December 2025
Universal Health Coverage Day, 12th December 2025, reminds us of our shared global promise that everyone, should receive the quality healthcare they need, where they are, without facing financial hardship. And yet, millions continue to live and suffer without access to life’s essential health services.
In this issue, we reflect upon what true Universal Health Coverage means: care which is not constrained by geography, income, or diagnosis, but which is anchored in dignity, compassion, and equity. We travel through stories from the field, and insights from professionals to understand what has been achieved so far and what remains as a challenge in the pursuit of assuring that nobody is left behind when it comes to relief from serious health-related suffering.
Universal Health Coverage: From the Chairman’s Desk
The Unfinished Promise: Path to Universal Health Coverage
The global pursuit of Universal Health Coverage (UHC) – ensuring all people have access to quality health services without financial hardship – remains a defining challenge of our times. As the World Health Organization (WHO) notes, more than half the world’s population still lacks access to essential health services, and a quarter faces financial catastrophe when seeking care. While the goal is universally accepted as a “moral and ethical imperative,” the path is fraught with complex, context-specific hurdles, primarily around financing, equity, and the fundamental role of primary care.
Integration of palliative care in Primary Health Care
The focus on Primary Health Centres (PHCs) signifies a shift from a “hospital-centric” model to one that addresses a person’s entire health journey, closer to their homes and communities. In Low and Middle-Income Countries (LMICs) while this is most welcome, UHC is meaningless if it neglects citizens with serious illnesses, and therefore, must include cost-effective palliative care within essential benefit packages. Such integration is not just a human rights obligation, but a financially smart move that reduces long-term healthcare expenditure.
India’s Complex Equation: Insurance, Out-of-Pocket Costs, and Regulation
In India, a nation with immense diversity and a massive population, the debate centres on implementation challenges. While public-funded insurance schemes like the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) have made strides in covering inpatient, secondary, and tertiary care for vulnerable populations, research and studies point out critical gaps.
- Out-of-Pocket Expenditure: A major concern is that many schemes do not adequately cover outpatient care, medicines, and diagnostics, which constitute a significant portion of a household’s out-of-pocket expenditure. Many families are still pushed into poverty due to health expenses, highlighting a gap in the promised financial protection.
- Public vs. Private Sector: While private sector offers capacity and quality, the very fact that it is profit-driven, can exacerbate overcharging and inequality in access.
- Workforce and Infrastructure: Shortage of skilled healthcare professionals and inadequate infrastructure, particularly in rural areas, remain persistent barriers.
- Addressing these systemic issues cannot be solved by financing alone; it requires a concerted effort to build capacity and ensure equitable distribution of resources.
Global Imperative
Universal health coverage is an indispensable goal for a healthier, more equitable, and resilient world. However, its realisation demands moving beyond fragmented, vertical programs to a comprehensive, integrated approach that prioritises public funding, strengthens primary care, and actively involves communities in planning and accountability, ensuring that no one is truly left behind.
– Binod Hariharan
Chairman, & Chief Executive Officer (CEO), Pallium India
“Crossing Rivers, Carrying Home”
Photo Essay from Pakke Kesang, Arunachal Pradesh and Chamba, Himachal Pradesh
This photo essay from Pakke Kessang District in Arunachal Pradesh and Chamba in Himachal Pradesh offers a window into the lived realities of healthcare access in some of India’s most remote regions. It is more than a record of distance and terrain—it is an homage to the quiet strength of healthcare workers who cross rivers, forests, and mountains to ensure no one is left behind.
It honours the resilience of communities who receive care with dignity and hope, and serves as a reminder that the journey toward health equity is rarely straightforward, but always essential.
Each photo holds moments of solitude, solidarity, and service—together illustrating the true spirit of Universal Health Coverage: care that reaches every individual, no matter how remote the path.
Pakke Kesang, Arunachal Pradesh – Balancing care across bamboo bridges | Crossing the river
Pakke Kesang, Arunachal Pradesh – Wheels through water – bridging the last mile | Sharing paths with life – on the way to healing | One figure, one purpose – reaching the unreachable
Chamba, Himachal Pradesh – Palliative care physician and ASHA during Home visit walk 2 hours through hilly terrain to visit patient
Big Strategies to Help Small People
Reflections on Children’s Palliative Care as a Component of Universal Health Coverage.
Each December 12th, we recognize Universal Health Coverage Day. For palliative care providers, it offers an opportunity to reflect on the progress made in reaching new communities through innovation and new partnerships.
