Hospice care around the world

Qualitative studies describe hospices in and around Buenos Aires as non-governmental, faith-inspired institutions staffed by volunteers with nurses, physicians, psychologists and a priest. One hospice ran Hospice at Hospitals, Hospice at Home and a residence. Evidence covers single sites only.^315,316

Australian peer-reviewed reports describe "hospice" mainly as small local services within wider palliative care, such as a four-bed end-of-life unit inside a residential aged care facility in one rural NSW town and a community-based specialist palliative care service in Gympie, Queensland. The terms hospice and palliative care overlap in this literature, and these are single-site examples.^356,357

Recent PubMed literature describes hospice care as a service inside cancer centers, for example at one public quaternary cancer hospital in Sao Paulo. No national hospice model was described in the sources read.³¹⁷

Canadian sources use the combined term "hospice palliative care"; after palliative care arrived in 1975, "hospice" came to label community-based organizations, and British Columbia now has 68 hospice societies, mostly volunteer-based, with only a few running inpatient hospice facilities. Ontario's regional programs link residential hospices with palliative care units and consultation teams.^352,353

China's national hospice program started with 2017 guidelines and pilots in five districts, expanded in pilot batches in 2019 and 2023. Hospice is delivered through hospice departments and wards in hospitals and community health centers and some integrated medical and elderly care institutions, under a 2024 national standard for geriatric hospice wards. Policy is government-driven, and Chinese sources use hospice and palliative care interchangeably.^182,306,307

Hospice in Ethiopia centers on Hospice Ethiopia, a non-governmental organization in Addis Ababa that runs day care and home-based hospice services with community volunteers. The same sources describe it as the main palliative care NGO, and palliative care entered the government system in 2015, so hospice and palliative care overlap in this literature.^292,293

Georgian sources use 'palliative care' for adult services, delivered since 2006 through a state program of inpatient, outpatient and home care. 'Hospice' names a service for children: a children's hospice opened in 2017, and a 2026 review lists one non-state-funded children's hospice, Firefly World.^154,152

German hospice care includes inpatient hospices for people who can no longer be cared for at home and outpatient hospice services that rely mainly on trained volunteers for psychosocial support. Day hospice services are a newer addition, and uniform experience with them is still lacking. Nearly 300 inpatient hospices were listed in 2025.^308,309,311

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

In Indonesia, hospice care is largely home-based and run by nonprofits. The Indonesian Cancer Foundation began home hospice programs in 1995 with teams of doctors, nurses and volunteers, and it is now developing hospice buildings in South Jakarta. This account is written by the foundation itself.⁷¹

As of 2022, Iran had no hospice centers and no integrated, formal hospice program. A few centers, mainly in large cities, provide sporadic palliative care at home or in hospital that includes end-of-life care, and researchers have proposed a national hospice model.³²⁵

Japanese research uses "hospice" and "palliative care unit" (PCU) together, as in "inpatient hospice/palliative care units", so the terms are largely interchangeable. National evaluations cover hospital-based PCUs and separate home hospice services, and most participating institutions reported no religious affiliation.^345,346

Jordanian sources from King Hussein Cancer Center use the joint term hospice and palliative care. The center has provided inpatient, outpatient clinic and home care hospice and palliative care settings since at least 2006, delivered by a team of physicians, nurses, social workers, pharmacists and spiritual counselors (single center).^299,300

Nairobi Hospice opened in 1990, and until about 2010 palliative care in Kenya was mainly provided by a small number of hospices. Since then, the national hospice and palliative care association has helped set up palliative care units in public hospitals that link discharged patients to a hospice where one exists. Some hospices, such as one in Western Kenya, run inpatient beds and rural outreach.^12,61,289

Hospice-type care in Lebanon is home based and run by nonprofits. Balsam, founded in 2010 as the country's first palliative care service, draws on French mobile teams and North American hospice and offers 24/7 home care; a 2024 overview counts three nonprofits giving home-based palliative care mainly to end-of-life patients. Local papers use 'home-based hospice' and 'home-based palliative care' for the same kind of service.^327,328,329

