How Kerala seeks to converge palliative care with extreme poverty eradication

Palliative care initiatives, alongside efforts to eradicate extreme poverty and enhance waste management, will be Kerala’s top priorities in the coming year. The government has introduced a multi-departmental coordination proposal to ensure effective implementation.

This initiative is set to serve as a flagship project for the Pinarayi Vijayan-led government as it gears up for local self-government elections next year and Assembly polls in 2026.

Many schemes so far

The Left Democratic Front (LDF) government has a history of launching flagship developmental projects that comprehensively address various aspects of life such as the Total Literacy Mission of the 1980s, the People’s Plan Campaign of the 1990s and the Kudumbashree Mission.

The aim is to achieve a waste-free “New Kerala” and intensify efforts to eradicate extreme poverty. Special meetings of the governing councils of local self-government institutions will be convened for this purpose. Meetings of palliative care organisations will also be held.

All political parties will be involved in these efforts, with the chief minister addressing the special sessions convened as part of this initiative.

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Battling poverty is the key

“Poverty alleviation does not merely mean providing food but also ensuring sustainable livelihoods. It’s important to support those capable of earning a living, excluding the elderly and those unable to work due to illness,” the chief minister said.

“Local self-government institutions must identify and liberate families in extreme poverty within their areas. Such individuals can be included in employment guarantee schemes. Interventions should be tailored to the specific needs of each family.

“People’s committees will monitor the progress of poverty eradication at the local level,” said Vijayan.

Community-based palliative care

Palliative care will be a key focus of the New Kerala vision, reflecting the state’s leadership in this field, with the highest number of palliative care units in the country.

While not extensively studied, Kerala’s community-based palliative care model is widely regarded as a highly sustainable and effective initiative, often considered the best in India.

The state is home to over 1,600 institutions providing palliative care services, accounting for 80 per cent of the 2,000 such services across the country.

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Kerala’s policies lauded

Palliative care services are available in every district of Kerala, albeit with some limitations, reaching over 70 per cent of those in need — significantly higher than the national average of 23 per cent.

According to the report of the Lancet Commission on the Value of Death, 2022, the model developed in Kerala is an example of profound systems change. It has succeeded in changing narratives around death and dying, building a powerful community response, increasing the number of people able to access care, influencing state and national policy, and challenging models of care globally.

It has also succeeded in redefining care at the end of life as a public concern beyond services and professionals. This is why the government is relying on the state’s extensive palliative care network to launch its integrated welfare-focused project.

Role of local-self government

Local self-government institutions should lead in palliative care activities, addressing not only patients’ issues but also the challenges faced by the elderly.

Existing agencies should be included in this effort. Registration processes for such agencies should be transparent and non-discriminatory, adhering to the guidelines set at the local level. Details of such organisations operating within their jurisdiction must be collected by each local self-government body, said the chief minister.

Minister outlines broad goals

“We are planning to establish a portal for the palliative care network which will be integrated with the health and social justice departments. There are various social and religious organisations at play in the sector. Nobody will be left alone in the initiative. The care should be inclusive, encompassing patients, the elderly, and persons with disabilities, without distinguishing between APL and BPL categories,” local self-government minister MB Rajesh told The Federal.

“The domiciliary care programme will be expanded for this purpose, and individual care plans must be devised at the panchayat level. Existing old-age homes must ensure services for abandoned elderly individuals. The government policy is to ensure no one is left without care in their locality,” added the minister.

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Kerala’s battle against poverty

In the area of extreme poverty eradication, the state has already way ahead of the other states, he said.

According to the data released by NITI Aayog on the Multidimensional Poverty Index, Kerala stands out as the least impoverished state in India.

Only 0.7 per cent of its population falls under the multidimensional poverty category, based on factors such as child and adolescent mortality, maternal health, education, housing, sanitation, access to clean drinking water and electricity.

The report also highlights Kottayam district as the least impoverished district in the country, with an absolute poverty rate of zero. These figures reflect Kerala’s remarkable progress in poverty alleviation.

NITI Aayog on Kerala

While only 0.55 per cent of Kerala’s population is classified as multidimensionally poor, the corresponding national figure is 14.96 per cent, as per the NITI Aayog index. With overall poverty levels significantly reduced, Kerala has shifted its focus to eradicating extreme poverty through tailored interventions.

In November 2023, the state’s local self-government department had identified 64,006 households, comprising 103,099 individuals, as meeting the criteria for extreme poverty.

“We have achieved nearly 70 per cent of this goal in the past year and are on the verge of declaring the state as the first in the country to be free of extreme poverty by November 2025,” said minister Rajesh. “Housing remains an area where more work is needed. We have identified individuals without housing and have begun allocating funds to them through the Life Mission initiative.”

Welfare activities

He added: “People without land or housing are our primary concern. The government believes that individuals who are single may not require a separate house but can be accommodated in shared housing setups, rented spaces or community living arrangements. This approach is one way to address the issue, and we are making significant progress in this direction.”

According to the plan, welfare activities of various departments would be utilised effectively, and necessary assistive devices be distributed. Allocated funds must be efficiently utilised by local bodies. Sponsorships should be organised for housing construction. The ‘Care Fund’ concept in local self-government institutions should be implemented effectively. Micro-plans involving all departments must be executed, with Collectors reviewing the overall project in each district.

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Unified public campaign

District, block and panchayat-level institutions must actively participate, with monthly progress review meetings at each level. A nodal officer must be appointed. Local bodies may declare themselves free from extreme poverty before 1 November 2025 if they achieve the goal earlier.

A unified public campaign titled ‘Waste-Free New Kerala’, ensuring widespread public participation, is another project the government wants to push in the election year. The aim should be achieving complete sanitation across the state.

Kerala must announce total sanitation by March 30. Neighbourhoods, tourist spots, villages, cities, offices and educational institutions must adopt green practices. Implementation committees should be formed in wards lacking them within this month.

Cleanliness, public waste

Local bodies must act if wastewater pipes from houses or other establishments flow into water sources such as canals. Mechanisms for testing E. coli presence in water sources must be set up, with inspections planned for December and January.

Septic tanks must be installed where required, and facilities for collecting and processing public waste should be established. The operation of household waste processing systems must be ensured, and repairs carried out if necessary.

Community organic waste processing systems should be guaranteed in flats and residential associations.

Wooing the voters

With these developmental and welfare initiatives in place, the government is again preparing to approach the electorate, hoping to counteract anti-incumbency sentiments. However, the ongoing financial crunch poses a significant challenge.

Facing alienation from minority groups and a segment of antagonized Hindu voters, the government is relying on its tried-and-tested strategy of leveraging welfare and development as its key electoral plank. This approach has a proven track record of success, as evidenced by the LDF’s strong performance in the 2020 local self-government elections and the 2021 Assembly elections, despite adverse circumstances such as controversies like the gold smuggling case and other issues.