Volunteers – The nightingales of India An innovative model of community palliative care in resource poor India

The challenge before palliative care workers in the developing world is to develop a culturally and socioeconomically appropriate system that is accessible to most of those who need it. Experience has shown that copying the western hospice system is not a practical solution for India.

India's population exceeds 1 billion and it is estimated more than 6 million of these are in need of palliative care at anyone time. This includes the 800,000 new cancer cases per year who are incurable at the time of presentation, as well as patients with chronic illnesses such as paraplegia and chronic psychiatric illnesses.

Kerala, a southwest state in India with a population of around 33 million has two thirds of India's 100 palliative care centres. It has developed an innovative community owned healthcare model known as the Neighborhood Network in Palliative Care (NNPC).

The NNPC model of care involves a core of medical, nursing and social work professionals at the local health centres, supported by a much larger number of volunteers within the local communities. These volunteers make regular home visits and are trained in a holistic palliative care approach. They undertake key roles in identifying and addressing a variety of issues including financial problems, identifying patients in need of care, creating awareness in the community and fundraising, as well as performing nursing tasks, providing counseling and supporting the family unit. Their regular home visits result in improved emotional, social and financial support, enhanced compliance with medical and nursing instructions, faster reporting of symptoms to the doctor, as well early identification of patients in need.

The NNPC program has shown that local communities with limited economic resources can be empowered to identify the chronically and terminally ill, and to support them and the family unit, with a self-sustainable community led service.