Access to palliative care in India: situational analysis and modeling of access from public healthcare centers

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This study aimed to assess the geographical accessibility of palliative care (PC) in India and estimate changes in accessibility based on its delivery from different levels of the public health system. Methods: Pallium India’s 2022 directory provided a list of active palliative care centers (PCC-PI). We analyzed the density of PCC-PIs per ten million population, the median travel time to the nearest center using motorized vehicle and the access population coverage. Palliative care delivery scenarios combining primary, secondary, and tertiary public healthcare centers were created to evaluate changes in access. Results: In 2022, India had 526 active palliative care centers, with a density of 4 per 10 million population. The highest densities were in Lakshadweep, Goa, and Kerala. The median [IQR] travel time to the nearest PCC-PI was 118 [71,179] minutes, and 23.7%, 39.9%, and 71% of people lived within 30, 60, and 120 minutes, respectively. Rural areas had worse access than urban areas, with considerable variation across states. States like Kerala and Chandigarh had near-universal access, while Madhya Pradesh and Bihar had much lower coverage. Access improved significantly when palliative care was integrated into all levels of the healthcare system. Conclusion: Access to palliative care in India is limited, especially in rural areas. Expanding integration with the public health system could enhance access, ensuring more equitable care nationwide. Palliative care access to care geographical access health policy Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction The World Health Organization defines palliative care as “an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.” 1 Realizing the impact of palliative care on the quality of life of patients and caregivers, in 2014, the World Health Organization passed a resolution urging member states to provide palliative care services as a part of comprehensive care. 2 Four in ten people in India are estimated to have at least one chronic disease and this burden is expected to rise. 3 , 4 With the rising incidence of chronic diseases, the need for palliative care is also expected to rise in India to address serious health-related suffering which is commonly associated with end-stage chronic diseases. 5 – 7 Palliative care is most commonly needed for patients suffering from cardiovascular diseases, chronic respiratory diseases, cancer, and neurological illnesses among others. It is estimated that less than 4% of people in need of palliative care have access to it in India. 8 Specifically in patients with last-stage cancer, who account for nearly one–third of all palliative care needs, the unmet need for palliative care is 98.3% in India. 9 There are various barriers to poor delivery of palliative care in India like poor awareness among healthcare providers and patients, lack of trained workforce, lack of access to essential controlled medicines, and lack of support from policymakers. 10 Inequitable distribution of services, when available, and poor geographic access to health centers with available services also act as significant barriers to palliative care delivery in India. The National Program for Palliative Care (NPPC) was launched in 2012 by the Ministry of Health & Family Welfare in India, to promote palliative care provision in the government infrastructure at all healthcare levels. 11 The National Health Policy 2017 focused more on the delivery of palliative care from primary health centers and community engagement. It introduced palliative care services to be delivered at the grassroots levels by community health workers and from the primary care unit of public health infrastructure, Health and Wellness Centers (HWC). 12 This enabled a mechanism for the continuum of care. The National Program for Prevention and Control of Non-Communicable Diseases (NPNCD) also reinforced palliative care provision from district hospitals and medical colleges. 