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Integration of palliative care in various countries has faced similar obstacles, despite the varying health care systems in each country. For instance, there is low awareness and acceptance of palliative care by both the general population and health care providers. Palliative care in most cases is equated with end-of-life or cancer care only. The misconception makes it difficult for patients to get this type of care early enough during their disease processes since it only starts when one is already critically ill. Cultural factors also play a big role in the late discussion of this care as many cultures have a stigma attached to talking about death.

The second challenge relates to pain management, particularly the reluctance of healthcare providers to administer medication and the fear among the patients to use morphine due to perceived addiction or being in the last phase of the illness. At times, there is lack of morphine, which poses another problem in this regard.

There is an imbalance in the kind of services provided by health care facilities, where palliative care is primarily targeted at people living with cancer and not those suffering from other conditions such as heart failures, respiratory diseases, renal failure, and dementia. More people suffer from non-communicable diseases, but most palliative care programs are not directed to them.

Hospitalization is another obstacle faced by palliative care programs because in many cases, palliative care services are provided within hospitals, and hence there are multiple readmissions as the condition deteriorates. Patients are expected to receive services in hospices or at home and even in the community, but this option is underdeveloped in most cases.

There is no availability of trained personnel for palliative care in some countries. Lack of training can be seen from the fact that palliative care services are poorly incorporated into medical and nursing curriculum. Therefore, the health care professionals will not be adequately educated about pain management and end-of-life services. Also, in cases where the professional is not adequately trained, it becomes difficult to offer quality palliative care.

Other system-related challenges also exist. For example, there is a lack of integration of palliative care within the primary healthcare systems, ineffective referral processes, as well as the lack of policies and financing mechanisms that would facilitate its implementation. Moreover, in some countries, such as India, palliative care programs are either funded externally or are not considered in the framework of national health plans and budgets, which complicates its development and expansion.

On top of that, there are socioeconomic factors that hinder the access to necessary services. Financial issues, transportation difficulties, and weak infrastructure in some countries may prevent individuals from using appropriate resources. As a result, family members face mental, psychological, and even physical strain due to the lack of proper assistance and education.

However, there are several ways out of the situation. First of all, it is essential to implement palliative care within existing healthcare systems to recognize needs at an early stage. The promotion of the service will help to dispel common myths about it and encourage more patients to seek professional advice. Furthermore, encouraging home- and community-based services will reduce the load on hospitals and increase convenience. Let us work on embedding palliative care in NCD clinics as a standard of care for the patients who are eligible.

In addition, facilitating access to medications, particularly opioid-based ones, and enhancing education among healthcare professionals will also be crucial. While establishing the supply chain is important, addressing reasons for staff not wanting to prescribe or dispense morphine will be important by way of training, and also addressing the myths and fears by patients on morphine use. Additionally, its important to continue to empathize to complete evaluation of pain and its management- such as following the WHO step ladder model, using the adjuctsand  the non-pharmacological options.

Overall, while palliative care has been established in many countries, the core difficulties relate to raising awareness, integration into systems, training of staff, and engagement of communities. Addressing all of them will allow overcoming these obstacles.

Part of integration is to engage all peer and community networkds: Such as faith leaders, elders, extended families ( even children), patient or family alumni, etc

Exploring culturally appropriate ways of truth telling- as this will be context specific, and sometimes patient specific aswell…. And the focus shouldn’t be prognosis- but rather on the goals of care for the patient, while balancing as much as possible family desires.

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I am a Family Physician, in Lagos Nigeria. I am involved with Teaching medical students, Postgraduate Msc and Resident doctors and focus on Emergency medicine, Palliative and Geriatric Medicine. I am also looking forward to doing a fellowship Geriatric Medicine. I enjoy conducting research and grant writing.

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Nurse Manager at Al-Malath organization,

it is an organization for palliative care services in Jordan providing home visits for cancer patients at end life and for elderly people with dementia and Alzheimer.