At the global level, the World Health Assembly passed a resolution in 2014 calling on all countries to strengthen access to palliative care. In addition, palliative care was recognized as one of the five core pillars of primary health care by the World Health Organization in 2018. Despite this progress, only 14% of people who require palliative care have access to it, and, unfortunately, this includes less than 3% of children.
Globally, efforts to expand access to essential health care for children facing health-related suffering have faced significant challenges. The overarching barrier that prevents children from receiving the health care they need is poverty. Two in five children worldwide live in severe deprivation – 90% of those living in Sub-Saharan Africa and South Asia. Poverty reduction efforts have been significantly impacted since the COVID-19 pandemic due to global development aid cuts, emerging conflicts, and new challenges from climate change.
Welcome to a new edition of Pallium India’s newsletter. Thank you for joining us. Here you can find updates from the palliative care world, upcoming events including training for professionals and volunteers, interesting articles, career opportunities and so on.
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Christmas Giving: ‘Happiness Box’
Light up a home with kindness
This Christmas help bring smiles to families living with the weight of serious illness.
Your contribution of INR 750/- can provide a Box of Joy filled with essentials, festive goodies, and hope for one family.
Beyond the Sessions: Reflections from the Field
Thaen – The Bitter Sweetness She Left Behind
Thaen (name changed) was only seventeen when she arrived at Pallium India. Diagnosed with an aggressive brain tumour and tormented by recurrent epileptic seizures, she came seeking comfort, stability, and the compassionate presence of a team that could walk alongside her.
When I was first asked to meet her, I felt an unexpected wave of self-doubt. I questioned whether my skills, empathy, and experience would be enough. But I gathered courage and stepped into that first session.
To my surprise, it unfolded gently — far better than I had imagined. Thaen welcomed me with a soft, unguarded warmth. She herself was unaware of the gravity of her prognosis, as was her family. Over the following days, our sessions continued, forming threads of a delicate connection. Yet each passing day also brought visible signs of her decline. Communicating with her grew increasingly difficult. We tried everything — her phone, scribbled notes, communication apps — but nothing succeeded.
The Making of an Ironwoman
Pallium India’s Pride, Dr. Sreedevi Warrier’s Triathlon Triumph
On November 9, Dr. Sreedevi Warrier—Head of the Department of Education & Skill Building at Pallium India, a palliative care physician, and mother of two—completed the Ironman 70.3 triathlon in Goa, conquering a 1.9 km swim, 90 km bike ride, and 21.1 km run in an impressive 7 hours and 48 minutes.
She recalls the anxiety she felt on the eve of the event. “I was worried about so many things. That was when my son sent me a photo of the medal I received after my first 10-kilometre run with the message, ‘This is where it all started, remember.’ That’s when I realized how far I had come and decided to do it for my children. And I did. At the end of each segment, I was so overwhelmed that I broke down! It is also special because, as far as I know, there are hardly any women from Kerala who have completed the triathlon in this age category [40-44].”
A Big Dream, Realised
8 November 2025 was a truly beautiful day. For the past few years, I have carried a dream of conducting a palliative care awareness class for the people of my own neighbourhood. To make this dream come true, I needed a space. I approached many people, but nothing seemed to work out.
One day, when I went to the local Urban Primary Health Centre for a consultation, I met a very friendly doctor there. Remembering the saying, “even a single word can bring you an elephant, if spoken at the right time,” I shared my wish with Dr Bismi, the Medical Officer. I told her that I would bring both the local people and the team to conduct the session, and all I needed was her help in arranging the venue.
The required permissions were arranged by the doctor and Junior Health Inspector Chinchu.
The Pallium India team arrived.
Trivandrum Institute of Palliative Sciences (TIPS), Pallium India
| Beneficiaries reached till August 2025: | 31,682 | |
| Palliative Care centres / services catalysed: | 226 | |
| Stakeholders trained (virtual and onsite): | 13,214 |
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Reports / News / Articles
Ensuring Affordable Medicines for All
Civil Society Charts Path Forward on Medicine Access at Hyderabad Strategy Meeting. Advocates, Experts Unite to Address Affordability, Quality, and Availability Challenges
The Third World Network’s Working Group on Access to Medicines and Treatments convened its Annual CSO Strategy Meeting in Hyderabad on November 22–23, 2025, bringing together patient advocates, legal experts, healthcare professionals, and policy researchers to address critical challenges threatening equitable access to medicines across India and the Global South. Over two intensive days, participants examined historical lessons, dissected current regulatory debates, and mapped collective strategies to defend health as a fundamental right in an era of rising pharmaceutical costs and monopoly pressures.
