The Health department is worried that primary care palliative care activities at the grassroots level could get disrupted, putting hundreds of bedridden or chronically ill patients in rural areas in peril, as most local self-government institutions (LSGIs) have been seriously short of Plan funds since December 2025.

Palliative care nurses posted for community palliative care in many grama panchayats, especially in northern districts, have not received their salaries for months. Many LSGIs are also unable to pay the salary of ambulance drivers, meet fuel expenses, buy the necessary consumables — diapers, catheters, surgical gloves or medicines, according to reports. The issue was raised by many medical officers at the recent DMOs’ conference.

Kerala’s community palliative care is primarily governed by the State Palliative Care Policy (first declared in 2008 and revised in 2019) along with subsequent Government Orders and circulars directing the LSGIs to implement home-based care.

The policy mandates that all local bodies — panchayats, municipalities, and corporations — include palliative care projects in their Annual Plans.

The Health department estimates that 0.6% of Kerala’s population is bedridden due to various health conditions. Additionally, another 2% of the population, though not confined to bed, goes through serious health sufferings due to long-term illnesses.

In the public sector, Kerala has 1,141 primary palliative care units encompassing all grama panchayats, municipalities, and corporations. These units (one per every 30,000 population), comprising one nurse trained in palliative care, one trained local health volunteer, one health worker/ ASHA and ward member/councillor, are expected to visit every bedridden or sick patient in their area at least once a month.

The palliative care nurse is appointed by the LSGIs. Apart from the salary of the nurse, the local bodies are expected to meet the vehicle expenses, the driver’s salary, and the expenses for their noon meal. They also have to find funds for medicines (approximately ₹6-12 lakh/year), consumables, and assistive aids like wheelchairs or water beds for patients.

The project belongs to the LSGIs while the Health department is the implementing authority. LSGIs use the Plan development funds plus the funds they raise through donations for community palliative care.

Since December 2025, there has been a serious shortfall in the Plan funds allocated to the local bodies. The revised Budget presented by the new UDF government reduced the Plan fund allocation further by ₹1,533.55 crore.

“In many panchayats, welfare projects are in doldrums. But palliative care is not something that can be compromised because for many families, even the once-a-month routine visit by the palliative care team and the medicines and supplies like diapers they provide are crucial,” a medical officer says.

He says this situation has happened before too. But then, the government had issued a GO which clearly says that palliative care should not be disrupted and that in the event of funds crunch, medical officers can utilise funds from the relevant hospital management committees (HNC) for the same, which could be recouped later by the HMC whenever Plan funds are available.

“Thus, across the State, wherever HMCs are flush with funds, palliative care nurses’ salaries are being taken care of. But then, the situation may not sustain for long as only 50% of the HMC funds can be utilised by the medical officer. Unless the Plan funds impasse is resolved soon, palliative care activities in the State could be badly affected,” he points out.

Published - July 21, 2026 08:00 pm IST