Malawi's literature mostly uses the term palliative care, delivered through hospital-based programs, home-based care and some NGO stand-alone centres. Dedicated inpatient hospice facilities are rare; St. Gabriel's Hospital has a dedicated inpatient palliative care unit with 24 hospice beds. Hospitals in a southern Malawi project increased referrals to hospice or other palliative care programs.^103,104

In Malaysia, hospice mainly means NGO-run community home care, started in 1991 under voluntary organizations, alongside public hospital palliative units and public clinic domiciliary care. In 2021, 25 of 29 registered community palliative care teams were registered under the Malaysian Hospice Council, and Hospis Malaysia is a charity serving about 2000 patients a year. Local writing uses hospice and community palliative care almost interchangeably.^301,47

Mongolia began palliative care development in 2000, and hospice units sit within a national network of palliative beds. Six hospice units in Ulaanbaatar hold 50 beds, alongside palliative beds in districts and provinces and a 5-bed pediatric inpatient unit opened in 2014.⁹⁴

Hospice Nepal, started in 2000 in Kathmandu Valley, is described as the first formally established modern hospice, with a Pashupatinath Hospice listed from 1995. Five hospices are dedicated to cancer patients alongside four palliative care units in cancer hospitals, run by NGOs, a Buddhist charitable foundation, a temple-linked site and a cancer hospital, and NGO programs also give home-based hospice care.⁵³

Nigerian sources use the joint term hospice and palliative care. Hospice Nigeria was set up in Lagos in 1998 as a registered charity, and University College Hospital Ibadan, a federal teaching hospital, opened a hospital-based hospice and palliative care unit with inpatient, day care and home-based services in 2007. A stand-alone pediatric hospice opened in Lagos in 2023.^65,291

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

The Philippines pairs the terms, with a 2016 Department of Health order establishing the National Policy on Palliative and Hospice Care and a Hospice and Palliative Care Act drafted in 2015 that has not passed the Senate. A 2021 Manual of Operations sets standards for the national program, and the proposed law would require local government units to run home-based programs.⁷⁹

In Romania, hospice is closely tied to HOSPICE Casa Sperantei, a foundation that has pioneered palliative care since 1992. It developed home-based care, inpatient units, day care centers and hospital support teams, so in this literature the hospice name covers the full range of specialist palliative services.^189,312

The Saudi sources read describe end-of-life services as hospital palliative care units, community home care, outpatient clinics and consultations. Hospice appears only as a study label ('hospice-eligible') in one Jeddah hospital study.^323,324

South African hospices are mainly non-profit NGOs that provide inpatient, day care and home-based care. St Luke's Combined Hospices in Cape Town was founded in 1980, and hospices formed the Hospice Palliative Care Association as a national body in 1987. The national association has 104 member organisations, and not all of them call themselves hospices.^{295,296,297,133}

Korean hospice care is delivered by hospitals designated by the Ministry of Health and Welfare under the Act on Decisions on Life-sustaining Treatment, enacted in 2016 and enforced in 2017, with about 100 designated hospitals running inpatient hospice wards. A consultative hospice program for patients in acute wards has run as a pilot since August 2017, and home-based hospice has been insurance-covered since September 2020.^350,210,211

Thai literature mostly uses palliative care, and hospice appears as a small set of hospice wards and faith-based organizations caring for people with AIDS or cancer, alongside community home care. Thailand is described as having few hospices.^304,305

Turkish sources describe hospice services as absent. Dying patients are cared for in hospitals, including palliative care units and intensive care units, through hospital-based home health services, or at home by family. Local papers use 'hospice' for a missing service and 'palliative care' for existing hospital units.^320,322,321

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

Ukrainian sources use the combined term palliative and hospice care, and a legal review treats hospice care as a component of palliative care. The first Ukrainian hospice was an institution for cancer patients in Lviv. In a Kyiv survey, mobile teams and home-based services were the most requested forms of this care.^196,313,314