13 Currently, palliative care in India is provided by both public and private healthcare centers. However, private centers are leading the way in service delivery due to the lack of implementation of the existing programs for palliative care in India. 14 As per the guidelines of the National Medical Commission, it is not mandatory to have a department for palliative care to establish a medical college. 15 The limited training courses and limited awareness of palliative care in India also make establishing palliative care departments in public hospitals at all service delivery levels -primary, secondary, and tertiary - challenging. 16 With limited centers providing palliative care, it becomes important to understand the geographical distribution of these centers and geographical accessibility i.e., the time taken to reach the nearest center, to plan further scale-up of palliative care services in India. 17 Since people requiring palliative care are most often bed or homebound, the proximity to the center with palliative care services becomes all the more crucial to understand as poor accessibility will increase the cost of care due to the financial burden of the cost of travel and loss of wages of caregiver. 18 Since India continues to be predominantly rural with most of the health centers concentrated in urban areas, it also becomes essential to study the differential access to palliative care between rural and urban areas. Even though individual-level barriers to access to palliative care have been studied, the geographical distribution and accessibility to palliative care and its urban-rural disparity in India remain unstudied. 19 We aimed to assess the multiple measures of geographic accessibility to palliative care centers including density per 10 million people, travel time to the nearest palliative care center, and the access population coverage (APC) of centers at the national and state levels. We provide motorized accessibility estimates for 36 Indian states/union territories (UTs). We also assessed the access disparities for people living in rural and urban areas. Lastly, we also assessed how access to palliative care would change based on different scenarios of palliative care delivery from different levels of the public health system as recommended by NPPC and NPNCD programs. 2. Methodology 2.1 Study setting India is the seventh-largest and most populated country in the world with a projected population of more than 1.4 billion in 2023. 20 India has 28 states and 8 union territories. A majority of the Indian population resides in rural areas with less than 30% of the population residing in urban areas. The landscape varies from hilly terrain in the northernmost and north-eastern part of the country, plains in the northern region, to plateau in the southern peninsular region of the country. The terrain is important to remember while trying to understand geographical access to healthcare in the country. India has a mixed healthcare system with both public and private providers. 21 The public health system is multi-layered. Primary care in India is provided through Health and Wellness Centers (sub-centers and primary healthcare centers), secondary care through Community Health Centers (CHCs), and tertiary care through District Hospitals (DH), and Teaching Hospitals (THs). For this study, both public and private THs were included under the public health system as common guidelines of the National Medical Commission, Government of India strictly regulates them. Since morphine can not be prescribed from sub-centers in India, they were not included in assessing access to palliative care. Thus, the smallest unit of the public health infrastructure included was the primary health center (PHC). 