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My name is Emodi Kenechukwu, Kene for short. I am a Family Physician and I live and work in my country Nigeria. Glad to be here

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Holistic Palliative Care Approach- Team Pink

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Holistic Palliative Care Approach- Team Pink

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•⁠ ⁠Holistic care means we see full person. Not only cancer. We see body, mind, family, money problem, and faith.

•⁠ ⁠Many patients are very sick. Some in ICU. Some taking chemotherapy. They have pain, breathing problem, weakness, fear. We treat pain and other symptoms.

•⁠ ⁠Family love patient very much. Many times they say “do everything.” So we must talk slowly and clearly. We explain disease and future in simple words. No false hope. No harsh talk.

•⁠ ⁠In our culture, family is very important. Decision is taken together. So we involve family in every discussion.

•⁠ ⁠Many families have money problem. So we must think before giving costly treatment which may not help. Avoid useless expense.

•⁠ ⁠Patient feelings are also important. We sit near them. We listen. We ask, “What is troubling you most today?”

•⁠ ⁠Education level and health understanding are different for each family. So we speak in easy language.

•⁠ ⁠Palliative care should start early, not only in last stage. Main aim is good quality of life — less pain, more comfort, more respect.

•⁠ ⁠In low resource setting, we improve what is already there. No need to make big costly new system.

•⁠ ⁠In our hospital, teamwork is very strong. Doctors, nurses, social workers, chaplains, community health workers — all work together.

•⁠ ⁠Budget may be less, but people are creative and helpful. We support each other and serve patients with heart.

In simple words, holistic care means caring with head and heart — less suffering, more comfort, more dignity.

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Team Blue I am Ngozi Udechukwu a pediatrician from Nigeria. It promises to be very rewarding ( I had some initial distractions of being a patient's relation )

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Team Blue I am Ngozi Udechukwu a pediatrician from Nigeria. It promises to be very rewarding ( I had some initial distractions of being a patient's relation )

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Hi

Am Gladys, a Critical Care Nurse Specialist

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Group Reflection on Palliative care in your region - Pink Team

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Group Reflection on Palliative care in your region - Pink Team

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We had an engaging discussion. We got to know about different countries and their status of Palliative care. Some of the common points we identified are as follows:

1.Most of the team members identified that palliative medicine is mostly restricted to tertiary hospitals and greatly lacking at community levels.

2. There is derth of trained physicians and many countries doesn't allow non physicians to prescribe opioids. Lack of availability of essential narcotics also is a major challenge!!

3. Talking about finances, at most of the countries palliative care services are still not covered by insurance policies. These cause a lot of problems while distributing the services equatiably.

4. Last but not the least, early or timely integration of PC is still not the standard of practice. Adequate structured hospice is lacking making quality of end of life care poor.

Possible solutions:

1. Integration of PC at district level health care services.

2. Training paramedic staffs for safe opioids prescription for community level PC.

3. Govt policy for integration of PC.

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Health & Wellbeing has been identified as one among the top 3 of 17 Sustainable Development Goals by UN. Though the life expectancy has increased and we have healthy elderly and super elderly population, yet the intrinsic and extrinsic environmental factors have imposed a serious threat to humanity with various life-threatening and life limiting illnesses. Which give rise to emerging need of palliative care services.

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Perspective on definitions of palliative care 

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Perspective on definitions of palliative care 

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WHO has given a well conceptualized framework for health and extended Palliative Care definition to include life threatening illnesses by early detection, impeccable assessment and relief from pain and sufferings for improving the quality of life and quality of death.

Now when we compare it with other definition of IAHPC after a gap of 16 years, we can identify the key differences in scope, timing of onset of care and focus.

However, as we move forward, we can think of including community participation, addressing the grief / bereavement support to the family and care giver in the palliative care scope.

Y Shailaja: a compassionate nurse and professional social worker

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experienced a real exciting interactive sessions. thanks and regards to all

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Hello

I’m team blue. My name is Ouchy BON. I’m from Cambodia. I’m worked at Khmer Soviet friendship hospital of Phnom Penh, Cambodia. I’m so interested and happy to join this course. I hope to continue this course smoothly and successfully, to be further improved nursing care and health care at my hospital. Thank you.