UK hospices run inpatient units, Hospice at Home services and day services; 199 adult inpatient hospice units operate across the UK. Of 128 Hospice at Home services in England, 88% were charity-led and 12% NHS-led, and these services date from the modern hospice movement of the late 1960s.^339,340,341

US hospice developed in the 1970s and is organized around the Medicare hospice benefit, delivered mostly by home-based agencies. For-profit ownership has grown, and almost half of Medicare hospice enrollees in 2011 received care from multiagency chains.^330,332

Zambia has hospices that work alongside other palliative care organisations. In 2009-11, eight hospices and palliative care organisations took part in a national initiative that helped them expand services, secure fuel for transport and support home carers.¹⁸⁴

At one Buenos Aires hospice, admission was flexible and prioritized terminal disease, low income, and lack of family support. Most families found the hospice through friends, and stays averaged 37 days, with some patients arriving in the last hours of life. Staff also assessed what patients knew about diagnosis and prognosis on entry.³¹⁵

In British Columbia, inpatient hospice facilities serve terminally ill people who are expected to die within a few months. In long-term care, hospice use does not track eligibility well, with some people who do not meet eligibility receiving it and many who might benefit not receiving it.^352,355

Official Chinese guidelines define hospice care for terminally ill patients, typically those with a life expectancy of six months or less. Local payment rules can narrow access further: Dalian's 2020 bed-based payment policy covers only locally insured patients at urban inpatient providers. Shanghai physicians report that they usually start end-of-life talks only once expected survival is under three months.^182,362

Community volunteers help Hospice Ethiopia find patients at home, and hospital staff rarely link patients to home-based care centers because of high workload. These findings come from one qualitative study in Addis Ababa and report no formal admission criteria.²⁹³

Admission to an inpatient hospice requires a medical certificate of a terminal illness expected to lead to death within weeks or months, with no curative treatment possible, and confirmation that care at home is not feasible. Hospice care excludes further life-prolonging therapy such as anti-tumor therapy. About one third of hospice admissions in 2023 came directly from hospitals.^308,310

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

Patients reach the Indonesian Cancer Foundation home hospice program late: 79% died at home after a median of 1 to 2 months of care. The program serves cancer patients the foundation describes as vulnerable. No formal admission criteria are published.⁷¹

In a 2014 survey of all 251 PCUs, the most common admission condition (86%) was that the patient or family knows the diagnosis, and 71% required the patient or a family member to agree to a do-not-resuscitate policy. Units prioritized people who had waited a long time after applying, pointing to waiting lists.³⁴⁶

At King Hussein Cancer Center, hospice enrollment follows the oncologist's judgment that anticancer therapy is no longer beneficial, a formal referral to the palliative team and a family meeting to agree on goals of care. In a 2024 review of readmissions from hospice, 63.8% of patients still had Full Code status (single center).²⁹⁹

At one Western Kenya inpatient hospice, women with breast cancer were admitted a median of one year after diagnosis, 98% had pain on admission, and over 70% died in the hospice (single site). Authors at Nairobi Hospice report anecdotal evidence that many people see a hospice as a death sentence and use it as a last option.^289,290

Balsam reports that access does not depend on a prognosis of 6 months or less or on giving up curative treatment, and the same team follows patients through the illness. Patients come from hospital palliative teams under memoranda of understanding and from referring physicians. Self-description by the provider.³²⁷

Most community palliative care patients come by referral from hospitals. At one NGO community center, 86.7% of 4346 referred decedents had cancer, and median referral-to-death was 32 days for cancer and 19 days for noncancer patients (2017 to 2019, single center).^47,302

Most Nepali hospices admit cancer patients: a 2021 review lists five hospices dedicated to cancer care. Other NGO hospices serve people with HIV/AIDS, spinal injuries and survivors of human trafficking, and Blue Diamond Society runs a free hospice for LGBTQI+ people. At Hospice Nepal in 2006, 63% of admitted cancer patients were unaware of their diagnosis or prognosis, so admission did not depend on the patient knowing the prognosis.^53,360,361

