World Health Organization 20, Avenue Appia

Palliative care as part of PHC
Available evidence indicates that most people around the world prefer to be at home in the last phase 
of their life 
(15,26,27). To respect this preference, and to avoid or reduce overcrowding in expensive 
hospitals, palliative care is needed in the community and in patients’ homes. Pain relief and palliative care 
programmes should be incorporated into existing health care systems and that palliative care be accessible 
in patients’ homes 
(28). Primary care clinicians with basic training in palliative care and a set of simple, 
safe, effective and inexpensive medicines and equipment can respond effectively to the palliative care 
needs of most patients 
(29). However, arrangements should be put in place so that primary care clinicians 
can easily and reliably consult physicians with more advanced palliative care training about complex or 
unfamiliar problems. Arrangements also should be put in place so that clinicians at community and district 
levels can easily and rapidly transfer patients to a higher level institution when needed to relieve refractory 
suffering 
(30,31).
The cost savings of integrated care
Many health problems that commonly generate referral to more expensive specialist care can be competently 
and adequately addressed by PHC. These problems include simple reproductive health and gynecologic 
problems, many non-severe communicable diseases, many chronic illnesses (including multimorbidities), 
uncomplicated substance use disorders and other non-complex mental health problems. They also could 
include uncomplicated pain or other symptoms associated with serious or life-threatening conditions. 
Available data indicate that palliative care integrated into PHC can be both of high quality and cost 
effective even in a low-income country 
(32). This integration also may save money for health care systems 
and provide financial risk protection for patients’ families by reducing dependency on hospital outpatient 
and inpatient services 
(1,32–35). Involvement of CHWs and community volunteers in palliative home care 
also may increase social solidarity and cohesion 
(29).

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Integrating palliative care and symptom relief into primary health care