2.2 Data sources 2.2.1 Palliative care centers: A list of functioning palliative care centers in the country was curated using Pallium India's website directory. Pallium India is India’s leading palliative care non-profit and advocacy organization which was started in 2003. The directory of palliative care centers was created in 2010 with the primary objective of assisting patients, and medical and non-medical professionals to locate a palliative care center in their vicinity. The organization’s regional state/UT-level facilitators support the establishment of new centers and keep track of active palliative care centers in their respective states/UTs. The regional facilitator (RF) reaches out to the head of the center and gets their approval for being part of the directory. After their approval, the RF collects the details about that center's services in a standard form. In addition to the name, address, and contact details of the palliative care center, this form also includes information on the availability of morphine, any specialized palliative care, and the type of services available like Outpatient, Inpatient, or home care. Once this information is received from the center, it's updated to a master database of centers maintained in an Excel sheet. The directory is updated every six months. For our analysis, we used the directory which was last updated in December 2022. 2.2.2 Public health centers: To comprehensively map the public health centers, the study necessitated the collection, extraction, and collation of data from multiple data sources ( Supplementary Table 1 ). The geolocation information for the Primary Health Centers (PHCs) and Community Health Centers (CHCs) was obtained from the Geographic Information System (GIS) dataset of the Pradhan Mantri Gram Sadak Yojana (PMGSY). 22 The PMGSY is a fully centrally funded initiative by the Government of India aimed at providing year-round connectivity to previously inaccessible areas as part of a poverty reduction effort. We used the PMGSY GIS dataset from October 2021 to extract geo-coordinates and other relevant geographic details for the health facilities under examination, specifically the PHCs and CHCs. However, GIS data for PHCs were unavailable in 52 districts, and CHC data were missing for 90 districts. The location of District Hospitals (DHs) was extracted from the National Institute for Transforming India (NITI) Aayog’s Report on the evaluation of DHs published in 2021. 23 Lastly, data on the location of Teaching Hospitals (THs) was extracted from the National Health Profile Report 2022 published by the Central Bureau of Health Intelligence. 24 2.2.3 Access outcomes: Data on motorized friction rasters for every square kilometer were obtained from the Malaria Atlas Project (MAP) 2019, an international research collaboration focusing on mapping the global response to malaria. 25 The friction rasters contain information related to the transport network in the given region and the factors that affect the time taken to move from one location to the other. Road, rail networks, navigable rivers, and shipping lanes are included in the transport networks. Environmental factors, like land cover and slope, affect the travel speed and political factors include national and state/UT boundaries that impact travel time. 26 2.2.4 Population projections and national and state-level borders: High-resolution (1 sq. km) United Nations (UN) adjusted population counts from the WorldPop dataset for 2020 for India served as our source of population data. 27 The administrative borders of India were drawn from the publicly available shapefile. 28 2.3 Outcomes We had three primary outcomes for the situational analysis . First,wereport the density of palliative care centers per 10 million people to understand their geographic distribution relative to the regional population. Second, we report the travel time to the nearest palliative care center. Using the granular estimates of travel time for each 1 km 2 pixel or grid cell, we report the median and interquartile range (IQR) values at aggregate group levels. Lastly, we report the Access Population Coverage (APC) which we defined as the percentage of the population with timely access to the nearest palliative care center. We estimated the timely access for motorized transport and