At the Ibadan unit, referred patients with life-limiting illness judged to need palliative care were enrolled, and home care required consent and residence within a 30 km radius. In this single-site review, 80% of referred cancer patients had stage III or IV disease, and some were referred on the day they died.²⁹¹

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

The national hospice association says member hospices serve people of any age with a life-limiting condition. Patients at one Cape Town hospice described initial reluctance to be linked to hospice because they associated it with death and dying.^133,296

The national registry reports that only terminally ill cancer patients are eligible for inpatient hospice care under Article 2 of the Act, with terminal status confirmed by physicians, and around 80% of patients knew they had terminal illness at admission. Median inpatient hospice stay was 14 days in 2019 and 2020, and 54.7% of hospice users started hospice more than 30 days after their last anticancer therapy.^350,351

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

Referral criteria vary widely by service. Among 70 Hospice at Home services in England, 17.1% cared only for actively dying patients (up to 2 weeks), while 57.1% accepted patients with over 6 months' prognosis with no upper limit.³³⁹

Under the Medicare hospice benefit, patients need an estimated prognosis of 6 months or less and must forgo curative or disease-modifying treatment for the terminal illness. Stays are often short, with a median of 12 to 13 days in one large California health system.^330,331,338

In a 2000 to 2001 Lusaka study, an NGO-run inpatient hospice took terminally ill patients referred from surrounding low-income compounds, mostly people with advanced HIV before antiretroviral therapy was available. Referrals came from an HIV clinic and community services, and no formal entry criteria were described.³⁶³

The hospice studied was a non-governmental organization that relied on about 80 volunteers. The authors report that caregivers felt abandoned by the health and social security systems and that end-of-life care at home was being delegated to non-governmental organizations. Single-site data.³¹⁵

In the two evaluated services, care was free to patients: the NSW unit was funded by the Local Health District, and the Queensland service combined government funding with local fundraising. These are single-site findings.^356,357

A 2025 national study reports that no government-funded hospice services exist in Bangladesh. The few formal providers are NGOs and hospitals. Only 6.93% of the 1,270 seriously ill adults surveyed had health insurance.³⁵⁹

At one public quaternary cancer hospital in Sao Paulo, hospice care was costed as part of the public hospital's own spending and made up 29.5% of palliative care costs for 2985 patients who died in 2010 to 2013. Single-site data; national payment rules for hospice under the SUS were not described.³¹⁷

In British Columbia, most hospice society funding comes from individual and corporate donors, with supplemental support from regional health authorities. The 24-hour medical and nursing care in inpatient hospice facilities is typically fully funded by health authorities. This is a provincial finding.³⁵²

No dedicated medical insurance payment scheme exists for hospice care, and fee-for-service leaves many essential services outside reimbursement. The 2023 national pilot plan set out a per-bed-day payment approach, and some local schemes limit payment to locally insured patients.¹⁸²

NGOs such as Hospice Ethiopia that provide home-based palliative care are described as fully donor-dependent. NGO and faith-based coordinators report fewer donors supporting patients than in earlier years.^136,294

The children's hospice Firefly World is not state funded. The state palliative program fully covers opioids and reimburses 80%-90% of inpatient palliative care costs, using reimbursement rates set in 2004.¹⁵⁴

Insurance covers most inpatient hospice costs, and charitable donations cover the remainder. The 2015 Hospice and Palliative Care Act raised reimbursement rates and expanded outpatient funding.³⁰⁸

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

A 2022 policy model for Iranian hospice care, written while no hospice centers existed, proposed mixed funding: government funding, insurance service packages with set prices, private investment and charity support. The authors judged private and donor funding the more important source. This is a proposal, and one co-author works for the MACSA charity.³²⁵

PCU care is paid through public health insurance at a national per-day rate, reported as JPY 51350 per day for Days 1-30 and JPY 45820 per day for Days 31-60. Hospitals must meet facility criteria to bill PCU inpatient charges, and some services such as disease rehabilitation are not separately reimbursable there.^347,348

