People living in Low, and Middle Income Countries (LICs and LMICs)

The content and key messages on this page have been developed in collaboration with clinicians, campaigners, people accessing palliative care, and their caregivers. You can use this content in your social media and as part of your World Hospice and Palliative Care Day activities.

Thank you to Ashla Rani from Pallium India Trust for her contribution to this page. 

WHPCA would love to hear about any projects that are working to create equity in access to palliative care for LGBTQ+ people. Please share them with us by contacting our Communications Manager.


People living in Low, and Middle Income Countries (LMICs)

Leave no-one behind – equity in access to palliative care

The following are the common barriers to equitable care in LMICs

What are the problems?

1.    Failure of healthcare system to include palliative care:

Palliative care is not part of healthcare in most countries. Inappropriate disease specific treatment is given to patients with chronic and life limiting illnesses, destroying them physically, emotionally and financially.[1]

2.    Lack of access to controlled medicines:

Prohibitive laws and policies which prevent access to controlled medicines for pain relief.

3.    Lack of education/awareness:

Palliative care is not included in the curriculum for healthcare professionals. The public and administrators are unaware of palliative care.

4.    Vulnerable population is left behind:

Even where palliative care is available, people with disabilities, children, elderly, those geographically, socially and politically isolated, those subjected to gender discrimination including LGBTQ+ people and other vulnerable population are ordinarily left out in implementation of any strategy.

5.    Inadequate primary/secondary/tertiary health care:

Adequate primary healthcare services are not available to treat lifestyle diseases like diabetes and hypertension. Adequate rehabilitation facilities are not available for people living with disabilities.

What can be done?

If we are to leave no one behind in LMICs, we need to create a global action plan specific for in LMICs with adaptable implementation strategy.

1.    Document common barriers to access to palliative care in LMICs with particular attention to

a)    National policy/program

b)    Palliative care education

c)    Access to controlled medicines

d)    Factors contributing to vulnerable population being left behind

e)    Inadequacy of primary, secondary and tertiary healthcare forcing palliative care providers to incorporate it into their work

2.    Create guidelines for development of national palliative care programs or policies with implementation strategy inclusive of education and opioid access with attention to the vulnerable population.

3.    Provide easily accessible education materials including Massive Online Open Courses (MOOC) & webinars specific to in LMICs

4.    Develop supply chains for affordable controlled medicines.

[1] Sakthivel Selvaraj, Habib Hasan Farooqui, and Anup Karan Quantifying the financial burden of households’ out-of-pocket payments on medicines in India: a repeated cross-sectional analysis of National Sample Survey data, 1994-2014

BMJ Open. 2018 May 31;8(5)

Inspiring projects: 

Compassionate Narayanganj

This innovative project was funded by UK Aid Direct. The aim was to build a compassionate community to ensure people access the health care that they need when living with and dying from serious illness in the Narayanganj City Corporation of Bangladesh. Find out more. 



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