Palliative Care: Need for Human Resource and Infrastructure

Palliative care is provided by a team of physicians, nurses and other health professionals who work together with the primary care physician and referred specialists (or for patients who don't have those, hospital or hospice staff) to provide an extra layer of support. Hence, palliative care is to be initiated by the Nodal Drug-resistant TB Centres (NDR-TBCs) in the states.

There are 2 main modalities of palliative care under the National TB Elimination Program (NTEP):

1. Home-based care
2. Institution-based care

Institution-based end-of-life care should be available to those for whom home care is not feasible or desirable. As far as possible, institution-based palliative care should be minimized to a duration that is absolutely essential as per the decision of the concerned NDR-TBC committee.

Human Resource Requirements for Home-based Palliative Care

Most palliative care must be home-based through a trained and counselled family member or caretaker with regular visits by healthcare workers and psychosocial/ spiritual support through local community-based self-help groups, Non-government Organisations (NGOs) or Panchayati Raj institutions. 

Home-based care should be offered to patients and families who want to keep the patient at home,whenever appropriate infection control practices can be followed. 

• The staff at the NDR-TBC can counsel and train family members/ caretakers with the aim to extend home-based palliative care to patients. 
• All health workers must receive training in palliative care to enable them to extend support to family members or caretakers providing home-based palliative care.
• Community-based workers could be trained in palliative care to scale-up existing health care delivery to include pain and symptom control. 

​Human Resource and Infrastructure Requirements for Institution-based Palliative Care

In rare circumstances, institution-based palliative care may be initiated with a longer duration of admission at selected NDR-TBCs.

• Interested NGOs or faith-based organizations with indoor facilities that could be engaged through a Memorandum of Understanding (MoU) and guided by NDR-TBCs. In all such facilities, airborne infection control (AIC) measures as per national AIC guidelines must be strictly implemented. As soon as the patient’s condition improves, s/he must be discharged with adequate counselling to the family member or caretaker for home-based palliative care and regular consultative visits to NDR-TBC as and when medically required.
• Delivery of palliative care from within respiratory clinical services by existing staff with additional training, with clear criteria for referral to palliative care specialists for complex patients, is to be established. 
• NDR-TBCs should link up with local palliative care and hospice teams from the network of Pallium India and the Indian Association of Palliative Care.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.

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