King Hussein Cancer Center, the main palliative and hospice provider in Jordan, is a non-profit center whose staff report that it offers fully government-covered treatment to Jordanian patients. About 35% of Jordanians have no health insurance, and cover is mostly tied to employment. Both statements come from KHCC-affiliated authors.^{364,366,299,365}

At Nairobi Hospice, most insured patients had National Health Insurance Fund coverage, which did not include palliative care in its benefit package. Kenya uses user fees in higher-level facilities, and the authors state that utilization at Nairobi Hospice is mostly by affluent patients who can afford the services (single site, 2013 data).²⁹⁰

Home-based services are free to patients, and Balsam runs without public funding on community donations, charity events and family support. Hospital-based palliative care is not reimbursed, so only those who can pay can use it.^327,328

NGO community palliative care is offered free of charge and most community palliative care is donor-dependent. Hospis Malaysia is described as largely dependent on private donors, which the authors see as a limit to national expansion.⁴⁷

Palliative care in Nepal is described as heavily donor dependent, and an international NGO has given financial support to hospices. The Health Insurance Board covers NRS 500 per day for insured patients receiving palliative care, but out-of-pocket spending remains the main source of funding.⁵³

Nigeria has no national budget line for palliative care, patients rely heavily on out-of-pocket payment, and palliative care medicines are excluded from the National Health Insurance Scheme. At Ibadan, the hospital pays unit staff while a non-governmental organization subsidizes home visits through fundraising (single site).^65,291

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

Without an enacted hospice and palliative care law, financing is fragmented and depends on shifting administrative priorities. Palliative care provisions sit inside the 2019 Universal Health Care Act and National Integrated Cancer Control Act, and national associations see the standalone law as the route to sustainable funding.⁷⁹

Romania adopted funding mechanisms that let health insurance funds reimburse palliative care services, alongside opioid policy review and quality standards. The source is written by hospice staff and does not say what share of hospice costs insurance covers.¹⁸⁹

About 150 hospices are funded mainly by the charitable sector with no income from government, and member organisations depend largely on donor funding to offer a mostly free service. As of 2021, the government had not committed to publicly funded palliative care services.^{296,297,298,101}

Hospice care is covered by National Health Insurance, and coverage was extended to home-based hospice from September 1, 2020. Among registered inpatient hospice patients, nearly 90% were covered by National Health Insurance and around 9% by the Medical Aid program.^211,350

Hospice has little presence in Turkey: a 2007 EAPC survey counted one hospice center, and a 2021 review says it is time to invest in hospice care. End-of-life inpatient care runs through hospital palliative care centers, and Social Security, which covers 98.6% of residents, began reimbursing inpatient palliative care in 2014. The first charity-run Cancer Nursing Home opened in 1993 and closed in 1997 because it could not raise enough money.^39,367,322

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

In a 2011 survey, all Ukrainian respondents named full-time hospices and palliative care units as the main place of care, and 80% said this care was only partly publicly funded. A 2024 modeling study of mobile palliative teams paid by the National Health Service of Ukraine, grouped by the authors under palliative and hospice care, used a base rate of 69,326.04 UAH and judged the tariffs below actual costs.^369,197

Charitable funds or donations were the main income for 71.2% of Hospice at Home services in England, with NHS funding the main source for 25.8%. In children's services, 13 of 17 UK specialist paediatric palliative care teams had posts partly or fully charity-funded.^339,344

Medicare pays for hospice through the hospice benefit, and hospice expansion in nursing homes between 2004 and 2009 raised net Medicare spending by a mean $6,761 per decedent. Medicare applies an aggregate annual cap per hospice and does not cover custodial care, while most hospices report providing some charity care.^334,333,335

In 2009-11 a national advocacy initiative part-funded eight Zambian hospices and palliative care organisations, which allowed them to expand services and pay for drugs, fuel and home carer support. The evaluators concluded that palliative care must be integrated into the public health system and secure long-term funding to thrive.¹⁸⁴

One Buenos Aires hospice cared for 400 patients from 2002 to 2011 and served mostly lower and lower-middle income families. The authors describe weak links between the hospice and formal health institutions, since only 2 of 40 families were referred by an institution.³¹⁵

