Values in Care
    Working evidence register. Some national estimates are dated, modeled or secondary. Every figure shows its evidence type, data year and last-checked date.
    Side by side

    Compare countries across the same questions

    Pick up to four countries and the dimensions you care about. Each cell shows either a labelled, cited figure, a sourced note, or the open question standing in its place. Save the arrangement as a snapshot, share it as a link, or print it with every citation attached.

    Countries (3 of 4 selected)
    Dimensions shown
    Show

    Every cell, with its evidence label and citation.

    Saved review snapshots

    A snapshot stores the arrangement, not the evidence. Reopen one and the figures, evidence labels and citations are read fresh from the register.

    Every cell is either sourced or plainly open. Nothing is inferred across countries.
    DimensionPakistanWorked example · 9 domains reviewed · 6 high-confidence · 3 dated estimates · 6 material gapsIndiaAnalog · 9 domains reviewed · 7 high-confidence · 7 dated estimates · 8 material gapsUgandaAnalog · 9 domains reviewed · 9 high-confidence · 6 dated estimates · 5 material gaps
    Opioid supplyIs a therapeutic opioid physically available in the wards that need it?
    • 3.71 MME per 1,000 people per day Opioid analgesic consumption, 2019 SOURCE-CHECKED · 2019 DATA3
    • 4.88 MME per 1,000 people per day Opioid analgesic consumption, 2015 SOURCE-CHECKED · 2015 DATA3
    • 3.45 MME per 1,000 people per day Opioid analgesic consumption, 2019 SOURCE-CHECKED · 2019 DATA3
    • 1.39 MME per 1,000 people per day Opioid analgesic consumption, 2015 SOURCE-CHECKED · 2015 DATA3
    • 716 kg per year Medical morphine consumption, 1985 SOURCE-CHECKED158
    • 18 kg per year Medical morphine consumption, 1997 SOURCE-CHECKED158
    • 278 kg per year Medical morphine consumption, 2014 SOURCE-CHECKED · 2014 DATA158
    • 0 percent Kerala government palliative care providers able to prescribe oral morphine, 2020 SOURCE-CHECKED · 2020 DATA121

    No peer-reviewed before-and-after evaluation of the 2014 amendment's effect on consumption was found. Years after it, dispensing was still confined to hospital pharmacies in several states, and in Kerala no surveyed government provider could prescribe oral morphine.3,11,119,121

    Subnational evidence

    OpenDid national consumption rise because of the 2014 amendment, on an INCB-comparable series?

    Government supplies free oral morphine as an essential medicine and has co-manufactured it nationally since 2011.12

    National evidence
    Narcotics regulationWhat licensing regime governs stocking and dispensing, and when did it last change?

    OpenWhich specific licensing clauses, in which provincial rules, produce the stocking bottleneck?

    The 2014 NDPS amendment created an Essential Narcotic Drugs class regulated centrally and replaced multiple state licences with a single state-level Recognised Medical Institution approval from the State Drug Controller, under uniform central rules.11,50

    National evidence

    Statutory Instrument 2004 No. 24, made under the National Drug Policy and Authority Statute, carries the prescriber expansion and ties prescribing to the Ministry of Health guidelines for handling Class A drugs.34

    National evidence
    Prescriber authorityWho is legally allowed to prescribe, and can that group be widened?
    • Unknown people Practicing palliative specialists nationally, current ILLUSTRATIVE ONLY25

    OpenIs any nurse or clinical officer prescribing authority available under current law?

    • 10 days Hands-on training required before a physician may prescribe oral morphine, Kerala, 2015 SOURCE-CHECKED · 2015 DATA51

    The amendment created no new prescriber class. A registered medical practitioner still signs, but for essential narcotic drugs must additionally have completed training in pain relief and palliative care. Stocking and dispensing sit with the recognised medical institution, not the individual.50,51

    National evidence

    OpenHow many recognised medical institutions are registered nationally?

    A clinical officer or nurse holding a certificate in specialist palliative care may prescribe and supply the listed morphine preparations, under the 2004 narcotic analgesic regulations.12,34

    National evidence
    Service deliveryThrough what structure does care actually reach a patient at home?