considered timely access as within 30, 60, and 120 minutes. APC combined the population and timeliness aspects of access to care. For our secondary outcome, we report the same geographical accessibility outcomes mentioned above for different models of palliative care service delivery through public health centers and teaching hospitals. The following models of palliative care delivery from the combination of different levels of the public health system were studied: Scenario I: Palliative care centers mentioned in Pallium India’s directory (PCC-PI) and public tertiary healthcare system only (THs and DHs (as proposed by the NPNCD)) Scenario II: PCC-PI and public tertiary and secondary health care systems (THs, DHs, and CHCs). Scenario III: PCC-PI and the entire public health system (THs, DHs, CHCs, and PHCs (as proposed by NPPC & Ayushman Bharat program)). Scenario IV: Public healthcare system only (THs, DHs, CHCs, and PHCs). 2.4 Data analysis For the geocoding of the centers, addresses were cleaned manually for improved machine readability. We used the Google Maps Application Programming Interface (API) for geocoding. For locations that returned multiple sets of coordinates, the ones with the most relevant address string were chosen. Geo-coordinates were used to identify and remove duplicates and points extending beyond India's latitude and longitude limits. State-wise population data were extracted by imposing administrative boundaries. For travel times, the Dijkstra algorithm was utilized to compute the minimum time required to traverse the friction surface from every pixel (grid cell) on the map to the geo-coordinates of every palliative care and public health center. The algorithm was implemented for motorized transport. As walking long distances is not feasible for palliative care patients, we did not calculate travel time for a walking mode of transport. Access time for motorized transport was set at thresholds of 30, 60, and 120 minutes per previously published literature. 30–32 A binary accessibility raster was created with ‘1’s for pixels that fulfilled the timeliness criterion of each proxy variable and ‘NA’s (Not Applicable) for cases otherwise. This raster was then overlaid on the population raster (extent matched). The population figures at each pixel were multiplied with the weights (i.e. ‘1’s and ‘NA’s) to get the population number with timely access. The main analysis looked at the geographical access to PCC-PI and the secondary analysis looked at the geographical access to the centers as per the scenarios mentioned in Section 2.3. 3. Results 3.1 Situational analysis of access to PCC-PI 3.1.1 PCC-PI Density The Pallium India’s directory contained 526 active palliative care centers in 2022. Out-patient, in-patient, and home care were provided in 410 (77.9%), 324 (61.6%), and 381 (72.4%) centers, respectively. Of the 504 centers with available data, morphine was present in 333 (66.1%) centers. At least one trained healthcare worker was present in 477 (90.7%) centers. Services were free at 371 (73%) out of 508 centers with available data and 19 (3.7%) centers provided free service to only those from poor socio-economic backgrounds. Of all centers, 44.5% centers were present in Kerala, and no centers were present in Andaman & Nicobar Islands, Dadra & Nagar Haveli, Daman & Diu, and Ladakh. The PCC-PI density at the national level was 4 centers per 10 million population. In states/UTs with palliative care centers, the density was the highest in Lakshadweep with 147 centers for every 10 million, followed by Goa (96 centers/10 million) and Kerala (66 centers/ 10 million) ( Table 1 ) . Table 1 Palliative care centers per 10 million population in India State/UT Projected population (2022) Number of palliative care centers (PCC-PI) PCC-PI per 10 million people Andaman & Nicobar Islands 402000 0 0.0 Andhra Pradesh 90879000 13 1.4 Arunachal Pradesh 1548000 1 6.5 Assam 35378000 12 3.4 Bihar 124919000 8 0.6 Chandigarh 1219000 5 41.0 Chhattisgarh 29836000 7 2.3 Dadra & Nagar Haveli and Daman & Diu 1170000 0 0.0 