Day One: Histories, Lessons, and New Campaigns
Welcome remarks from co-convenors KM Gopa Kumar and Jyotsna Singh framed the gathering within India’s pharmaceutical journey—from the landmark 1975 Hathi Committee recommendations to two decades of navigating the TRIPS Agreement.
Pallium India at HCLTech Grants’ 10-Year Celebration
Pallium India was invited to participate in a special event hosted by the HCL Foundation at the India Habitat Centre, New Delhi, marking ten years of the HCLTech Grant. The gathering brought together finalists and winners from the past decade—organisations working with exceptional commitment in the fields of Health, Education, and Environment/Biodiversity.
The hall was filled with inspiring leaders from across the country, representing organisations that continue to drive change in some of the most challenging environments. The formal program was followed by cultural performances.
In the 10th Edition, Pallium India was recognised as the Runner-Up under the Health category for the HCLTech Grant 2025—a proud acknowledgement of our work to improve access to palliative care in India.
Empowering Safe Narcotics Management
A Collaborative Online Training Session
On 14th November 2025, an impactful online training session on “Use and Management of Narcotics Dispensing and Stocking” was conducted, bringing together healthcare leaders and frontline professionals from multiple states to strengthen safe and responsible narcotics management.
The session was delivered by Dr. Sunil Kumar, Director, TIPS, Pallium India, who provided valuable guidance on regulatory requirements, safe dispensing practices, documentation, and the role of essential narcotic medicines in palliative care.
Palliative Care Sensitization Session at Government Medical College, Thiruvananthapuram
As part of the ongoing project to integrate palliative care into mainstream health systems, Pallium India conducted a follow-up sensitization session with the Department of Radiotherapy at Government Medical College, Thiruvananthapuram. The session, aimed at enhancing knowledge and clinical confidence in pain management, was held on Friday, 21 November 2025, from 8:15 AM to 9:15 AM at the Radiotherapy Lecture Hall.
The topic for the day was ‘Pain Pathophysiology and the Use of Adjuvants’, and the session witnessed active participation from around 18 attendees, including faculty members and postgraduate students. The discussion was highly interactive, reflecting strong interest and engagement from all participants.
Generating Evidence in Fostering Palliative Care Delivery
Publishing research data truly enhances reproducibility and integrity and broadens the impact of research. Research and Innovation Department’s research – Factors influencing caregiver burden and its prevalence level amongst family caregivers of patients with palliative care needs and serious illnesses – on family or informal caregivers was published in the recent edition of BMC Palliative Care. As a palliative care institution, Pallium India works towards the betterment of its beneficiaries, the patient and family as a whole. Caregivers from the family are an integral part of palliative care delivery, and this research adds to the organisation’s values of leaving no one behind. Caring for a family member at home is challenging and demanding, as older patients with palliative care needs and serious illnesses or approaching end-of-life often have intricate symptoms and healthcare needs that worsen as their disease progresses and death approaches. This research broadens our scope by seeking to create evidence-based services for caregivers. Identifying caregiver burden and their quality of life helps us formulate and pave new paths to address their needs. Many studies examine the burden of caregiving among informal or family caregivers; however, research exploring caregiver burden among patients enrolled in palliative care settings is limited. Our study explored and estimated the prevalence of caregiver burden and identified factors influencing it among family caregivers of patients receiving Pallium India services.
MoU Signed for 60-Hour Palliative Care Learning Program for House Surgeons
A Memorandum of Understanding (MoU) was signed between the Kerala University of Health Sciences (KUHS) and the Trivandrum Institute of Palliative Sciences (TIPS), Pallium India, to launch a 60-hour Palliative Care Learning Program for medical house surgeons across the state.
The MoU was signed on 13th October 2025 at the KUHS headquarters by Dr. S. Gopakumar, Registrar, KUHS, and Dr. M.M. Sunilkumar, Director, TIPS – Pallium India. The agreement marks an important step towards integrating palliative care into medical education, equipping future doctors with essential skills in patient-centered care and pain management. The signing was attended by: Dr. Mohanan Kunnummel, Vice Chancellor, KUHS, Dr. C.P. Vijayan, Pro Vice Chancellor, Dr. Binoj R, Academic Dean, Dr. Shaji K.S, Research Dean, Dr. Geetha M. Govindaraj, Professor & Head, School of Family Health Studies and Dr. Anoop Kumar N, Associate Professor.