    Specialized palliative care in Pakistan is offered by only a few institutions. At Aga Khan University Hospital in Karachi, a program started in 2017 delivers inpatient, outpatient and home-based care and served 3747 patients in 2017 to 2019, and its outpatient clinic is described as the first in Karachi (self-reported, single institution).278,279,280

    Single-site evidenceSelf-reported

    OpenHow is palliative care delivered outside large private tertiary hospitals, for example in public hospitals and rural districts?

    • 83 of 139 nationally Palliative care delivery points located in Kerala, 2008 SOURCE-CHECKED124
    • 19 centres Palliative care centres in West Bengal's first phase of the national programme, 2018 SOURCE-CHECKED · 2018 DATA117

    The National Programme for Palliative Care, launched in 2012, is implemented state by state and unevenly, with some states starting years later. Primary care wellness centres studied in Odisha offered inadequate palliative care. Services were heavily concentrated in Kerala.124,117,122

    Mixed scope

    OpenHow many services exist by state today, and how much post-2014 growth lies outside Kerala?

    • 226 facilities Accredited palliative care facilities, 2020 SOURCE-CHECKED · 2020 DATA35
    • 30 districts of 135 Districts with no accredited facility, 2020 SOURCE-CHECKED · 2020 DATA35
    • 88.50 percent Population living in a district with a service, 2020 SOURCE-CHECKED · 2020 DATA35
    • 68.10 percent Accredited facilities in the public sector, 2020 SOURCE-CHECKED · 2020 DATA35

    OpenWho staffs the accredited facilities, and how many carry a certificated prescriber?

    FinancingWho pays for the drug, the visit and the workforce?
    • 54.30 percent Out-of-pocket share of health spending, exact, 2020 UNDER REVIEW19

    Palliative care associations report poor allocation and use of government funds and little insurance cover for home and outpatient palliative care. Patients at a national cancer centre called for palliative care to be added to the national insurance benefit packages.118,120

    Mixed scope

    OpenWho pays for morphine procurement at recognised medical institutions, and what does the national programme spend?

    • 94 percent Stand-alone service donations from external sources, 2019 SOURCE-CHECKED · 2019 DATA36

    Government support to stand-alone services arrives as medicines, training and tax exemption rather than cash.36

    National evidence

    OpenWhat changed in donor funding after 2025?

    Training and recognitionWhat credential exists, who awards it, and does anyone recognize it?

    A postgraduate certificate in palliative care exists at National University of Medical Sciences with the Shaheen Palliative Care Project.7

    Single-site evidence
    • 24 percent Kerala palliative care providers with a full-time trained physician, 2020 SOURCE-CHECKED · 2020 DATA121

    The national programme trains district medical officers through a short cascade model, and a 2024 assessment found most training need unmet afterwards. Even in Kerala, most providers had no full-time trained physician.117,121

    Mixed scope

    OpenWhen was the MD in Palliative Medicine recognised, and how many graduates and certificate holders are there?

    • 12 months Diploma in Clinical Palliative Care, course length, 2022 SOURCE-CHECKED · 2022 DATA37

    The Diploma in Clinical Palliative Care is open to registered nurses and clinical officers, and its graduates may prescribe oral liquid morphine.37

    National evidence
    Opioid safeguardsHow are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief?

    An anthropological study argues that narcotics enforcement aimed at illicit supply and unviably low price ceilings make morphine scarce in Pakistani hospitals while heroin circulates illicitly. In a national survey of 2,838 hospital health professionals, only 27.7% knew patients must sign an opioid agreement and 22.2% knew of the drug monitoring program. A mystery-shopper study found 95% of 200 sampled Punjab pharmacies were run by non-qualified staff and sold controlled drugs without prescription.551,552,553

    Mixed scope

    OpenIs opioid agonist treatment (methadone or buprenorphine) available in Pakistan outside pilot HIV programs, and is naloxone stocked in hospitals and pharmacies?

    India's 1985 NDPS Act set harsh custodial sentences even for minor clerical errors in hospitals stocking opioids, and the 2014 amendment to improve medical access has been slow to implement. Opioid substitution therapy with buprenorphine, buprenorphine-naloxone and methadone grew through the National AIDS Control Programme, though coverage targets are still far off. Delhi doctors named tough opioid regulations as their most common barrier to prescribing, and people who use opioids in Kashmir reported low naloxone knowledge and poor access.540,541,542,543,544

    Mixed scope

    OpenHow many Recognized Medical Institutions stock oral morphine under the 2014 NDPS amendment, state by state, and is take-home naloxone available outside deaddiction centers?

