AWARE: Anaesthesia trainee wellbeing at respective educational institutions: A national prospective study of burnout, depressive symptoms and occupational stress.

Community-based approaches to palliative care have gained growing attention worldwide as both an alternative and a complement to hospital- and hospice-based models, strengthening support for individuals at the end-of-life or with serious illness. One example of a particularly influential model is Neighbourhood Networks in Palliative Care (NNPC), developed in Kerala, India. Established in 1993, NNPC has become a globally recognized model for delivering community-led palliative care, particularly in resource-constrained settings. It is frequently cited for its innovative, cost-effective, and resource-efficient approach to care. In the Global North, the format of “compassionate communities” has been developed as a public health approach to end-of-life and palliative care, and this model is now active in 19 countries across the Americas, Europe, and the Asia-Pacific region. Unlike other health issues (e.g., dengue prevention or maternal and child health programs) that have long been integrated into global health agendas, national policies, and community health systems, community-based palliative care remains relatively new within the public health framework. Its incorporation into both global and national health strategies has been relatively slow. Nevertheless, a growing body of research emphasizes the essential role of palliative care within public health interventions and increasingly recognizes it as a significant public health concern given the serious burden of health-related suffering affecting many countries, especially in the Global South. However, it was not until the 2018 Declaration of Astana that the World Health Organization explicitly affirmed its commitment to strengthening global palliative care efforts—particularly by supporting the integration of community-based palliative care services into primary healthcare systems. Community-based approaches to palliative care take diverse forms around the world. Some models are highly formalized, while others benefit from informal structures. Many of these less formal initiatives are sustained by volunteer efforts. In the Global South, these often emerge from grassroots movements as they are deeply rooted in the cultural value of mutual care within the community. With recent international and national policies emphasizing the integration of palliative care into health systems, it is likely that community-based models—particularly those that rely on informal volunteer networks—will move toward greater formalization, as has been observed for other public health issues. Formalization refers to the extent to which an organization defines and enforces rules, regulations, and policies that guide member behavior by institutionalizing and standardizing its procedures and practices. Analysis of the formalization of other community-based health programs shows that formalization is largely driven by increasing expectations of efficiency, transparency, and accountability, alongside the introduction of institutional forces such as enhanced monitoring systems, mandatory reporting requirements, legal and regulatory obligations, and dominant management practices.