Lead with Compassion
An Initiative to Advance the Integration of Palliative Care into Hospital Services
A powerful step forward for hospital-based palliative care in Thiruvananthapuram
Pallium India, in collaboration with the Trivandrum Institute of Palliative Sciences (TIPS), successfully hosted an initiative to advance the integration of palliative care in hospital services. ‘Lead with Compassion’ initiative brought together leaders committed to transforming the healthcare experience through empathy and dignity.
– 13 private hospitals from across Thiruvananthapuram participated, represented by MDs, CMOs, PROs, senior physicians, and administrative leaders.
– 35 participants engaged in meaningful dialogue on strengthening palliative care within institutional systems.
Dr. Sunilkumar, Dr. M.R. Rajagopal, Dr. Arjun Devarajan and Dr. Aakash Vijayan shared insights on integrating palliative care into mainstream healthcare, improving patient experiences, and building compassionate care pathways within hospitals.
The event was seamlessly coordinated by CSO – Shijo Kurian Thomas and TIPS Executive Director – Manoj G.S., whose dedicated efforts made the program successful.
International Day of Persons with Disabilities
1-2 December 2025 | Manaveeyam Veedhi, Thiruvananthapuram
We are observing International Day of Persons with Disabilities with a poster campaign at Manaveeyam Veedhi, Thiruvananthapuram, celebrating the resilience, talent and spirit of people living with disabilities. Check our social media pages for updates.
Video of the Month
Finding Joy in Suffering: Lessons from Terminally ill Children
Subscribe to Pallium India’s YouTube channel for videos related to palliative care and our activities. You can watch previous webinars and training sessions, as well as listen to caregivers, survivors and others sharing their experiences.
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Book of the Month
The Love Song of Miss Queenie Hennessy
Rachel Joyce’s bestseller, The Unlikely Pilgrimage of Harold Fry, has an exquisite, funny and heartrending parallel story in this book.
In a small hospice on the Northumberland coast, Queenie Hennessy waits—her world reduced to quiet hallways, salt-stung air, and the tender care of nursing sisters. She is dying, and she knows it. Yet something unexpected has returned to her days: hope. It arrived in the form of a letter from Harold Fry, the man she once silently loved and never confessed to. Instead of sending his reply, Harold has begun walking the 600 miles from Devon to reach her, telling her only to wait.
As news of his journey spreads, the whole hospice begins to wait with her. Patients who are close to death find reason to hold on a little longer, staff find themselves cheering for a stranger, and Queenie—frail and failing—begins to write the story she has carried for twenty years: her love, her regret, and the secret tied to Harold’s son that shaped both their lives.
Walk with the Weary – by Dr M R Rajagopal
A masterclass in how to care for others deeply and compassionately no matter who they are, Walk with the Weary is simultaneously the story of Dr Rajagopal’s life and his calling and the world of Indian palliative care.
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PARTING SHOT
Walking With Dignity: Strengthening Palliative Care
How Giva Foundation Would Like to Step In
Over the past months, my journey into the world of palliative care has been deeply moving, eye-opening, purpose-defining & humbling. As part of the GIVA Foundation’s exploration into this critical yet underserved space, I visited a few palliative care centres — Romila Palliative Care Centre in Mumbai, Dr Prasanna’s Palliative Care Centre at Thane, Dr Eric Borges’ – SUKOON Nilaya in Mumbai, Dementia Alliance Centre in Bengaluru and the CIPLA Palliative Care Centre at Pune. Common factor – all of them are providing compassionate selfless and quality care to the Palliative care needs for the patients.
Sukoon-Nilaya | Cipla Palliative Care Centre | Health care workers at Cipla Palliative Care Centre
What I witnessed there continues to stay with me every day.
Insights & Learnings
My visits to palliative care centres and also few patient homes revealed how transformative early guidance and counselling can be for patients and families. Many had lived for months with fear, confusion, or complete uncertainty about their condition. When a trained professional explains what is happening and provides a realistic path forward, fear eases to relief and hopelessness shifts to clarity. Emotional counselling further stabilizes families, helping them process the diagnosis, accept the situation, and make informed decisions with a sense of clarity and confidence.
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