Delhi 20965000 15 7.2 Goa 1567000 15 95.7 Gujarat 70648000 14 2.0 Haryana 29846000 6 2.0 Himachal Pradesh 7431000 7 9.4 Jammu & Kashmir 13804000 6 4.3 Jharkhand 38969000 6 1.5 Karnataka 67268000 12 1.8 Kerala 35633000 234 65.7 Lakshadweep 68000 1 147.1 Madhya Pradesh 85548000 9 1.1 Maharashtra 125411000 22 1.8 Manipur 3194000 3 9.4 Meghalaya 3318000 1 3.0 Mizoram 1227000 7 57.0 Nagaland 2213000 3 13.6 Odisha 44162000 6 1.4 Puducherry 1608000 4 24.9 Punjab 30535000 8 2.6 Rajasthan 80153000 9 1.1 Sikkim 683000 2 29.3 Tamil Nadu 76631000 44 5.7 Telangana 37907000 18 4.7 Tripura 4109000 1 2.4 Uttar Pradesh 233297000 12 0.5 Uttarakhand 11518000 5 4.3 West Bengal 98604000 10 1.0 3.1.2 Timely access to PCC-PI Nationally, the median [IQR] travel time to the nearest palliative care center was 118 [71, 179] minutes. The median (IQR) time was longer for rural (120 [72, 180] minutes) than for urban areas (57 [16, 109] minutes). Notable differences were noticed in access to the nearest palliative care center at the state/UT level. The median time to reach the nearest PCC-PI was the lowest for Lakshadweep (median [IQR] = 1[1, 2] minutes) and the highest for Ladakh (median [IQR] = 591 [412, 881] minutes) (Table 2 ) . Twenty-nine states/UTs had a median time longer than 30 minutes. The median travel time was worse for rural areas than for urban areas in all states/UTs (Table 2 ). The state/UT with the lowest rural median travel time was Lakshadweep (1 [1, 1] minute) and rural Ladakh had the highest median travel time of 591 [412, 880] minutes. Similarly, the median travel time of urban Chandigarh (3 [2, 5] minutes) was the lowest, and urban Ladakh (137 [137, 145] minutes) was the highest. Compared with the national median travel time, 15 states/union territories did worse. Table 2 State-wise time to reach the nearest palliative care center (PCC-PI) for total, rural, and urban populations. S. No. State/UT name Time to reach the nearest center (minutes) Total population Rural population Urban population Mean (SD) Median (IQR) Mean (SD) Median (IQR) Mean (SD) Median (IQR) 1 Arunachal Pradesh 715.4 (613.0) 505.1 (247.9, 1011.7) 713.9 (611.2) 504.5 (247.8, 1009.4) 67.3 (71.9) 34.3 (5.1, 146.6) 2 Assam 115.4 (100.5) 90.6 (58.2, 142.6) 117.1 (101.7) 92.0 (59.4, 143.9) 77.2 (59.0) 65.3 (34.7, 97.8) 3 Chandigarh 3.8 (2.3) 3.2 (1.9, 5.0) 7.9 (2.1) 8.4 (6.1, 9.3) 3.5 (2.0) 3.1 (1.8, 4.9) 4 Karnataka 113.5 (56.6) 108.3 (68.8, 156.6) 114.5 (56.2) 109.2 (69.7, 157.3) 69.5 (57.9) 61.3 (11.9, 112.2) 5 Manipur 202.0 (203.6) 128.0 (69.4, 270.8) 204.8 (203.4) 130.7 (71.6, 274.0) 22.3 (19.3) 17.7 (6.5, 32.7) 6 Meghalaya 153.9 (107.2) 139.0 (77.3, 207.3) 154.5 (107.3) 139.3 (77.8, 207.6) 87.0 (78.3) 57.7 (13.8, 170.2) 7 Mizoram 142.4 (108.7) 110.1 (60.7, 198.1) 142.4 (108.5) 110.2 (60.9, 198.1) 12.8 (16.7) 3.7 (1.9, 36.4) 8 Nagaland 129.2 (88.8) 106.8 (72.2, 161.8) 129.8 (88.3) 107.2 (73.1, 162.4) 26.2 (33.7) 5.2 (3.3, 52.8) 9 Punjab 52.4 (23.5) 51.9 (34.6, 69.6) 53.2 (23.0) 52.7 (35.4, 70.1) 33.9 (25.9) 33.0 (9.4, 50.9) 10 Rajasthan 158.4 (87.7) 143.5 (102.1, 193.9) 159.1 (87.6) 144.0 (102.6, 194.4) 101.5 (64.2) 107.0 (52.4, 142.5) 11 Sikkim 253.8 (262.0) 169.0 (44.2, 383.5) 254.1 (260.5) 169.8 (45.2, 384.2) 8.7 (8.0) 5.6 (2.3, 18.5) 12 Tripura 94.7 (51.8) 90.8 (60.4, 118.7) 96.2 (51.0) 91.8 (62.6, 119.8) 53.3 (39.2) 49.9 (10.9, 88.7) 13 Uttarakhand 330.7 (365.1) 205.8 (109.6, 361.0) 334.3 (366.5) 207.9 (111.8, 367.6) 95.0 (88.4) 58.3 (16.9, 171.2) 14 Telangana 78.9 (47.7) 69.5 (43.7, 106.8) 79.9 (47.4) 70.2 (44.6, 107.6) 33.9 (36.2) 13.1 (5.9, 55.0) 15 Bihar 99.0 (45.7) 96.3 (66.4, 127.3) 101.0 (46.1) 98.4 (68.1, 129.5) 80.8 (37.4) 82.0 (53.8, 105.7) 16 Kerala 39.3 (77.6) 14.4 (7.8, 28.4) 44.7 (82.9) 16.4 (9.1, 34.1) 8.6 (9.9) 6.7 (3.4, 11.5) 17 Madhya Pradesh 139.0 (57.9) 136.1 (98.6, 175.2) 139.5 (57.7) 136.5 (99.0, 175.5) 101.2 (60.9) 107.7 (56.4, 148.7) 18 Andaman & Nicobar # NA NA NA NA NA NA 19 Gujarat 171.3 (147.5) 133.1 (80.2, 212.9) 145.6 (95.3) 126.2 (77.5, 192.2) 75.7 (66.9) 63.8 (16.2, 115.4) 20 Lakshadweep* 1.0 (0.8) 1.4 (0.7, 1.8) 0.9 (0.8) 0.8 (0.4, 1.2) NA NA 21 Odisha 174.1 (73.0) 176.0 (127.0, 219.0) 175.3 (72.6) 177.0 (128.6, 219.7) 101.0 (60.9) 98.9 (52.9, 153.0) 22 Dadra and Nagar Haveli and Daman and Diu 128.1 (31.6) 122.4 (115.7, 129.7) 128.9 (27.7) 123.9 (118.2, 131.5) 115.2 (27.7) 113.0 (99.0, 118.6) 23 Ladakh 699.9 (415.2) 591.2 (412.3, 880.6) 699.8 (415.2) 591.1 (412.2, 880.2) 144.5 (12.5) 137.4 (137.2, 144.7) 24 Jammu & Kashmir 306.9 (461.6) 130.1 (57.0, 333.6) 315.2 (466.0) 137.2 (61.7, 342.0) 32.3 (44.1) 20.2 (7.7, 35.4) 25 Chhattisgarh 163.2 (89.8) 151.3 (93.1, 222.6) 164.4 (89.4) 152.4 (94.5, 223.5) 69.0 (63.6) 45.1 (23.2, 93.6) 26 Delhi 11.2 (8.2) 8.7 (4.8, 15.9) 23.7 (5.5) 23.1 (19.7, 27.2) 9.1 (6.5) 7.5 (4.3, 12.1) 27 Goa 35.5 (39.2) 24.3 (12.7, 41.4) 37.6 (39.8) 25.8 (14.6, 43.1) 7.2 (6.6) 4.6 (2.1, 11.4) 28 Haryana 70.1 (33.1) 68.3 (43.6, 94.1) 71.5 (32.7) 69.6 (45.2, 95.1) 44.0 (30.5) 36.9 (17.8, 69.3) 29 Himachal Pradesh 342.3 (384.9) 182.2 (55.3, 526.0) 344.3 (385.0) 185.4 (56.0, 530.2) 34.2 (22.8) 33.5 (13.3, 48.5) 30 Jharkhand 120.4 (64.1) 114.4 (66.7, 168.7) 121.6 (63.6) 115.8 (68.4, 169.5) 81.0 (66.9) 55.4 (32.5, 123.3) 31 Tamil Nadu 58.8 (36.4) 54.6 (33.9, 77.8) 60.0 (36.3) 55.8 (35.2, 78.6) 32.0 (27.9) 25.2 (6.9, 49.6) 32 Uttar Pradesh 114.8 (54.3) 111.0 (73.9, 152.3) 115.9 (53.9) 111.8 (75.2, 153.0) 94.8 (57.9) 94.7 (44.5, 137.1) 33 West Bengal 124.8 (108.0) 115.0 (70.4, 155.5) 128.8 (105.2) 119.1 (77.4, 157.7) 81.8 (60.8) 66.3 (31.5, 122.5) 34 Andhra Pradesh 98.2 (51.6) 92.8 (59.4, 131.0) 99.2 (51.3) 93.6 (60.5, 131.7) 52.2 (40.6) 44.4 (17.8, 79.5) 35 Puducherry 34.5 (36.4) 11.9 (5.6, 84.0) 41.4 (37.4) 16.8 (8.4, 85.7) 20.0 (31.2) 5.0 (2.6, 11.5) 36 Maharashtra 114.9 (58.2) 108.8 (71.8, 154.0) 116.0 (57.8) 109.5 (73.0, 154.7) 70.2 (58.0) 53.1 (15.5, 119.2) # Does not have a palliative care center *Does not have an urban population 3.1.3 Access Population Coverage (APC) of PCC-PI Nationally, only 23.7% of the population resided within 30 minutes, 39.9% within 60 minutes drive, and 71% within 120 minutes from the nearest PCC-PI. The coverage of PCC-PIs was worse in rural areas with only 11.8% of the population within 30 minutes, 29.3% within 60 minutes, and 65.2% within 120 minutes as compared to the urban areas where 55.6% of the population was within 30 minutes, 68.4% within 60 minutes and 86.3% within 120 minutes of the nearest PCC-PI. Among the state/UTs, 30, 22, and 8 states/UTs had less than 50% population within 30 minutes, 60 minutes, and 120 minutes, respectively. Chandigarh, Delhi, Kerala, and Goa had more than 90% of the total population within 30 minutes (Fig. 1 ). When compared with the percentage of the population within 30 minutes at the national level, 17 states/UTs did worse. The percentage of the population with access within 30 minutes and 60 minutes was worse for rural areas as compared to urban areas in all states/UTs (Table 3 ). In states/UTs with at least one palliative care center, Madhya Pradesh had only 3.3% of the population with access within 30 minutes as compared to Chandigarh and Kerala where 100% and 93.2% had access to the nearest PCC-PI within 30 minutes. Similarly, the percentage of the population with access within 30 minutes was the lowest for urban Bihar (18.8%) and the highest for urban Sikkim (100%). Rural populations of Chandigarh, Goa, and Kerala had a higher percentage of the population within 30 minutes of access than urban populations of 28 states/UTs (Fig. 2 ). Table 3 Access population coverage of palliative care centers (PCC-PI) for total, rural, and urban populations. S. No State/UT name Access population coverage (%) Total population Rural population Urban population Within 30 minutes Within 60 minutes Within 120 minutes Within 30 minutes Within 60 minutes Within 120 minutes Within 30 minutes Within 60 minutes Within 120 minutes 1 Arunachal Pradesh 9.5 14.5 34.8 6.9 11.7 32.6 71.2 81.6 87.7 2 Assam 14.8 38.0 79.5 10.9 34.4 78.5 33.2 55.1 84.5 3 Chandigarh 100.0 100.0 100.0 100.0 100.0 100.0 99.9 99.9 99.9 4 Karnataka 27.9 41.3 71.3 12.1 28.4 64.3 67.9 74.0 89.0 