National Programme for Palliative Care (NPPC)
Technical Divisions of Dte.GHS

Introduction

Palliative care is an approach that improves the quality of life of patients and families who face life-threatening illness by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to the end of life and bereavement.

The Ministry of Health & Family Welfare, Government of India constituted an expert group on Palliative care which submitted its report ‘Proposal of Strategies for Palliative Care in India’ in November, 2012. On the basis of the Report, an EPC note for 12th Five Year Plan was formulated. the Palliative Care is part of the ‘Mission Flexipool’ under National Health Mission (NHM).

A model PIP, a framework of operational and financial guidelines, for the states has been designed. On the basis of a model PIP, the states/UTs may prepare their proposals related with Palliative Care and incorporate them in their respective PIPs to seek financial support under NHM.

Goal: Availability and accessibility of rational, quality pain relief and palliative care to the needy, as an integral part of Health Care at all levels, in alignment with the community requirements.

Objectives:

• Improve the capacity to provide palliative care service delivery within government health programs such as the National Program for Prevention and Control of Cancer, Cardiovascular Disease, Diabetes, and Stroke; National Program for Health Care of the Elderly; the National AIDS Control Program; and the National Rural Health Mission.
• Refine the legal and regulatory systems and support implementation to ensure access and availability of Opioids for medical and scientific use while maintaining measure for preventing diversion and misuse
• Encourage attitudinal shifts amongst healthcare professionals by strengthening and incorporating principles of long term care and palliative care into the educational curricula (of medical, nursing, pharmacy and social work courses).
• Promote behaviour change in the community through increasing public awareness and improved skills and knowledge regarding pain relief and palliative care leading to community owned initiatives supporting health care system.
• Develop national standards for palliative care services and continuously evolve the design and implementation of the National program to ensure progress towards the vision of the program

Scope of services

Service provision:

• Provision of basic palliative care services through OPD and IPD services at district hospital by qualified/trained palliative care professionals.
• Provision of out-reach services at CHC/PHC by Palliative Care team at fixed interval for providing palliative care to the patients admitted at CHC/PHC.

Training:

• Training of Palliative Care team (Physician, Nurses and Multi-task Worker) in acquiring at least basic palliative care skills at the nearest Medical College/Palliative Care centre. 
• Training of non-specialist doctors, nurses and other healthcare personnel of district/CHC/ Taluk Hospital/PHC in acquiring basic palliative care skills at the nearest Medical College/Palliative Care centre.

Community Awareness :

• Sensitization and training of Community Health Workers and care-givers for acquiring basic nursing skills. 
• The CMHO or District Program Officer will coordinate with State Program Officer for IEC activities in the district. 
• Awareness regarding pain and palliative care and the availability of palliative care resources/centres in the community. 
• Interpersonal communication would be carried out through health care providers and grass root functionaries i.e. Community Health Workers, ASHA, AWW, SHG/ Youth Club, panchayat members etc. for which education material would be developed to facilitate IEC/BCC activities. 

Monitoring and Supervision 

Reporting will be done to report physical and financial progress made under the program by the State and the district at regular intervals to the Central Program Division. In this regard, Monitoring Performa will be developed by the Central Program Division and shared with State/District Palliative Care Cell/Team.

Components:

1. Establishment of State Palliative Care Cell: (State Palliative Care Cell is functional in 36)
   • Co-ordinator (1)
   • Data Entry Operator (1)
2. Capacity building at District Hospital:
• Physical infrastructure (renovation, equipment etc.)
• Human resource (1 Physician; 4 Nurses; 1 Multi-task worker)
• Training (6 wks for Physician & Nurse)

 Activities at district & sub-district levels:

• OPD services for Palliative care (afternoon clinic).
• Up-to 10 beds dedicated to Palliative care.
• OPD & Home-based palliative care services at CHCs*.
• Referral services & support for patients requiring palliative care at PHCs*.
• Community awareness.

Budget for District Hospital:

 

Non-Recurring:

Infrastructure strengthening: (renovation of Palliative Care unit/OPD/beds/ miscellaneous equipments etc.): Rs. 15 lakhs.

Recurring:

Manpower:
• One Physician @ Rs 60,000 per month x 12 months
• Four nurses @ Rs. 30,000 per month x 12 months
• One Multi task worker @ Rs. 15,000 per month x 12 months
Training:
• Rs. 2 lakh per training program consisting of 50 participants.
Miscellaneous (Including travel/POL/stationary/communication/drugs etc.):
• Rs. 8 lakh
 Total for a Palliative Care Unit at District: 48.4 Lakhs

State Palliative care cell:

• One Co-ordinator: Rs. 60,000 per month x 12 months
• One Data Entry Operator: Rs. 15,000 per month x 12 months
Miscellaneous (Including workshop/stationary/POL/communication etc.):
• Rs. 50,000 to Rs. 1,00,000 per year
Total for Palliative Care Cell at state:
• Rs. 9.5 – Rs. 10.0 lakhs for a year.