The Kerala model of community-based palliative care: A scoping review of service delivery, implementation strategies, implementation gaps, and transferable lessons

Background Community-based palliative care is increasingly recognized as a strategy for improving equitable access in low- and middle-income countries (LMICs). Although the Kerala model is widely regarded as an established community-based programme, evidence describing its characteristics, service delivery, implementation, sustainability, and outcomes remains dispersed across diverse evidence sources. Objectives To map and synthesize the available evidence on the Kerala model of community-based palliative care, including its characteristics, service delivery, implementation strategies, implementation gaps, community participation, caregiver experiences, sustainability, and transferable lessons relevant to strengthening palliative care in LMICs. Methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). PubMed, Scopus, Embase, and Google Scholar were searched for studies published between January 1999 and March 2026. Two reviewers independently screened studies and charted data, and the findings were synthesized using descriptive numerical summaries and narrative thematic synthesis to map the available evidence. Results Thirty evidence sources were included. The findings showed that the Kerala model delivers multidisciplinary home-based palliative care through collaboration among healthcare professionals, trained volunteers, family caregivers, local self-government institutions, and community organizations. Care extended beyond symptom management to include rehabilitation, psychosocial and financial support, caregiver education, essential medicines, assistive devices, and community resource mobilization. Community participation, primary healthcare integration, supportive governance, and volunteer engagement were central to programme implementation. Key implementation gaps included workforce shortages, caregiver burden, inadequate rehabilitation services, regional variation in service delivery, limited physician availability, and inequitable access to essential medicines. Conclusion The Kerala model represents a mature community-based palliative care approach in an LMIC. Its integration of multidisciplinary home-based care, community participation, primary healthcare, and supportive governance provides an adaptable framework for strengthening equitable, sustainable, and person-centred palliative care.