Palliative care and sustainable development in the Philippines: Learning from Kerala’s community model

To the Editor,

The recent study by Gowri and Abdul Azeez on Palliative care policy and practice in Kerala, India: Implications for Sustainable Development Goal 3—Health and well-being offers a timely and insightful contribution to global health discourse, particularly on how local models of care can significantly impact Sustainable Development Goal 3 (SDG 3) on good health and well-being. ¹ The authors highlight Kerala’s pioneering approach to community-based palliative care, underpinned by strong policy support, widespread community participation, and a sustainability framework that integrates both governmental and grassroots interventions. Kerala’s achievement of near-universal access to palliative care represents a major success, especially in contrast to the global reality of severe inequity in palliative care access. ¹ This paper aims to examine the policy and practice of palliative care in the Philippines in relation to achieving SDG 3 on health and well-being.

SDG 3, which seeks to “ensure healthy lives and promote well-being for all at all ages,” provides a critical framework for advancing palliative care globally, especially in low- and middle-income countries like the Philippines. ¹ While global health systems have often prioritized curative interventions and the reduction of premature mortality, SDG 3 importantly broadens the scope of health to include holistic well-being. ² Palliative care, with its emphasis on alleviating suffering, improving quality of life, and offering psychosocial and spiritual support, addresses essential dimensions of well-being often neglected in mainstream healthcare delivery. Thus, embedding palliative care within SDG 3 is not an optional add-on but a necessary condition for achieving genuine, equitable health for all. ¹

In the Philippine context, the significance of this integration becomes even more apparent. Despite national policies on palliative and hospice care (PHC), access remains fragmented and largely concentrated in urban, hospital-based settings. ² Moreover, cultural taboos surrounding death and dying often prevent early engagement with palliative services, leaving many Filipinos without adequate support in the most vulnerable stages of life. ³ Framing palliative care as an essential component of SDG 3 provides both a moral imperative and a policy directive to bridge these gaps. It challenges healthcare planners, government institutions, and civil society organizations to move beyond episodic or charitable models of care toward systemic, community-rooted, and rights-based approaches. ¹

The Philippines faces many of the same challenges in palliative care provision identified globally: limited access, inadequate professional training, fragmented service delivery, and sociocultural taboos surrounding death and dying. ² Drawing from the Kerala experience, three strategic recommendations emerge for the Philippines. First, the Kerala model thrived not just because of policy but because it empowered local governance units (LGUs) and community organizations to own and manage palliative care delivery. The Philippine government should develop LGU-based implementation frameworks for palliative care, integrated into barangay health programs, with corresponding funding allocations through local health budgets. Second, Kerala leveraged local volunteerism; the Philippines, with its vibrant faith-based organizations and barangay-level civic groups, can do the same. Partnerships with Catholic parishes, Basic Ecclesial Communities (BECs), and Islamic community groups in Mindanao could serve as foundational pillars for localized, culturally appropriate palliative care efforts. ³ Third, Kerala’s success partially stems from recognizing palliative care as a public good. The Philippine Universal Health Care Act (RA 11223) should explicitly operationalize SDG 3 in palliative care under its primary healthcare networks, ensuring that PhilHealth benefits include meaningful coverage for palliative services—not just hospital-based, but also community- and home-based care. ²

In 2021, PHC was formally integrated into the Philippine national health system across all disease categories, age groups, and levels of care. ⁴ This integration was operationalized through the issuance of the first edition of the Manual of operations, procedures, and standards for National Palliative and Hospice Care Program, which includes both basic and intermediate training modules for health practitioners. ⁴ The Manual serves as a foundational guide for healthcare providers, program implementers, and allied health professionals, offering standardized procedures for implementing PHC across various service delivery frameworks and clinical contexts. ⁴ The Philippine Department of Health (DOH), in partnership with key organizations such as Hospice Philippines, the Philippine Cancer Society, the Philippine Society of Hospice and Palliative Medicine, and the Pain Society of the Philippines, has committed to advancing the SDG 3 agenda as part of the country’s broader goal of achieving Universal Health Care (UHC). ⁴ These efforts represent important progress in institutionalizing SDG 3 in palliative care within national health priorities. However, bridging the persistent gaps between policy and local implementation remains the crucial next step, particularly in ensuring that these frameworks translate into meaningful services at the community level, especially for marginalized populations. ⁵

In conclusion, Gowri and Abdul Azeez’s work demonstrates the potential of community-centered palliative care to advance SDG 3, but it must be contextualized critically for application in countries such as the Philippines. Through anchoring SDG 3 policy at the grassroots level and embedding palliative care within universal health structures, the Philippines can move from sporadic access to a sustainable, equity-driven palliative care model. Achieving health and well-being for all—including those at the end of life—is not just a clinical issue; it is a moral imperative aligned with the full promise of sustainable development.

Jeff Clyde G. Corpuz, PhD Department of Theology and Religious Education, De La Salle University, Manila, Philippines