The median travel time to the nearest palliative care centre is 118 minutes nationwide, 57 minutes in urban areas and 120 minutes in rural regions. But not in Kerala.
Published Nov 22, 2025 | 7:00 AM ⚊ Updated Nov 22, 2025 | 7:00 AM
Synopsis: Kerala boasts the most accessible palliative care network in India, rivalled only by Chandigarh and Delhi and outperforming even several wealthier Western countries such as Germany, a new analysis has found. Patients in the state reach a centre in a median of 14 minutes, compared with the national average of 118 minutes. Nationally, fewer than four percent of the nearly one crore Indians who need palliative care actually receive it.
For lakhs of Indians living with life-limiting illnesses such as cancer, palliative care is often the only source of relief.
It is an approach focused on easing the physical, emotional, social and spiritual suffering caused by serious health conditions, and on improving the well-being of patients and their families. Yet it remains one of the most neglected areas of healthcare.
A new analysis by the Association for Socially Applicable Research and Pallium India shows just how wide the gap is.
Fewer than four percent of patients who need palliative care receive it, even though an estimated 70 lakh to one crore people require such support each year. Access remains one of the biggest barriers.
The median travel time to the nearest palliative care centre is 118 minutes nationwide, 57 minutes in urban areas and 120 minutes in rural regions.
But not in Kerala. The state’s much-lauded healthcare system hosts 44.5 percent of India’s palliative care centres despite serving just 2.5 percent of the population. Some 94.6 percent of residents live within 30 minutes of a centre.
This means patients in the state can reach palliative care in a median of just 14 minutes, the shortest in the country and a sharp contrast to the national average.
The analysis, published in ecancermedicalscience, examined 526 palliative care centres operating in 2022. It calculated travel times, mapped geographic coverage and modelled the reach that public health systems could achieve.
“This analysis makes a lot of assumptions, people own vehicles, road conditions are good, weather is clear and there is no traffic. The travel times reported are under those assumptions. The ground reality will be much worse. But despite these assumptions travel times across the country are quite long,” says lead co-author Dr Parth Sharma, speaking to South First.
The study found that Kerala achieves 92.9 percent rural coverage. Villages offer better access than cities in twenty-six other states and union territories. The state operates 65.7 centres per crore people. Urban residents reach 97.2 percent coverage, but the rural achievement stands unprecedented.
“Rural populations of Chandigarh, Goa and Kerala had a higher percentage of the population within 30 minutes of access than urban populations of twenty-six states/UTs,” the study notes.
Civil society participation, sustained government support and community mobilisation created Kerala’s palliative care movement. The model emerges from decades of work, not sudden policy intervention.
Across South India, access to palliative care spans the spectrum.
Puducherry mirrors Kerala’s success on a smaller scale. The union territory places 82.5 percent of residents within 30 minutes of a centre. Urban access reaches 91.6 percent. The median travel time is 11.9 minutes. With 24.9 centres per crore people, Puducherry demonstrates that size need not determine outcomes.
Tamil Nadu occupies a middle position among southern states. The state operates 5.7 centres per crore people, below Kerala but ahead of its neighbours. Coverage splits sharply between urban and rural areas. While 73.6 percent of city dwellers live within 30 minutes of a centre, only 28.4 percent of rural residents enjoy the same access. The median travel time extends to 54.6 minutes.
Telangana presents a stark divide. Urban residents secure 80.2 percent coverage within 30 minutes, driven by hospital networks and non-profit providers. Step outside the cities and the picture transforms. Just 22 percent of rural residents reach a centre within that timeframe. The rural median travel time stretches to 70 minutes. The state maintains 4.7 centres per crore people.
Karnataka struggles with geographic reach despite hosting premier cancer treatment facilities. Only 27.9 percent of the total population can access a centre within 30 minutes. Rural coverage drops to 12.1 percent. The median travel time reaches 108.3 minutes, among the highest in southern India. The state operates just 1.8 centres per crore people.
Andhra Pradesh performs worse than all other southern states across multiple measures. A mere 23.5 percent of residents live within 30 minutes of a centre. Rural access falls to 16.3 percent.
Nationally, India averages just four palliative care centres per crore people. The 526 centres mapped in 2022 are distributed unevenly across states. Some regions concentrate services while others operate none.
“The median time to reach the nearest PC centre was nearly 2 hours, and only 23.7 percent of people had access to PC services within 30 minutes of motorised access,” the authors write.
Of these centres, 410 provided outpatient services, 324 offered inpatient care and 381 delivered home visits. Morphine, the foundation of pain management for terminal illness, was stocked at 333 centres. That leaves 171 centres unable to provide basic pain relief.
“Of the 504 centres with available data, morphine was present in 333 (66.1 percent) centres. At least one trained healthcare worker was present in 477 (90.7 percent) centres,” the study notes.
Services remained free at 371 centres. Another nineteen offered free care only to people from poor backgrounds. The remaining centres charged fees that families managing terminal illness often cannot afford.
Four regions reported zero palliative care centres: Andaman and Nicobar Islands, Dadra and Nagar Haveli, Daman and Diu and Ladakh. Residents facing terminal diagnoses must leave their territories entirely. For Ladakh, the median travel time to reach a centre rises to nearly ten hours. Only 3.6 percent of residents live within two hours of the nearest facility.
“No centres were present in Andaman and Nicobar Islands, Dadra and Nagar Haveli, Daman and Diu and Ladakh,” the authors note.
The urban-rural gap extends beyond centre placement into the infrastructure that determines whether patients can travel. Road density in urban areas measured 5296.3 per 1,000 square kilometres in 2018–2019. Rural road density reached only 1458.1 per 1,000 square kilometres.
“This can be explained by the poorer road infrastructure in rural areas, which increases travel times. In 2018–2019, the average road density in urban and rural areas was 5296.3 and 1458.1 per 1,000 km2, respectively,” the authors explain.
Healthcare professionals cluster in cities, drawn by amenities and career opportunities. Centres follow the workforce, leaving villages to manage on their own.
“An urban-rural disparity in the establishment of health centres has also contributed to the difference in travel times in urban and rural areas. As health professionals in India prefer to practice in urban areas, owing to the availability of better amenities and more opportunities for career growth, more centres tend to be established in urban areas,” the study notes.
Kerala’s achievement is particularly notable, since the analysis found that it was comparable to some of the richest western economies. The state is only bettered by two Indian cities: Chandigarh and Delhi.
Switzerland places 95 percent of residents within 30 minutes of a palliative care centre. Germany reaches 86 percent, Ireland 84 percent and Spain 79 percent. Only four Indian states or union territories meet Ireland’s benchmark.
“While Chandigarh (100 percent), Delhi (99.2 percent), Kerala (95.7 percent) and Goa (92.8 percent) reported better access in terms of APC compared to Germany (86 percent), all other states/UTs in India reported access poorer than Ireland (84 percent),” the authors write.
Even wealthy countries face rural-urban divides. Rural areas in states within the United States such as Virginia, Tennessee and West Virginia show travel times nearly five times longer than urban areas in the same states.
(Edited by Dese Gowda)
