World Health Organization 20, Avenue Appia

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A WHO guide for planners, implementers and managers
Integration of palliative care 
strengthens public health systems and 
promotes UHC
Well-planned integration of palliative care into public health care systems can improve their performance, 
reduce costs and promote UHC 
(1). Palliative care networks that entail home care linked with and supervised 
by hospital-based inpatient and/or outpatient palliative care units can do more than improve the quality 
of life of patients. Data from HICs and high-middle-income countries show that such networks also can 
reduce length of stay in hospitals and enable many patients to remain at home or in the community, 
thereby reducing unnecessary hospital admissions for symptom control and relief, particularly near the 
end of life 
(7). Hence, palliative care can reduce hospital overcrowding and costs for overburdened health 
systems and provide financial risk protection for patients and their families 
(92–101). Within hospitals, 
the presence of a palliative care inpatient unit also can improve patients’ quality of life and reduce costs, 
in part by reducing use of life-sustaining treatments and cancer chemotherapy near the end of life that 
likely are harmful rather than beneficial as well as expensive 
(102-104). While no such studies from low- 
and low-middle-income countries have been reported yet, it appears that the start-up costs necessary to 
integrate people-centred palliative care services into health care systems – policy development, essential 
medicine procurement, training and increasing staffing – may pay dividends over time by improving patient 
outcomes, reducing costs for the health care system, and reducing dysfunctional overuse of hospitals and 
non-beneficial interventions.
Integration of palliative care specifically into PHC can yield additional benefits. Palliative home care should 
be provided in most cases as part of the PHC system by expanding home care services provided particularly 
by CHWs or nurses. Visiting patients at home presents an ideal opportunity both to inquire about the well-
being of the household and family and to educate them. Nurses as well as CHWs can be trained to provide 
education not only on caregiving for the patient, but also, for example, on smoking cessation, indoor air 
quality, HIV prevention and the importance of a healthy diet, exercise, prenatal care and screening for 
cervical cancer. In addition, inquiring about the well-being of household and family members can promote 
earlier recognition of tuberculosis, cancer and other illnesses as well as social problems such as lack of 
food, school tuition for children or decent housing. Thus, integration of palliative care into PHC systems 
also can strengthen the system’s capacity for health promotion, disease prevention and early recognition 
of disease 
(25,105).
Integration of palliative care into PHC also may improve disease treatment outcomes 
(106). PHC systems 
with enhanced home care capacity due to integration of palliative care can provide visits to patients in 
advance of an appointment for chemotherapy, radiotherapy or oncology follow-up to make sure the patient 
has the means and intention of keeping it. During visits, palliative home care staff also can promote 
adherence to outpatient treatment of myriad illnesses, including breast cancer, HIV/AIDS, tuberculosis, 
hypertension and diabetes mellitus. In general, palliative home care visits can help to prevent loss-to-
follow-up of patients receiving palliative care and of their family members who also are receiving health 
care.

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