5 Manipur 42.5 71.2 89.1 27.3 60.8 84.8 84.2 99.5 100.0 6 Meghalaya 22.8 35.9 57.1 17.7 31.5 54.6 69.7 76.1 79.5 7 Mizoram 38.1 59.5 79.9 30.4 53.6 76.8 92.8 100.0 100.0 8 Nagaland 34.1 50.5 81.9 19.4 36.9 75.7 81.5 94.4 100.0 9 Punjab 33.1 72.3 99.6 24.3 66.7 99.2 60.5 89.8 100.0 10 Rajasthan 10.8 18.9 48.6 5.1 13.5 44.8 37.0 43.3 65.7 11 Sikkim 81.7 92.9 96.1 80.2 92.2 95.8 100.0 100.0 100.0 12 Tripura 26.4 47.7 89.0 16.2 38.7 86.5 62.4 79.5 97.3 13 Uttarakhand 21.8 40.8 52.3 12.3 32.8 47.5 50.5 64.6 66.6 14 Telangana 41.0 66.4 92.8 22.0 55.2 90.4 80.2 89.5 97.7 15 Bihar 9.2 28.9 80.3 6.9 26.3 78.1 18.8 39.6 89.1 16 Kerala 95.7 98.5 99.2 93.2 97.6 98.9 98.1 99.1 99.2 17 Madhya Pradesh 8.9 15.8 45.8 3.3 10.0 41.3 35.6 43.4 67.7 18 Andaman & Nicobar # 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 19 Gujarat 31.2 43.4 70.5 11.2 27.0 60.0 67.5 72.8 88.9 20 Lakshadweep* 15.7 15.7 15.7 0.0 0.0 0.0 NA NA NA 21 Odisha 7.4 17.4 42.5 4.0 13.9 39.1 28.8 39.4 63.3 22 Dadra and Nagar Haveli and Daman and Diu 0.0 0.0 64.8 0.0 0.0 41.7 0.0 0.0 89.4 23 Ladakh 0.0 0.0 3.6 0.0 0.0 3.6 0.0 0.0 0.0 24 Jammu & Kashmir 43.5 65.3 84.4 36.0 59.1 81.1 76.3 92.2 98.5 25 Chhattisgarh 16.5 34.7 68.0 8.8 26.6 63.1 59.5 79.4 95.4 26 Delhi 99.2 100.0 100.0 80.6 96.2 96.2 99.7 100.0 100.0 27 Goa 92.8 98.9 99.4 90.2 98.7 99.3 97.4 97.4 97.4 28 Haryana 28.1 56.4 96.7 15.8 47.6 94.9 55.9 76.3 100.0 29 Himachal Pradesh 30.0 71.7 92.3 28.0 70.0 91.6 54.9 92.5 100.0 30 Jharkhand 15.4 36.1 62.4 8.0 25.7 55.4 42.6 74.0 87.9 31 Tamil Nadu 42.9 73.6 99.3 28.4 65.7 98.6 73.6 90.4 100.0 32 Uttar Pradesh 10.9 24.2 60.9 5.6 18.3 57.8 30.2 45.4 72.0 33 West Bengal 22.2 36.4 65.5 4.4 18.1 52.5 49.8 64.7 85.3 34 Andhra Pradesh 23.6 49.2 85.6 16.3 42.3 82.4 46.9 71.2 95.3 35 Puducherry 83.8 84.9 100.0 61.6 63.3 96.2 92.0 92.3 99.5 36 Maharashtra 30.0 43.2 68.8 8.9 24.0 59.8 65.0 75.0 83.5 # Does not have a palliative care center *Does not have an urban population 3.2 Scenarios of Palliative Care Delivery from PCC-PI and Public Health Centers 3.2.1 Scenario I: PCC-PI and public tertiary healthcare system only (teaching and district hospitals (as proposed by the NPNCD)) Travel times Nationally, the median [IQR] travel time to the nearest center using a motorized vehicle was 51 [30, 82] minutes. The travel duration was longer for rural (51 [31, 83] minutes) than for urban areas (14 [4, 32] minutes). Among state/UTs, Lakshadweep had the shortest median [IQR] travel time of 1 [1, 1] minutes and Ladakh had the longest, 1770 [1770, 1770] minutes. Travel times for rural areas were longer than for urban areas in all states/UTs ( Supplementary Table 2 ). APC About 54.5% of the national population resided within 30 minutes, 86.4% within 60 minutes and 98.4% within 120 minutes of their nearest center. Rural areas had lower APC than urban areas for access within 30 minutes (42.5% vs 87.2%), 60 minutes (82.0% vs 98.4%), and 120 minutes (97.8% vs 100.0%). Among state/UTs, Delhi (100%), Chandigarh (100%), Puducherry (97.7%), Kerala (95.9%), Goa (93.5%), and Dadra & Nagar Haveli and Daman & Diu (93.1%) had more than 90% of the population within 30 minutes of the nearest center. When compared with the percentage of the population within 30 minutes at the national level, 15 states/UTs did worse. The percentage of the population within 30 minutes was worse for rural areas than for urban areas in all states/UTs ( Supplementary Table 3 ). 3.2.2 Scenario II: PCC-PI and public tertiary and secondary health care systems (Medical colleges, district hospitals, and community health centers). Travel times Nationally, the median [IQR] travel time for the total population to the nearest center was 31 [15,54] minutes. The travel duration was longer for rural (32 [18, 56] minutes) than for urban populations (8 [3, 19] minutes). Among the state/UTs, Lakshadweep had the shortest median [IQR] travel time of 1 [1, 1] minutes and Ladakh had the longest time of 350 [171, 634] minutes. Travel times for rural areas were longer than for urban areas in all states/UTs ( Supplementary Table 