Palliative Care as a Health System Indicator in Georgia: Unmet Need, Access Barriers, and Policy Implications

Abstract

Background:
Palliative care is increasingly recognised as a fundamental component of universal health coverage (UHC) and people-centred health systems. The World Health Organization estimates that approximately 56.8 million people worldwide require palliative care each year, including individuals in the final stages of life and patients living with chronic or progressive illness who require symptom management and supportive care [1,2]. However, only about 14% of those who need palliative care globally receive it, with the greatest unmet need concentrated in low- and middle-income countries [1,2]. The Lancet Commission on Palliative Care and Pain Relief estimated that more than 61 million people experience serious health-related suffering annually, driven largely by cancer, cardiovascular diseases, chronic respiratory diseases, neurological disorders, and advanced organ failure [3]. Demographic ageing and the rising prevalence of non-communicable diseases are expected to substantially increase the global demand for palliative care in the coming decades [4].

Methods:
This article presents a policy-oriented narrative review and conceptual analysis based on international literature, national policy documents, and health system statistics. The analysis synthesised evidence from three complementary domains: global research on palliative care needs and serious health-related suffering; Georgia-specific literature and policy frameworks addressing the development of palliative care services and opioid access; and national health system statistics describing healthcare infrastructure, workforce capacity, and service utilisation. Evidence from these sources was integrated to examine how structural characteristics of the Georgian health system influence access to palliative care services and pain management within the broader context of health system performance [5–8].

Results:
Global evidence demonstrates a persistent mismatch between palliative care need and service availability. Research indicates that more than 80% of the global population lives in countries with inadequate access to opioid analgesics, while a small number of high-income countries account for the majority of global morphine consumption for medical purposes [9]. In Georgia, available evidence suggests that palliative care services remain limited in geographic coverage and insufficiently integrated within mainstream healthcare delivery. Major constraints include concentration of services in urban centres, limited development of community- and home-based palliative care models, gaps in workforce training, and administrative and regulatory barriers affecting opioid prescribing and dispensing practices. These challenges indicate that palliative care access in Georgia is constrained not only by service availability but also by broader structural factors within the healthcare system [10–13].

Conclusions:
Palliative care in Georgia should be interpreted not only as a specialised clinical service but also as a health system performance indicator reflecting equity of access, continuity of care, and availability of essential medicines. Persistent gaps in service coverage, opioid accessibility, workforce capacity, and community-based care reveal broader structural weaknesses within the healthcare system. Strengthening palliative care in Georgia will require expansion of community-based services, balanced opioid policy implementation, improved professional training, and systematic monitoring of service coverage and equity indicators. The Georgian case illustrates how palliative care can function as a tracer condition for evaluating health system responsiveness and equity in countries undergoing demographic and epidemiological transition.

Keywords:
palliative care; health systems; universal health coverage; serious health-related suffering; opioid access; health equity; Georgia