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This is Md Raihan,i’m a Public Health Professional and currently working as a PCMA & Reporting Focal under the Department of Palliative Care at the International Organization for Migration (IOM) in Cox’s Bazar for Rohingya refugees people

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The second definition by International Association for Hospice and Palliative Care is more definitive.

It is more inclusive and involves all aspects of palliative care and all ages ,including all stakeholders . It is to alleviate suffering, ensure comfort and support to the patient looking at the whole-person in a holistic approach.

SIMILARITIES: Improves quality of care for the patient, holistic approach though WHO further expands on what is holistic ie pain , etc

DIFFERENCES: WHO: An approach, how we do it

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Hello am sara Debebe research Assistant from Ethiopia.am very interseted with pallative care 

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Hello am sara Debebe research Assistant from Ethiopia.am very interseted with pallative care 

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Opps my Internet connection suddenly severely interrupted, can I join my Android? Plz,allow me

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Social and financial background of the patients is also important so there is understanding of the process. Signpost to external networks

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Communication and language uses for the patients and families is also important. Also spiritual and cultural aspects

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I am Dr Oyeniran Ayodeji Olaolu, an Obstetrician and Gynaecologist with special interest in Gynaecological oncology. I have been involved in palliative care since 2010 , I trained in hospice Africa Uganda, PGD Palliative medicine University of Cape town.

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Palliative is support for life limiting illness,alleviate suffering, fear, good death, holistic approach. Look at the disease progress, prognosis and help patient, family and care gives to prepare.Also ensure there is understanding of the disease prognosis.

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je suis medecin des soins palliatifs exerçant dans un centre régional d oncologie au Maroc

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I m Pharmacologist and palliative care physician from jammu , i m interested in this fellowship

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I am Jahanara Akther. I am joing from Bangladesh.

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Hey everyone. Im from the lovely island of Trinidad and Tobago

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Pink team I'm doctor anesthesiologist and palliative care from Libya I'm interested for this fellowship 

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Pink team I'm doctor anesthesiologist and palliative care from Libya I'm interested for this fellowship 

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comfort

meaningful

interest

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Hi,everyone, I am from Bangladesh.I am very glad to meet you all.

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Hi I am dr. Noor Chachan Psychiatrist from Iraq interested in Palliative care

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this padlet gave me a new name .how do i correct to my real name

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Hi, team Silver great and exciting to be here

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Hi, team Silver great and exciting to be here

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Hello! Everyone

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Hi testing

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I'm from Nigeria. I'm looking forward to acquiring more skills in Palliative care.

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I am a palliative care physician working with both cancer and non cancer patients in a home-based setting since the last 2 1/2 years. I am excited to be a part of this course. I hope to learn from the experiences of the faculty and mentors. I expect this will help me to improve my understanding and work. Thank you.

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Hi

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Hi, everyone, how are you? I am well.

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I am a Compassionate Registered Nurse with over 6 years of progressive clinical experience across hospital,

emergency, rehabilitation, home healthcare, oncology and school health settings in Cameroon and the UAE.

Currently serving as a Staff Nurse / School Clinic Nurse at Fakeeh University Hospital, Dubai, UAE. I have Strong

interest and hands-on experience in oncology and palliative nursing, including one-on-one post–cancer

survivorship care. Selected Fellow, Fellowship in Palliative Care (2026) and Foundation Course in Palliative Nursing ( Pallium India) Committed to delivering patient centered, culturally sensitive, and evidence-based care.

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This is Sathya Doraiswamy, Public Health Physician, currently based in New York, USA. I work for the United Nations Population Fund and want to move to palliative care as a career soon.

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greetings everyone, I'm jam gillian a nurse from Cameroon presently working in the Palliative/Oncology unit of the Bamenda Regional hospital.