    Uganda lets trained nurses prescribe oral morphine, and Hospice Africa Uganda assessed 34 patients on long-term oral morphine, finding two cases of addiction and one probable diversion among people with chronic non-cancer pain. Uganda introduced methadone treatment in 2020, with 55.2% of 343 clients retained at 12 months, and a Kampala pilot started 55 people on buprenorphine. Patients and supply staff still report legal barriers to an adequate opioid supply for pain.288,597,598,599,600

    Mixed scopeSelf-reported

    OpenDoes Uganda run any prescription monitoring for oral morphine, and is naloxone available to palliative care teams or to people who use drugs?

    Psychosocial and bereavementWhat psychological, social and grief support reaches patients and family caregivers?

    At one Karachi hospital, 70.2% of 326 caregivers of oncology patients had anxiety and 38.0% had depression, and the authors call for routine psychological screening of caregivers. Family caregivers of women with advanced breast cancer in Punjab described financial strain and emotional stress, often using religion to cope.554,555

    Subnational evidence

    OpenWhich Pakistani palliative care services include psychologists, social workers or bereavement support for adult patients and families?

    Cancer physicians who have worked with psycho-oncologists say the service improves care, and they call for national action to extend it equitably. In one Kerala district, 23.0% of 200 family caregivers of palliative patients had severe caregiver burden, and a home-based palliative unit that supported caregiver health and linked families to local government resources had a positive impact on caregiver burden. A national review found stigma toward the dying and the psychological burden of care add to limited, mostly urban end-of-life services.545,546,547,548

    Mixed scope

    OpenHow many palliative care services in India employ a psychologist or medical social worker, and do any offer structured bereavement follow-up for adult patients' families?

    Accredited palliative care facilities in Uganda offer psychosocial, legal, bereavement and spiritual support, but on average only for 7 months a year due to lack of transport and facilitation. A randomized trial in three public hospitals found that nurse-led palliative care with psychosocial support improved patient-reported outcomes for people with multidrug-resistant tuberculosis.35,601

    Mixed scope

    OpenHow many trained counselors, social workers or psychologists work in Uganda's palliative care services, and is caregiver mental health screened routinely?

    Children's palliative careHow do children with life-limiting conditions get palliative care and the medicines they need?

    A palliative team at a Peshawar cancer hospital reviewed notes for 150 referred children and found psychological and family challenges, financial constraints and limited resources. Bereaved parents at a Karachi hospital reported no institutional bereavement practices and barriers to psychological care, including stigma and cost. Caregivers of children with blood cancers receiving specialist palliative care in Karachi valued its holistic approach and better communication.556,557,558

    Single-site evidenceSelf-reported

    OpenHow many children in Pakistan are reached by pediatric palliative care each year, and are oral morphine formulations for children available at those centers?

    Across three tertiary cancer centres, 2.7% of 150 children with cancer needed palliative care as the focus of treatment and 49.3% had moderate needs, yet clinicians judged only 7 of 150 likely to benefit from referral. Family caregivers had more psychological distress (57%) than the children (33%). A Tamil-language bereavement needs tool for parents of children who died of cancer (CANCOPE-PI) was co-developed with bereaved caregivers in south India.549,550

    Subnational evidence

    OpenHow many children receive pediatric palliative care in India each year, and are child-appropriate oral morphine formulations available at those services?

    Uganda provides pediatric palliative care across the health system from neonates to young adults, yet in the Busoga sub-region 96.1% of children with cancer did not continue palliative care after discharge, and none of them had been referred to their nearest provider. Children were 6% of attendees at the Fort Portal hospital palliative care unit.287,602,603,288

    Mixed scopeSelf-reported

    OpenHow many children receive palliative care in Uganda each year, and are child-appropriate morphine formulations stocked outside referral hospitals?

    Hospice modelWhat does hospice mean here, who runs it, and in what settings?

