Essential & Expanded Palliative Care Packages
An IAHPC Delphi study involving two panels of global experts has culminated in Essential and Expanded Palliative Care Packages for Adults and Children, a resource for healthcare providers and advocates in countries of all income levels.
The Essential Packages, designed to be low-cost, list the medicines, equipment, and personnel necessary to reduce serious health-related suffering of people with life-limiting conditions and those at the end of life. The Expanded Packages are suited for settings where complex and specialized needs arise and where more resources are available.
The packages are the first work stream of the Global Access to Palliative Care (GAP) Project, an international initiative that aims to strengthen health systems and foster universal health coverage (UHC). The packages build on the 2018 Lancet Commission’s Essential Package for Palliative Care and Pain Relief.
IAHPC Executive Director Lilliana De Lima answers a few questions about the packages:
Are these packages mainly advocacy tools for administrators and Ministries of Health?
Primarily, yes: but not solely.
The new Essential and Expanded Packages are framed as policy blueprints “to guide national health strategies.” They are designed to be publicly financed entitlements aligned with universal health coverage. That’s an implementation target for decision-makers (health ministries, purchasers, and supply chains).
At the same time, the packages are also meant to be used across all levels of care, with a particular focus on primary care.
A New IAHPC Resource: Fast, Effective Dosage Intel
IAHPC's Pallimedicines is a new tool to give practitioners swift access to precise information on essential medicines, contained in the Manual on the Use of Essential Palliative Care Medicines for Adults, for 15 common symptoms related to palliative care. Searchable by symptom, the resource details starting dose; dosing frequency, increases, and reductions; maximum daily dose; precautions; and experts' comments.
This is a sample of the information at practitioners’ fingertips that complements the new Essential Palliative Care Package for Adults.
How do these packages and IAHPC's new Manual on the Use of Essential Palliative Care Medicines for Adults help physicians and nurses at the bedside?
The packages are “what must be available.” They list the minimum medicines, equipment, and human resources that should reliably exist in primary care. This sets the procurement and availability foundation for bedside care.
The manual is “how to use the medicines included in the essential palliative care package for adults.” It is written for generalist and primary palliative care teams, organized by the 15 most frequent and distressing symptoms (anxiety, breathlessness, pain, etc.). Each medicine listed for treatment includes the starting dose, titration frequency, maximum dose, precautions, and expert comments—explicitly prioritizing safety in community and primary-care settings. Bedside teams can open the manual to the identified symptom and follow a clear, consensus-based dosing pathway.
How can these resources improve palliative care in low-resource settings?
By their focus on access and affordability. The essential packages are designed as low-cost, primary-care-oriented resources to reduce serious health-related suffering and to be integrated into national benefit plans, which are desperately needed in low- and middle-income countries.
By their practical bedside guidance. Where specialists are scarce, the manual gives rapid, safe dosing/titration recommendations for the most common and distressing symptoms in palliative care for use by primary-care clinicians and nurses in homes and clinics.
By their focus on preparedness. The packages explicitly support public financing and health system resilience—including in emergencies—and add basic equipment that is often missing in low-resource sites (e.g., wound care materials, thermometers).
In essence, the packages are essential for access, while the manual enables their appropriate use at the bedside.