGOs and political parties, rely heavily on voluntary manpower. Kerala is notable for being the only place in the world where political parties are directly involved in delivering palliative care.

With foreign investors increasing stakes in major private hospitals, treatment costs have risen. What does this mean for palliative care access for the middle class, given most facilities aren’t covered by insurance?

The private sector makes only a limited contribution to palliative care in Kerala; most services come through local self-govt institutions and community-based initiatives. So the growing corporatisation of private healthcare is likely to have only a limited effect on palliative care delivery here.

Does India’s health industry treat palliative care as a legitimate part of healthcare, or does it still disproportionately fund curative treatment and hospitalisation?

It isn’t only a matter of the health sector’s approach. Society’s broader attitudes—shaped partly by the health industry’s own campaigns, reinforced by the media—often reflect a reluctance to confront death. End-of-life care and advanced illness aren’t purely clinical concerns; as Kerala has shown, institutions and civil society both have a role to play. Ultimately, end-of-life care is everyone’s responsibility, and a shared societal concern.

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