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Implementing palliative care in primary 
care
Public health strategy for palliative care
Lack of access to palliative care is a serious public health problem. Palliative care adapted to the needs 
of local communities and cultures should be thoroughly integrated into public health care systems 
(52). 
WHO recommends a public health strategy for integrating palliative care into health care systems in a cost-
effective manner to reach all in need 
(2,52, 53). This strategy entails:
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fostering political support;
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analysing palliative care needs and services;
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convening a national steering committee and obtaining agreement on an action plan;
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reviewing existing policies on palliative care and pain relief and revising them as needed or creating 
new ones;
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ensuring safe access to essential palliative medicines, including oral fast-acting morphine;
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initiating required training in palliative care for clinicians who treat people with palliative care needs;
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implementing palliative care services that are integrated into all health care systems at all levels; and
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measuring patient outcomes such as quality of life to ensure high quality of palliative care.
Seeking community engagement in palliative care delivery also is recommended 
(54). There will be modest 
start-up costs when implementing this strategy. For example, modest funding will be needed for the 
situation analysis, developing and achieving consensus for an action plan, revising or writing policies, 
assuring accessibility of essential medicines and establishing training programmes. In addition, funding is 
required to assure universal access to palliative care. However, there is evidence that palliative care, when 
well integrated into a health care system and including home care can save money for the health care 
system by reducing the need for hospital admissions near the end of patients’ lives (Chapter 3) 
(1). Thus, 
over time, palliative care integration into public health care systems may pay for itself and save money 
thereafter.
The public health strategy for palliative care assumes a functional PHC system. Some LMICs, such as 
Brazil and Costa Rica, have exemplary PHC, and others, such as Rwanda, are working towards universal 
access to PHC 
(55). However, the PHC system of many LMICs is underdeveloped (56). In these settings, 
PHC and palliative care may be developed and expanded at the same time. The same infrastructure and 
human resources that provide PHC can and should provide basic palliative care, and efforts to implement 
community-based palliative care can and should strengthen PHC. The similarity of the principles of PHC and 
palliative care has enabled such collaborative implementation in Kerala, India, for example 
(57).

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Integrating palliative care and symptom relief into primary health care