Kerala - Kochi   

Palliative care becoming part of NRHM programmes

Kozhikode: Palliative care is being linked up with National Rural Health Mission (NRHM) programmes in Kerala. The State is the first to launch such an initiative.

Palliative care will be given by making use of the services of Accredited Social Health Activists (ASHA), provided for in the mission, through the Neighbourhood Network in Palliative Care (NNPC). The activists are social workers who provide health care at the village level.

The mission, named Arogya Keralam, had initiated pilot projects for the care of the elderly, the bedridden and the terminally ill in Kozhikode, Malappuram, and Wayanad districts.

These projects, with the Institute of Palliative Medicine in Kozhikode as the implementing agency, have demonstrated the enormous potential in the area.

A mission project in palliative care in Malappuram played a major role in facilitating “Pariraksha,” a comprehensive home-care programme for bedridden patients.

Many places in north Kerala have an active neighbourhood network in palliative care coordinated by the institute.

ASHA is expected to play the role of village-level coordinators of community volunteers in palliative care. The projects have been submitted to authorities in Delhi for approval.

Suresh Kumar, Director of the institute, says that ASHA should be given basic training in palliative care. The present proposal is for two-day training with the institute, a WHO demonstration project, acting as the nodal centre.

ASHA will also have to be given the responsibility of finding, guiding and monitoring patients with chronic and incurable diseases. Effective linking up of ASHA with available services and initiatives in long-term and palliative care will have to be ensured.

ASHA in the northern districts needs to be linked up with community-owned palliative-care services and local government initiatives in palliative care. This will need reorientation of the primary health-care system to look after patients with chronic and incurable diseases.

Community-based palliative care initiatives are in various stages of development. Arogya Keralam needs to facilitate their development to ensure appropriate care for the incurably and chronically ill patients in the State.

Arogya Keralam aims to develop a model system of delivery of long-term and palliative care in the State with active collaboration from community groups working in the field, government hospitals, local self-governments and also the private sector in health care.

In Malappuram district, well-developed community initiatives exist. There, the process of integration with the government network and local self-government projects is under way. Plans for expansion of the initiatives to offer home care to all the patients in the district have started with the “Pariraksha” programme.

In Kozhikode, palliative-care projects integrating local self-government programmes exist in certain parts of the district. Volunteer networks are present.

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