A systematic review pooling studies from the UK, Australia, New Zealand and Canada found non-cancer patients, the oldest old, ethnic minorities and people in rural or deprived areas under-represented in hospice populations. Australia-specific figures were not reported separately in the abstract.³⁴³

Authors of a 2025 national survey describe hospice facilities in Bangladesh as limited, with fewer than ten NGOs and hospitals offering formal services, mostly concentrated in Dhaka. In the same survey, 7.1% of community respondents said they understood the concept of palliative care, and 39.5% were comfortable with the idea of hospice care.³⁵⁹

Across 32 private cancer centers in 2022, patients in an outpatient palliative care program had more home or hospice deaths than other patients (19.6% vs 10.4%). Home and hospice deaths were reported together, and the study was run by the private network that offers the program.³¹⁸

In a national aging cohort, 17.2% of decedents died in a hospice or palliative care unit, and dying in Quebec or of cancer raised the odds. Among long-term care residents, the reported hospice care rate was under 3%, with ageism, rurality and dementia identified as barriers.^354,355

By the end of 2023, national hospice pilots covered 185 cities or districts and over 4000 institutions had hospice departments. Policy analysis confirms rural-urban gaps, financial burdens for low-income and uninsured people, and weak services for children and non-cancer patients.^306,182

The few palliative care and hospice services are mostly in Addis Ababa, and services in one rural region were largely limited to people with HIV. The enrollment capacity of the home-based center limited access in the capital (qualitative data).^136,293

Children can use six state-funded pediatric palliative care units and one children's hospice. Palliative care overall reached 16.7% of estimated need in 2024, and services are concentrated in Tbilisi.¹⁵⁴

In 2023, 47,846 patients received inpatient hospice care, and one insurer's data from 2016 to 2019 showed 3.3% of deceased people used inpatient hospice, with large differences between federal states. Transfers from hospital track regional hospice bed density, and cancer was the main diagnosis in 68.8% of hospital-to-hospice transfers. Low-density regions have fewer hospice services, and in one regional stroke registry only 0.05% of stroke patients were discharged to a hospice.^308,309,310

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

The Indonesian Cancer Foundation reports serving 621 patients over the first 12 years of its home hospice program. It now provides an average of 80 services per year, and its Jakarta palliative service served 355 patients in 2022. These are small numbers for a country the authors describe as having 240 million people.⁷¹

Critically ill and end-of-life patients in Iran are generally hospitalized in ICUs, since no hospice centers exist. The palliative services that do exist are concentrated in large cities.³²⁵

A 2025 nationwide survey identified 462 hospitals meeting the facility criteria for PCU inpatient charges. In a national bereavement survey, patients with hematological malignancies were less likely to die in PCUs than those with solid tumors.^348,349

Palliative and hospice care in Jordan is limited to specialized hospital units such as KHCC and a few NGOs, and refugees have little access. At KHCC, 151 of 299 adult cancer inpatient deaths in 2017-2018 were under palliative (hospice) care, and 43 oncology patients with a referral request died without transfer. For those who did transfer, the median time from referral request to death was 14 days.^366,364,299

Before hospital integration began around 2010, the few hospices were not widely spread and served only a few patients and families. Kenya has more than 70 palliative care centers, yet utilization is low, and only 27% of Nairobi Hospice patients surveyed lived in Nairobi County, with rural access described as a challenge.^61,290

Balsam cares for over 300 patients a year, and three nonprofits provide home-based end-of-life care nationally. Hospital palliative services sit mainly in private facilities in Beirut, and Balsam built a telephone program for rural and remote villages.^327,328

Most palliative care in Malawi is hospital-based, and dedicated inpatient hospice capacity appears small, with St Gabriel's Hospital in Namitete running a 24-bed hospice unit. In a 2012 program in 13 southern hospitals, 104 of 153 recorded referrals were palliative care referrals, mostly to hospital palliative care services and hospice programs. That evaluation was funded and co-authored by APCA.^103,104

