The need for an effective palliative care strategy in Pakistan.

The development of palliative care around the world, or lack thereof, is an important public health problem. We are pleased that the Journal of Public Health Policy has provided a public health lens to the need for palliative care in developing countries in a Special Section of the Journal (January 2007, Number 1, Volume 28). The issue presented a range of topics from more generic issues in palliative care for developing countries (1) to specific examples of milestones achieved by some African nations, including integration of palliative care in the national health plan (2), to approaches to making cost-effective opioids available for pain relief (3,4). The epidemic of HIV/AIDS has invited a long overdue attention to palliative care in the region. While not stricken hard by HIV/AIDS, some developing countries present increasing need and some of the similar macro-level barriers to implementing palliative care. Through this letter, we would like to discuss the status of palliative care in Pakistan and the need for a proactive palliative care strategy for the country. Pakistan is a country of 168 million people; located in South Asia, it is a medium economy with one-third of people living below the income poverty line of $1/day (5). With government contributing only 2% of its gross domestic product on health, most healthcare is available through private, out-of-pocket spending. The existing