Intended for healthcare professionals


Learning from low income countries: what are the lessons?: Palliative care can be delivered through neighbourhood networks

BMJ 2004; 329 doi: (Published 11 November 2004) Cite this as: BMJ 2004;329:1184
  1. Suresh Kumar (pain{at}, director
  1. Institute of Palliative Medicine, Medical College, Calicut 673008, Kerala, India

    EDITOR—Neighbourhood network in palliative care is an initiative in the south Indian state of Kerala to develop a sustainable, community owned service for long term and palliative care. It aims at empowering local people to look after chronically ill and dying patients in the community.

    Most of the problems associated with chronic or incurable illness, being social issues, require interventions by communities. In Kerala's neighbourhood network, local volunteers are trained to identify the problems of chronically ill patients in their area and to intervene socially. These volunteer groups are supported by trained doctors and nurses. The project has managed to bring many groups and social initiatives such as cultural and social organisations and student groups together on a common platform of social justice to work for chronically ill people.

    Neighbourhood network programmes have shown exceptionally good success rates everywhere. More than 50% coverage for all chronically ill patients seems to have been achieved within two years of initiation of the project. The district where it was first launched now has an estimated coverage of more than 70%.

    Involving the local community in all stages of the project, from planning to monitoring, has ensured sustainability of the project. Neighbourhood groups locally find the resources to deliver care: 80% of the funds for programmes are raised locally. The groups' advocacy role also results in generating support from local government.

    Kerala's neighbourhood network in palliative care serves as a realistic option for most of the developing world in organising much needed sustainable services for chronically ill and dying patients.


    • Competing interests None declared.

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