Building sustainable and culturally inclusive palliative care services in Bangladesh
By focusing on sustainable policies, culturally inclusive care, and equitable access to pain relief, we can create a palliative care framework that serves all Bangladeshis
As we observe World Hospice and Palliative Care Day (WHPCD) 2024, the global health community takes a collective moment to reflect on the significant strides made over the past two decades while also critically evaluating the enduring gaps in palliative care services worldwide.
This annual observance, held on the second Saturday of October, serves as a reminder of our shared responsibility to ensure that no one faces life-limiting illnesses without access to compassionate, dignified, and appropriate care.
The theme for this year, "Ten Years Since the Resolution: How are we doing?" is not only a call to action but a moment of introspection for all stakeholders involved in healthcare, from policymakers to providers, from advocates to carers.
The theme draws its inspiration from the 2014 World Health Assembly (WHA) resolution, which was a landmark moment in global health policy. The resolution explicitly called on all member states to "strengthen palliative care as a component of comprehensive care throughout the life course." This meant integrating palliative care into national healthcare frameworks, ensuring that such services were available at all levels of care, and prioritising the needs of patients who require symptom management, pain relief, and psychosocial support.
Keep updated, follow The Business Standard's Google news channel
It was a recognition that palliative care is not just an end-of-life service but an essential element of healthcare that should be available from the point of diagnosis and continue beyond the patient's death in the form of bereavement care for their families.
In many high-income countries, the WHO resolution has catalysed significant progress. Palliative care services have expanded, awareness has grown, and training programs for healthcare providers have been strengthened. However, in low- and middle-income countries (LMICs) like Bangladesh, the picture remains starkly different.
Despite the growing awareness of the importance of palliative care, millions of people still lack access to these critical services. This disparity, often referred to as the "access abyss," highlights the chasm between the needs of the population and the availability of resources to meet those needs.
Bangladesh faces an immense palliative care burden, particularly as its population ages and the incidence of chronic, non-communicable diseases continues to rise. The need for palliative care is staggering, yet the current infrastructure is woefully inadequate.
As of 2024, there are only six comprehensive palliative care programs in the entire country, and all of them are based in the capital city, Dhaka. This geographical concentration creates significant barriers for patients living in rural areas, where the majority of Bangladesh's population resides. For these individuals, accessing palliative care often means travelling long distances, which is not only logistically challenging but also financially prohibitive.
Palliative care needs in Bangladesh: A grim reality
Bangladesh, like many low- and middle-income countries (LMICs), faces an overwhelming demand for palliative care services. More than 60 million people globally require palliative care each year, and a significant portion of this demand is concentrated in LMICs.
Despite these staggering numbers, access to care remains limited, with Bangladesh offering only six comprehensive palliative care programs, all located in Dhaka. This geographical concentration of services underscores a profound disparity, leaving the vast majority of the population, especially those in rural areas, without access to essential end-of-life care.
The challenges are multifaceted. A lack of awareness among healthcare providers, insufficient training, cultural taboos surrounding death and dying, and limited access to pain relief medications all contribute to the current state of palliative care in Bangladesh. For a nation with a population of over 170 million, these gaps not only fail to meet the healthcare needs of its people but also perpetuate unnecessary suffering.
Towards a sustainable palliative care framework
To address these challenges, a sustainable and inclusive approach to palliative care is imperative. The first step is policy development. Bangladesh must accelerate efforts to create a national policy and strategy for palliative care. This policy should be aligned with the broader goal of Universal Health Coverage (UHC), ensuring that palliative care services are integrated across all levels of the healthcare system, from primary to tertiary care.
One of the most critical aspects of this policy would be the inclusion of palliative care in primary healthcare. This can ensure that people living in rural areas, who make up a significant portion of the population, have access to basic palliative care services. It would also help decentralise the delivery of care, allowing district hospitals and community health centres to play a more significant role in providing support to patients and their families.
Furthermore, there is a pressing need for capacity building. Medical professionals, including doctors, nurses, and paramedics, must receive specialised training in palliative care. The government's proposed capacity-building initiatives, such as workshops and orientation programs for healthcare providers, are a step in the right direction. However, this effort needs to be expanded to include community health workers, religious leaders, and volunteers, all of whom can play vital roles in delivering culturally sensitive palliative care.
Cultural inclusivity: A key to effective care
In Bangladesh, cultural beliefs and social norms deeply influence attitudes toward death, illness, and caregiving. Therefore, a culturally inclusive approach to palliative care is essential. Religious leaders, for instance, hold significant influence in local communities and can be valuable allies in advocating for palliative care. By engaging with these leaders and incorporating spiritual care into the palliative care framework, we can ensure that care services align with the values and beliefs of patients and their families.
Additionally, community involvement is crucial for breaking the stigma surrounding death and palliative care. Public awareness campaigns through print and electronic media can help normalise discussions around end-of-life care, shifting the focus from fear and avoidance to one of compassion and support. These efforts can empower families and carers, offering them the tools and knowledge needed to care for their loved ones with dignity.
Overcoming barriers: Pain management and drug accessibility
One of the most glaring gaps in palliative care in Bangladesh is the limited access to pain relief medications, particularly opioids like morphine. The global disparity in pain relief is staggering, with high-income countries meeting over half of the palliative care needs, while LMICs like Bangladesh meet only 4%.
This inequality is not only unjust but also avoidable. Addressing this requires urgent policy changes to ensure the procurement of essential drugs, including morphine, for pain management. Moreover, healthcare professionals need to be trained in administering these medications responsibly and effectively.
A call to action
As we commemorate the 20th anniversary of WHPCD and reflect on the decade since the WHA resolution, it is clear that much work remains to be done. The palliative care needs of Bangladesh's population cannot be ignored any longer. The government, healthcare providers, and civil society must come together to build a healthcare system that prioritises the quality of life, not just survival.
The road ahead is challenging but not impossible. By focussing on sustainable policies, culturally inclusive care, and equitable access to pain relief, we can create a palliative care framework that serves all Bangladeshis. Every act of kindness, and every step taken toward improving palliative care services, brings us closer to a society where no one has to endure unnecessary suffering.
Let us use this year's WHPCD to hold stakeholders accountable and advocate for the full integration of palliative care into Bangladesh's healthcare system. Because every life matters, and every person deserves to live—and die—with dignity.
Sumit Banik is a public health activist and trainer.
Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the opinions and views of The Business Standard
