Survey of palliative care provision by faith- based health facilities in India and Nepal during COVID-19

Background: Faith-based organisations (FBO) contribute substantially to healthcare in low- and middle-income countries (LMIC). WHO worked with FBOs to define the primary care approach in the Alma-Ata Declaration and promotes FBO contributions to care underpinned by values of compassion and altruism, particularly for marginalised communities. Indian and Nepalese FBOs provide palliative care (PC) alongside other services, developing appropriate evidence-based models for remote rural areas and excluded urban groups. Covid-19 poses substantial challenges for FBO services. Initially, lockdown affected more than Covid-19 itself. Patients with advanced illness were unable to access care, supply chains (e.g. for morphine) were disrupted and communities faced hunger because of interrupted food supplies. With cases rising new challenges are emerging. Exploring and recording FBO responses enables good palliative care to be identified. This can inform practice in Covid-19 and future pandemics in LMIC nationally and internationally. Aims: To gain strategic understanding of PC provision by FBO in India and Nepal during the Covid-19 pandemic including: (a) Effects of Covid-19 on patients and families with PC needs. (b) FBO preparedness for responding to the crisis. (c) Impact of the pandemic on PC provision, including challenges and solutions that strengthen PC interventions. Methods: Mixed-method survey of PC provision by FBOs using: provider questionnaires, key informant interviews (KII), and patient questionnaires sent to all FBOs identified as providing PC. Questionnaire results will allow important findings to be explored in depth though KII. Results: The study began with an expert advisory group of senior PC clinicians reviewing the questionnaires and interview schedules. Field work will be completed by October 2020. Conclusions: Understanding FBO responses and strategies for PC during Covid-19 can enable appropriate public health strategies for LMIC to be defined.