Article Text

Download PDFPDF
Integrated management of non-communicable diseases in low-income settings: palliative care, primary care and community health synergies
  1. Daniel Munday1,
  2. Vandana Kanth2,
  3. Shadrach Khristi2 and
  4. Liz Grant3
  1. 1 Palliative Care Team, International Nepal Fellowship, Kathmandu, Nepal
  2. 2 Community Health, Duncan Hospital, Raxaul, Bihar, India
  3. 3 Global Health Academy, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Daniel Munday, Palliative Care Team, International Nepal Fellowship, Kathmandu, Nepal; daniel.munday{at}


Palliative care is recognised as a fundamental component of Universal Health Coverage (UHC), which individual countries, led by the United Nations and the WHO, are committed to achieving worldwide by 2030—Sustainable Development Goal (SDG) 3.8. As the incidence of non-communicable diseases (NCD) in low-income and middle-income countries (LMICs) increases, their prevention and control are the central aspects of UHC in these areas. While the main focus is on reducing premature mortality from NCDs (SDG 3.4), palliative care is becoming increasingly important in LMICs, in which 80% of the need is found. This paper discusses the challenges of providing comprehensive NCD management in LMICs, the role of palliative care in addressing the huge and growing burden of serious health-related suffering, and also its scope for leveraging various aspects of primary care NCD management. Drawing on experiences in India and Nepal, and particularly a project on the India–Nepal border in which palliative care, community health and primary care-led NCD management are being integrated, we explore the synergies arising and describe a model where palliative care is integral to the whole spectrum of NCD management, from promotion and prevention, through treatment, rehabilitation and palliation. We believe this model could provide a framework for integrated NCD management more generally in rural India and Nepal and also other LMICs as they work to make NCD management as part of UHC a reality.

  • universal health coverage
  • non-communicable disease management
  • palliative care
  • community health
  • primary care
  • low and middle income countries
  • India
  • Nepal

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors DM had the original concept for the article and discussed and developed it with all the authors. VK and SK provided details of the CHETNA programme and local knowledge about the community where the project is based and expertise regarding community health. LG provided expertise in global health and palliative care. DM drafted the article, and all authors were involved in contributing to it. All authors agreed with the submitted article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests VK and SK are employed by Duncan Hospital. DM undertook an evaluation of the CHETNA programme at Duncan Hospital, for which he received expenses but was not paid, and he evaluated the original EHA palliative care programme, for which he received an honorarium. LG has no conflict of interest to declare.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.