India’s rising palliative care needs and the policy response: A review of state palliative care policies

Background The need for palliative care is increasing in India. As health is primarily a state responsibility, state governments play a key role in translating national priorities into policies. This study examined how national and state palliative care policies address these challenges. Methods A documentary analysis of palliative care policies in India was conducted. Documents were identified through Google search, government website searches and expert consultation. Documents were reviewed against a framework based on the World Health Organisation public health model for palliative care development. Additional domains included paediatric palliative care, implementation, monitoring and evaluation, governance, financing, and cross-sectoral interventions. Results The analysis included the National Programme for Palliative Care (NPPC) and policies from Kerala, Maharashtra, Karnataka, Tamil Nadu, and Goa. All policies supported institution and home-based care, emphasised opioid availability, promoted health-system integration, and included workforce training and community engagement. Kerala and Tamil Nadu provided the most comprehensive approaches to health-system integration, community participation, and implementation planning, while Kerala demonstrated the strongest commitment to research and diversified financing. Considerable variation existed in implementation readiness, monitoring and evaluation frameworks, governance arrangements, and financing mechanisms. Most policies incorporated monitoring structures, although only some specified indicators, targets, or review processes. Paediatric palliative care was inconsistently addressed, with most policies lacking actionable implementation strategies. Despite increasing needs associated with population ageing and chronic disease, only Goa explicitly identified older adults as a vulnerable population, and no policy addressed advance care planning. Cross-sectoral approaches were limited; only Kerala and Tamil Nadu included explicit mechanisms linking palliative care with social welfare and community support systems. Conclusions Indian palliative care policies align with core palliative care development domains but remain insufficiently responsive to demographic and epidemiological transitions. Strengthening age-responsive planning, paediatric palliative care, financing, and intersectoral social support could improve preparedness for future palliative care needs.