Over the last two years, Thailand has witnessed significant developments in its palliative care framework, originally set forth by the National Health Commission (NHC) under the leadership of Dr. Nopporn Cheelon, M.D., who took on the role of chair of the sub-committee on this initiative. Established on May 16, 2023, the Quick Win project aimed to boost palliative care access within 100 days, marking the inception of the 'Palliative Care Centers' and the 'Hospital at Home' initiative.
Initially, the NHC aspired to achieve a 10% increase in access, successfully overseeing the establishment of 137 palliative care centers across 44 provinces, thereby creating 13 palliative care districts. The rapid national rollout aimed to integrate holistic care—a pivotal advancement for illness management, especially for terminal patients, emphasizing patient dignity during their final days.
Following Dr. Nopporn's lead, the mantle was passed to Dr. Somsak Thepsuthin for the fiscal year 2024, who expressed concerns surrounding the reach of these services. He aimed not just to maintain existing operations, but to extend them: his vision included establishing at least one palliative care center and one ‘Hospital at Home’ facility per district, along with ensuring palliative clinics were available statewide.
“It’s about creating more accessible avenues for patients who are nearing the end of their lives,” Dr. Thepsuthin stated during the early meetings discussing expansion.
Dr. Atipai Piriyakulkana, involved closely with community health initiatives, advocated for broader awareness surrounding the concept of 'Peaceful Death', which is reflective of the compassionate treatment philosophy prevalent within international hospice care. He remarked on the pressing need to model facilities such as hospices abroad, which focus on providing terminal patients with comfort rather than extended curative measures.
Despite the initial targets under the Quick Win project, there have been unresolved questions pertaining to its efficacy and outcomes over the past two years. With the aim of promoting greater access to quality palliative care services, Dr. Thepsuthin has proposed not only the expansion of centers but also focused efforts on public health campaigns to raise awareness.
The drive for comprehensive care extends beyond standard hospitals. Through the establishment of more 'Hospitals at Home', which facilitate care delivery within the comfort of familiar surroundings, the system endeavored to alleviate some burdens from both patients and the healthcare facilities alike.
On February 25, 2024, the NHC announced the initial batch of 30 palliative care centers for patients with dependency issues, affirming national health insurance coverage, allowing for extensive outreach to patients across various demographics, particularly the elderly and bedridden individuals. The initiative aims to encompass those requiring palliative or end-of-life care.
Dr. Nopporn Cheelon provided insights from this initiative, indicating positive outcomes, yet he also recognized persistent challenges. His commentary sheds light on the contrasts between facilities within urban contexts versus those located in rural regions, where healthcare accessibility may vary considerably. “While our targets are ambitious, achieving these goals depends heavily on proper facilitation on both community and governmental levels,” he remarked.
Though steps have been taken, substantial gaps remain, particularly addressing the holistic and comprehensive needs of terminally ill patients, especially within crowded urban hospitals like Bangkok. The archipelago of services often entails individual hospitals managing their resources and patients with limited communication with outside facilities.
Wanna Jarusamboon, leader of the community group Peaceful Death, expressed gratitude toward the initiative's impacts, stating, “We’re seeing direct enhancement of care quality, especially outside metropolitan areas.” She acknowledged the collective efforts emphasized by the expansion of telemedicine solutions among traditional medical regions, bringing newfound support to terminal care.
Yet, several obstacles persist. Nurse staffing shortages strain the efficacy of home care initiatives, rendering some locations incapable of maintaining continuous follow-up care and depriving many patients of timely interventions. “The bureaucratic structure exhibits notable fragility,” she added, insisting on the need for urgent solutions.
The limited number of operating palliative care centers—approximately 30 throughout the nation—has engendered skepticism even as grassroots movements and local investment take shape through organizations such as the Bangkok Metropolitan Administration. Earlier, local facilities attempted to address and bridge gaps by providing community-directed care, conveying the rationale behind the incremental improvements. “Currently, there is potential for substantial growth—but we require commitments from higher authorities to truly bolster the framework,” noted Wanna.
Further, the integration of hospital wards within localities for extended care signifies another push toward easing logistical burdens. “With the right investments, we can effectively cater to those seeking to transition from hospital to home,” stated Dr. Thepsuthin.
Dr. Atipai reiterated the need to adopt progressive educational paradigms to bring palliative care practices to the forefront of medical training. “Introducing this focus will cultivate future practitioners who respect the importance of end-of-life care,” he affirmed. “Empowering medical professionals remains at the crux of sustained progress.
Nevertheless, the looming challenge about the disparities between metropolitan and rural hospital systems continues to highlight the prevailing structural issues, leading to significant geographical divides. The increase of both population dynamics and healthcare needs constrains the healthcare options available, particularly for urban populations facing complex social settings.
“With the underlying intricacies woven between our healthcare practices, we must collaborate to construct solutions for patients striving for dignified end-of-life experiences,” Wanna articulated concisely.
Indeed, as the two years culminate with prospects of continued initiative enhancements, it remains evident there is still substantial progress to pursue to galvanize true access across every patient population. While the prospects have brightened thanks to recent initiatives, it’s imperative for all stakeholders to gather the momentum required to concertedly advance palliative care delivery throughout Thailand.