    Hospice care is not well established in Pakistan, and most end-of-life care happens in acute hospitals or at home. The hospice described in the literature is a charitable non-profit inpatient cancer hospice in Karachi, linked to a philanthropist-funded cancer hospital that also gives palliative care.275,276

    Single-site evidence

    OpenWhen was the Karachi hospice founded, and do any hospices or home hospice teams exist outside Karachi?

    Indian palliative care grew out of an early hospice movement in the 1980s, and hospice is discussed as one setting within palliative care. A leading example is Karunashraya, a 73-bed nonprofit hospice in Bangalore that has given free inpatient and home care to advanced cancer patients for over 30 years.281,283

    Mixed scopeSelf-reported

    OpenHow many dedicated hospices exist in India, and how many are run by NGOs, faith groups or the state?

    Hospice in Uganda means NGO-run services that mostly deliver home-based, outpatient and day care; Hospice Africa Uganda has operated since 1993. Kitovu Mobile Hospice offers mobile and home care and also cares for inpatients at Kitovu Hospital. Ugandan sources use hospice and stand-alone palliative care organization almost interchangeably.284,285,36

    Mixed scopeSelf-reported

    OpenHow many of Uganda's hospices run their own inpatient beds, and which are faith-based?

    Hospice eligibilityWho can enter hospice, on what criteria, and how late do patients arrive?

    The Karachi hospice admits patients with terminal cancer who are expected to die within six months, and it serves poor families. In a case study at the linked cancer and hospice hospital, all patients presented at a late stage of disease (single site).275,276

    Single-site evidence

    At the Bangalore hospice, admissions were advanced cancer patients referred mainly by doctors, with word of mouth, friends and relatives of former patients also common routes. Median time from admission to death was 8 to 10 days in 2021 and 2022, which shows very late arrival (single site, pandemic period).281

    Single-site evidenceSelf-reported

    Hospice Africa Uganda serves patients with AIDS as well as cancer, and people living with AIDS who were referred still presented with advanced disease after long suffering. Poverty and fear of stigma around disclosing an AIDS diagnosis acted as barriers to seeking help (single organization).286,12

    Single-site evidence

    OpenAre there written admission criteria or prognosis rules for Ugandan hospices, and at what stage do cancer patients arrive?

    Hospice fundingWho pays for hospice care: a public benefit, insurance, charity or families?

    The Karachi hospice is a charitable non-profit that gives food and medications to patients and their families during the stay. The linked cancer hospital is funded by philanthropists for people who cannot pay, while personal spending makes up around 58% of total health spending in Pakistan.275,276

    Single-site evidence

    The Bangalore hospice provides care free of charge with support from the Indian Cancer Society and a Rotary club. A pediatric perspective reports limited government funding and little private philanthropy for hospice care, and names financial burden as one reason hospices are underused.281,282

    Mixed scopeSelf-reported

    Stand-alone hospice and palliative care organizations in Uganda get 93% of their funding from donations, and 94% of those donations come from outside the country. Government support comes mainly as medicines, training and tax payments, and oral liquid morphine made at Hospice Africa Uganda is given free to prescribed patients.36,12

    National evidence

    OpenHas government budget support for hospices changed since public hospitals were told to provide palliative care?

    Hospice reachHow many dying people use hospice, and who is left out?

    At the time of one study, Karachi, a city of 16 million, had only one hospice. In a survey of 522 dialysis patients in seven units, only 5% reported knowledge of hospice services.275,277

    OpenHow many hospices exist in Pakistan today, and what share of people who die use them?

    Dedicated pediatric hospices are limited because most hospices focus on adults, so many children receive end-of-life care in general hospitals or at home. At the Bangalore hospice, high-income patients were about 2% of admissions and women were the majority, and less than 2% of India's population is reported to have access to palliative care.282,281

    Mixed scopeSelf-reported

    OpenWhat share of deaths in India, by state and by diagnosis, occur with hospice involvement?

    Only 11% of Ugandans who need palliative care receive it, with distance to hospitals and hospices and transport costs among the barriers. In Busoga sub-region, 96.1% of children with cancer did not continue palliative care after discharge, and none of them had been referred to a nearby provider. Rural, poor and pediatric populations are the groups most often left out.284,287,288

    Mixed scope

    OpenHow many patients do Ugandan hospices serve each year relative to national deaths?