NGO hospice services are mainly restricted to urban areas. In 2021 community teams operated in most of Malaysia except Perlis and Labuan, and in Sarawak NGOs provided community palliative care in only 2 of 40 districts. Median travel distance to the nearest palliative care service was 82 km in East Malaysia.^47,301

Mongolia reported 190 palliative and hospice beds for three million people, including 50 hospice beds in Ulaanbaatar. Figures come from a program self-review by national palliative care leaders.⁹⁴

Most hospice and palliative care centres are in the capital, with only a few in the periphery, and hilly terrain limits access. Most hospices serve cancer patients, while a few organizations serve people with HIV/AIDS, spinal injuries and trafficking survivors.⁵³

Palliative care services are restricted to a few tertiary facilities, and morphine is available only in a few urban tertiary institutions. Lagos has the country's only stand-alone pediatric hospice. At Ibadan, most referred patients did not receive home care, partly because they lived outside the 30 km catchment area.^65,291

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

A 2025 survey found 54 active hospice and palliative medicine specialists, a density of 0.05 per 100 000 population, concentrated in the National Capital Region and Davao. Several regions, including Bicol and Palawan, had none, and pediatric palliative services were inconsistent nationwide.⁸¹

At one Jeddah tertiary hospital (2021-2024), hospice-eligible cancer patients reached comfort-oriented care at death in 71% of cases, compared with 35% of hospice-eligible non-cancer patients. Non-cancer patients also had more ICU use (58% vs 21%). Single-site data.³²⁴

Hospice association members projected about 20,078 patients cared for each month nationally, based on a survey in which 40 of 96 organisations responded. The authors describe a maldistribution of hospices linked to apartheid, with about 33% of the population in rural areas.²⁹⁷

The hospice utilization rate among cancer deaths was 22.9% in 2018, 24.3% in 2019 and 23.0% in 2020. In 2020 there were 30 hospice beds per 1,000,000 people, ranging from 54 in Jeonbuk to 13 in Jeju, and dementia is treated as a non-hospice-eligible disease.^350,211

Among cancer deaths in two Madrid districts in 2005, 6% occurred in an inpatient hospice, compared with 74% in hospital, 17% at home and 3% in nursing homes. Hospital death was less common in the district with a palliative home care team (61% versus 77%). The data cover two areas of about 200,000 people each and one year.³⁶⁸

Palliative care providers at a Sri Lankan cancer center describe a shortage of hospice care. They say patients whose families cannot give care at home are left with hospice as a last resort. This comes from four provider interviews at one hospital.⁷⁶

Thailand has few hospices and a limited range of palliative care services. The study names referral systems, patient access to opioids and inequities in care distribution as unresolved problems.³⁰⁴

In one Ankara university hospital cohort of COPD patients (2014-2021), 77.3% died in hospital, and the authors link this to too few nursing homes and lack of hospice care. In Manisa, caregivers of terminal cancer patients cared for them at home with their own means because there was no hospice care.^321,320

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

A 2019 legal review reports an insufficient number of palliative and hospice departments and incomplete provision of free palliative care. A 2020 survey reported too few inpatient beds for palliative patients and no mobile team service, which left home care to family doctors.^196,198

Inpatient hospice deaths in England rose to 6.0% of all deaths in 2012, but only 5.2% of hospice decedents had non-cancer diagnoses and the share from the least deprived areas increased. Within 30 minutes' travel, 97.6% of England's population could reach an inpatient hospice compared with 70.3% in Scotland and 68.5% in Northern Ireland.^342,341,343

In a nationally representative cohort of older decedents, 25.8% used hospice only and 18.8% used both hospice and home health in the last six months of life. Among Medicare decedents with heart failure, 48.2% used hospice, with lower odds for Black, Hispanic, under-65 and Medicaid-eligible patients.^337,336

One Lusaka hospice had 20 adult beds and recorded 288 admissions and 6,685 bed nights over one year in 2000 to 2001, serving patients from several compounds. In 2009 to 2011 an advocacy program part-funded eight hospices and palliative care organisations, which let them expand services and support home carers.^363,184