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Hi i m tania from team olive

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Hello everyone im wiwiek from indonesia

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hello

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Amazing, Hello Everyone from Chittagong, I am Internist working Remote Gov.Hospital

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Very good learning indeed

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Hello! I’m Nilton Cruz, a GP from Timor-Leste. I work on developing palliative care services and promoting compassionate, patient centred care. Looking forward to connecting and learning with everyone here!

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Hello

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Hello All from South Africa and as part of team Orange.

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Hello everyone

Happy to be part of cohort 10

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Team Pink,

Hello everyone. Glad to be here and learning.

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I am an oncologist from Chittagong, Bangladesh hoping to help my patients needing palliation in a structured way.

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Hi I am bibi Jan from Singapore

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Hello Everyone! I'm Dr. Milan Farrell from Trinidad and Tobago. I am looking forward to deepening my knowledge in Palliative Care with all of you!

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Hello from team brown!

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hello

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Hi everyone

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Hello everyone🖖🏻

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Hello

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Hi everyone

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Hi

I am Dr.Nasir Uddin Mahmud Shuvo

From Bangladesh

I am an Oncologist

Belongs to magenta team

Very happy to be part of this amazing community

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team orange 🍊

From IRAq

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i ma trying this.i am leonad from kenya, a palliative care practioner in kenya

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I am Jocelyn, a pain medicine specialist and palliative care practitioner from the Philippines. I am excited to learn from everyone. Thank you very much for this highly interactive orientation.

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Hello everyone, glad to be a part of this Fellowship and eager to learn from everyone present here. Thank you!

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Hello everyone...

I am Dr. Navya from Kerala, India.....

Happy learning guys

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Greetings from Team Blue

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Pink - Swagata.

Hello everyone, Myself Dr Swagata Biswas, from India. I am a practicing Onco-anesthesiologist and leading the department of palliative care in a corporate hospital. I joined the course to learn about the capacity building of such unit and expand community level services.

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I am physician and public health professional from Bangladesh. I work mainly with maternal, child and adolescent health.

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Thank you so much for this course and it will be wonderful and exciting cheers

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I’m dr.Shruti gupta from team brown ..

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Ho everybody here is Chiara from Italy

Nice to meet all off you

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Hi , I’m Nisha from Hospis Malaysia, one of the palliative care nurse working in the community. Pleasure to meet all of you.

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Safreena here, mentor team green

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Team brown 2026

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Hallo, Nice to meet you everyone, i'm very exited to learn This Palliative Program

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Hello im wiwiek from Indonesia

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I'm Dr Rishi from Team Magenta. I am a Senior Resident in Radiotherapy and Oncology from AIIMS Jodhpur. In our region, access to end of life and incurable illness care is present but uneven. Palliative care which should start from Day 1 of the first OPD visit is often started reactively. With this course, I want to inculcate community palliative care strategies from across the globe to make sure I can optimise the care for my patients from cure to comfort.

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Hi Noureen Alani from Karachi Pakistan

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I am a course director - with a background in nursing, academia and leadership in palliative care 

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I am a course director - with a background in nursing, academia and leadership in palliative care 

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Good Morning I am Leah Roberts from Barbados

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exciting !

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Hi...My name gets translated into light in Persian language....I hope to get enlightened by the course

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I am a Pediatric Oncologist working in the UAE, with a passion towards Palliative care. Grateful to be here.

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I Hi everyone, I am from silver team.

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Thank you for this opportunity

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Hello, partners. I ' m from Brazil. I'm very happy to join th team. I'm doctor 

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Hello, partners. I ' m from Brazil. I'm very happy to join th team. I'm doctor 

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Hello, I’m Dr Nadva, a general practitioner from Muscat. I am very grateful for this opportunity to join the fellowship. Thank you!

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My name is Omar Jiménez. I work in two public hospitals in Mexico, and I am an internist. It is a pleasure to be part of this fellowship

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Hi, myself Dr Smaraki Mohanty, Professor in the department of Community Medicine from Odisha, India.

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Team scarlet

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hello! I am a public health practioner from Pakistan

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My team is Silver.

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i come from ghana

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Hi, Jonas from Malaysia, I'm a pal care doctor here!