India one of the worst places to die; Kerala an exception

India is one of the worst places to die in, according to Quality of Death Index 2015, compiled by the London-based Economist Intelligence Unit (EIU). EIU’s report titled ‘The quality of death: Ranking end-of-life care across the world’, however finds Kerala an exception which provides good end-of-life care to its people.

The report found UK as the best place in the world to die and ranked developing countries like India at the bottom of the index of 80 countries.

It praised Kerala’s provision of palliative care for patients with serious illnesses and the state stands out being the only Indian state to have a formal policy on palliative care services.

The report said, “While India ranks at the bottom of the Index in overall score, and performs badly on many indicators, Kerala, if measured on the same points, would buck the trend. With only 3 per cent of India’s population, the tiny state provides two-thirds of India’s palliative care services.”

“Moreover, the state has a formal palliative care policy in place (it is the only Indian state with such a policy) and its government provides funding for community-based care programmes,” it said.

Dr Suresh Kumar, Director of Institute of Palliative Medicine
Dr Suresh Kumar, director of Institute of Palliative Medicine

As per the report, Kerala’s palliative care system is being studied by experts from across the world for its potent combination of government support and civic involvement in end-of-life care.

The report highlights the benefits of volunteer networks in Kerala, where M R Rajagopal, chairman of Pallium India, and Suresh Kumar, director of the Institute of Palliative Medicine, have pioneered community-based models of palliative care.

Pointing at India’s meager government funding for end-of-life care, M R Rajagopal of Pallium India said, “In India less than 1% is spent on healthcare so it’s not only palliative care that suffers. There is no public funding, there is no socialized medicine and the same holds true for palliative care.”

Dr M R Rajagopal, chairman of Pallium India
Dr M R Rajagopal, chairman of Pallium India

“Kerala’s unique system proves the importance of these points, embodied in the Neighbourhood Network in Palliative Care (NNPC) project. Since 2001 this project, which grew from a more traditional, institutional-based palliative care experiment, has employed an army of volunteers that deliver services to patients who largely remain in their own homes” says the EIU report.

Developed countries dominate the index

Following UK, the Quality of Death Index places Australia in second, New Zealand in third while Ireland and Belgium complete the top five. US bags ninth position in the index.

“A very strong marker in our index is the availability of specialised palliative care workers and this is where the UK scores particularly well. The other super strong marker is the way that the countries do have a plan for palliative care. That means they are on the dynamic of measuring progress and improving,” said Annie Pannelay, EIU’s healthcare specialist.

The bottom ranks of the index are occupied by developing and BRIC countries, such as India, China, Mexico, Brazil and Uganda. These countries show a slow progress on providing end-of-life care. Taiwan has the highest rank in Asia, at sixth position. India and China ranked 67th and 71st respectively.

The Quality of Death Index, commissioned by the Lien Foundation, a Singaporean philanthropic organisation, is based on qualitative and quantitative indicators and took interviews of over 120 palliative care experts from around the world.

The report also put forwards several recommendations to improve palliative care across the world.