Improving Access

Project For Improving Access to Palliative Care in Cancer Centers

undertaken by  Pallium India, a registered trust, in collaboration with

  • The Pain and Policy Studies Group
  • Paul P. Carbone Comprehensive Cancer Center
  • University of Wisconsin School of Medicine and Public Health a WHO Collaborating Center (WHOCC), Madison,Wisconsin, USA
  • and assisted by The United States Cancer Pain Relief Committee (USCPRC)

Pallium India thanks all the 32 institutions which submitted applications under the project.

There were so many deserving applications and the screening committee found it difficult to arrive at a decision.  The selection has been finalized now; the project is sanctioned to the following institutions.

  • Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow.
  • Regional Cancer Center (IGIMS), Patna.
  • Meharbai Tata Memorial Hospital, Jamshedpur.

We look forward to working with these institutions.  A doctor-nurse team from Jamshedpur joined us for training at Trivandrum in March 2009.  The trainees from Lucknow and Patna were with us in May 2009.

We hope we shall be able to work also with the institutions whose applications we have not been able to fund.  We are looking for some funding for support of more institutions. In the meantime, we have been able to obtain some scholarships for training of doctors and nurses from any of these institutions; so we look forward to hearing from them.

Original brief

The aim of the project is to initiate or strengthen palliative care in three cancer treatment facilities which agree to making palliative care an institutional priority. The project will provide, a grant, train professionals and offer technical support.

Project details

  1. Three centers in India will be chosen for the project in its first year.
  2. Any cancer center or Oncology department in India without a well-established palliative care service, desirous of starting palliative care services or of expanding current palliative care services, is eligible to apply.
  3. A committee including members from Pallium India and the WHOCC, will screen applications and select three cancer centers. In selection of institutions for the funding, first priority will be given to cancer centers or major Oncology departments in States with little or no palliative care. If there are no eligible applications from such cancer centers, others will be considered.
  4. The selected institution must be willing to sign a memorandum of understanding (MOU) with Pallium India specifying the duties and responsibilities of each partner.
  5. The selected institution will have to agree to initiate a palliative care service within three months of completion of Step I.
  6. The applicant institution will have to agree to include the cost of required immediate release morphine in its annual drug budget, to take steps to ensure its uninterrupted availability and to ensure its rational use, adequate drug management procedures and proper documentation. Pallium India and the PPSG/WHOCC will provide the necessary advice in this matter and will assist in preparation of estimates.
  7. The applicant institution will have to agree to contribute the time of the two trainees during the training period, that the trained personnel will be able to spend at least 50% of their working time to palliative care, and that it will continue to provide the funds to continue palliative care and morphine availability when the project terminates at the end of two years.
  8. For all amounts given to the recipient institution, the institution will be obliged to submit receipts and detailed statement of expenses.
  9. The applicant institution will have to agree to cooperate with the visiting team from the training center for evaluation of outcomes including assistance to obtain relevant statistics on patient numbers, morphine prescriptions and dispensing.
  10. Pallium India and PPSG/WHOCC will support and assist the trainees with issues in palliative care and opioid availability by being available for e-mail consultations.
  11. Within one month of completion of training and at the completion of the project, each trainee will be required to submit a report outlining the work they did upon return to the institution, what issues they encountered, and how they addressed the problems.

Step 1: Training of professionals:

  1. The selected institution is expected to depute two professionals (preferably a doctor-nurse team) who have an interest in palliative care and satisfactorily complete a six weeks’ certificate course in palliative care. At least one of the two must be a doctor.
  2. The training will be provided in Trivandrum Institute of Palliative Sciences, Trivandrum, Kerala. (Descriptive note on the institution is attached)
  3. Minimum qualification for such training is MBBS degree for the doctor, a diploma in nursing or equivalent qualification for other professionals.
  4. Medium of instruction for the training is English. The trainee’s ability to handle English must be taken into consideration when the selected institution deputes trainees.
  5. The actual amount of money spent on travel necessary to participate in the training and an allowance to cover accommodation and food will be reimbursed to the candidate subject to the condition that the maximum amount that can be provided for this purpose would be Rs. 40,000 per trainee.

Step 2: Starting/improving palliative care service:

  1. The grant available for starting palliative care service (Rs. 7,20,000 per center for the whole project period of two years) will be disbursed in instalments by cheque.
  2. Upon completion of Step I, the first instalment of the take-off grant will be disbursed to the selected institution to enable starting/improving the palliative care facility.
  3. The selected institution is expected to start a palliative care service within three months of completion of training.
  4. Education of the local health care professionals, the public and government administrators will be a priority for successful establishment of palliative care services. Hence the project envisages one educational workshop in the locality to facilitate proper take-off of the palliative care service. This could be directed first and foremost at professionals in the institution; but would also be available to other professionals in the area, medical students, the public and administrators. Each workshop would be of one to two days’ duration. The agenda and the faculty for the workshops will follow the guidance given by Pallium India. . This should be taken up preferably within 3 months, and not later than 6 months.
  5. Pallium India and WHOCC will work with the selected institution to analyze issues related to opioid availability, conduct an opioid availability workshop and to seek solutions to any existing problems.

Financial support:

In addition to the amount available for initial travel and training of two professionals, financial support will be made available to selected institutions as follows and may be used only for the purposes of this project:

  • Local expenses including venue, audiovisual aids, refreshments and accommodation for education program and opioid availability workshop in the cancer center: Rs. 60,000
  • Take off grant to support palliative care service for a period of two years: Rs. 720,000

Note: The amount will not be transferred in bulk, but suitable advances would be disbursed by Pallium India for each step after committee evaluation of progress.

Monitoring and evaluation:

A screening committee including representatives of PPSG/WHOCC and Pallium India will be responsible for monitoring and evaluation of the project. The faculty member/members deputed by Pallium India for the educational program in the cancer center will also be entrusted with the responsibility of on-site monitoring and evaluation of the program.

Anticipated outcome:

It is expected that support during the early phase will cause either starting of a palliative care facility in three more oncology centers in India or in significant strengthening of existing services. The Indian experience so far shows that once a proper palliative care facility gets off the ground and its benefits become visible, further progress and sustainability are relatively easy. Cancer pain being emotive, support from the community is usually easily forthcoming. Over the long term, we expect that a visible palliative care service in one location will result in more palliative care facilities to develop elsewhere. The proposed educational program in Step 2 is expected to spread the message of palliative care among professionals, improve referral rate and establish a regulatory environment conducive to uninterrupted access to essential medicines including oral morphine.

About Trivandrum Institute of Palliative Sciences (TIPS):

TIPS is an institution established by Pallium India with the dual aims of establishing an effective palliative care delivery system and of providing quality palliative care education. It is housed in S.U.T Hospital complex at Pattom, Trivandrum, Kerala. It runs an outpatient clinic in its headquarters as well as home visit programs in Trivandrum city and neighboring rural areas. It also cares for inpatients in S.U.T Hospital and in a hospice. It conducts certificate courses in palliative medicine and nursing as well as training programs for volunteers in addition to awareness programs for the public.