Why and How: Advocating for the inclusion of Palliative Care in Universal Health Care

This article was exclusively written for The European Sting by Mr. Vedant Shekhar Jha, a second year Medical Cadet at the Armed Forces Medical College, Pune, India. He is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

According to WHO, over 930 million people (around 12% of the world’s population) spend at least 10% of their household budgets to pay for health care. Each year, nearly 40 million people need palliative care; 78% of them people live in low- and middle-income countries. Universal health coverage (UHC) is a major target in achieving the Sustainable Development Goals under SDG 3.8 (Ensuring healthy lives and promote well-being for all at all ages).

Health advocacy includes educating policymakers and the public about evidence-based policy. Palliative care advocacy is strongest when it includes the voices of the recipients and providers of healthcare services who can testify, witness to the vast unmet need for palliative care.

A comprehensive, cost-effective, and affordable package of care containing essential palliative care medicines, equipment, human resources, and psychosocial interventions must be included within UHC packages as suggested by the Lancet Commission on Palliative Care and Pain Relief. Even so, UHC is not just about ensuring a minimum package of health services, but also about ensuring a progressive expansion of health coverage and financial protection as more resources become available.

Encouraging public awareness and engagement in palliative care, can strengthen and enable people to demand palliative care. Innovative interdisciplinary and multi-sectoral programmes can produce the necessary evidence to show how a publicly funded, essential palliative care package can be integrated within primary care, and be free at the point of use under UHC. Inclusion of palliative care in the training curricula for health professionals and community health workers would significantly enhance capacity building towards inclusion of palliative care in UHC. Patients and families should be included in all activities to improve healthcare delivery, access, and awareness at the grassroot level.

In many countries, an awareness of the distinction between advocacy and lobbying could also preserve the tax-free or non-profit status of civil society organizations such as national palliative care associations. Lobbying includes “attempts to influence a legislative body through communication with a member or employee of a legislative body, or with a government official who participates in formulating legislation.” U.S- based NGOs are prohibited from engaging in lobbying activities in other countries by the U.S law. This does not, however, limit advocacy.

Robust financing structures are key to approaching universal health coverage through strengthening health systems at a global scale. Pooling funds from compulsory funding sources (such as mandatory insurance contributions) can spread the financial risks of illness across a population. Improving health service coverage and health outcomes depends on the availability, accessibility, and capacity of health workers to deliver quality people-centred integrated care.

Investing in the primary health care workforce is the most cost-effective way to ensure equitable access to essential health care. Good governance, sound procurement and supply of medicines, health technologies and well-functioning health information systems are other critical elements.

About the author

Vedant Shekhar Jha is currently a second year Medical Cadet at the Armed Forces Medical College, Pune. As a member of the Students’ Scientific Society of his college, he takes active interest in pursuing research opportunities. His interests include Oncology, Public Health, Mathematical Modelling and Neuroscience among many others. Vedant is the recipient of the Indian Council of Medical Research- Short Term Studentship 2019 (ICMR-STS 2019) research grant awarded to budding medical undergraduates with a keen interest in clinical research. He also enjoys singing, playing guitar and is an avid reader.