2 ). APC About 76.7% of the national population resided within 30 minutes, 95.2% within 60 minutes, and 99.1 within 120 minutes from the nearest center. Rural areas had lower APC compared with urban areas for 30 minutes (69.7% vs 95.8%), 60 minutes (93.5% vs 100%), and 120 minutes (98.7% vs 100%). Among the state/UTs, Delhi (100%), Chandigarh (100%), Puducherry (97.7%), Haryana (97.4%), Punjab (96.4%), Kerala (96.4%), Goa (93.6%), and Dadra & Nagar Haveli and Daman & Diu (93.3%) states/UTs had APC of more than 90% for 30 minutes. When compared with the APC for 30 minutes for the national population, 19 states/UTs did worse. The APC for 30 minutes was worse for rural areas as compared to urban areas in all states/UTs, except Chandigarh where 100% of both rural and urban populations were within 30 minutes of the nearest center (Supplementary Table 3) . 3.2.3 Scenario III: PCC-PI and entire public health system (medical colleges, district hospitals, community health centers, and health and wellness centers (as proposed by NPPC)) Travel times Nationally, the median [IQR] travel time to the nearest center was 16 [7, 33] minutes. The travel duration was longer for rural (16 [7, 33] minutes) than for urban areas (4 [2, 8] minutes). Among states/UTs, Lakshadweep had the shortest median [IQR] travel time of 1 [1, 1] minutes while Ladakh had the longest time of 301 [117, 515] minutes. Travel times for rural areas were longer than for urban areas in all states/UTs ( Supplementary Table 2 ). APC About 92.8% of the national population resided within 30 minutes, 98% within 60 minutes, and 99.3% within 120 minutes of their nearest center. Rural areas had lower APC than urban areas for 30 (90.3% vs 100%), 60 (97.3% vs 100%), and 120 minutes (99.0% vs 100%). Nineteen states/UTs had over 90% of their population within 30 minutes of the nearest center by motorized transport (Supplementary Table 3) . When compared with the percentage of the population covered within a 30-minute drive at the national level, 19 states/UTs did worse. 3.2.4 Scenario IV: Public healthcare system only (medical colleges, district hospitals, community health centers, and health and wellness centers) Travel times Nationally, the median [IQR] travel time to the nearest center was 16 [7, 33] minutes. The travel duration was longer for rural (16 [7, 33] minutes) than for urban areas (4 [2, 8] minutes). Among the state/UTs, Lakshadweep had the shortest travel time of 1 [1, 1] minute and Ladakh had the longest travel time of 300 [117, 585] minutes. Travel times for rural areas were worse than for urban areas in all states/UTs ( Supplementary Table 2 ). APC Around 92.8% of the total population resided within 30 minutes, 98.0% within 60 minutes, and 99.3% within 120 minutes from the nearest center. Rural areas had lower APC than urban areas for 30 minutes (90.3% vs 100%), 60 minutes (97.3% vs 100%), and 120 minutes (99.0% vs 100%). Among the state/UTs, 19 states/UTs had a population of more than 90% within 30 minutes of the nearest center ( Supplementary Table 3 ). When compared with the APC of the national population for 30 minutes, 20 states/UTs did worse. A comparison of all four scenarios revealed a progressive improvement in access in terms of time to reach the nearest center and the APC at all time thresholds, i.e., 30, 60 and 120 minutes (Supplementary Table 3–5). Figure 3 shows heatmaps of access to PCC-PI and centers in Scenario I-IV. The progressive reduction in area shaded ‘Red’ (highlighting region in which time taken to nearest center would be more than one hour) visually highlights the improvement in access. When compared to the APC of PCC-PI, the APCs from scenario I to IV were progressively improved ( Fig. 4 ) . The travel times and APC of scenario III were the same or nearly similar to scenario IV highlighting that the public health system alone could provide adequate access to palliative care in India. 4. Discussion India has only four palliative care centers per 10 million people. The median time to reach the nearest palliative care center was nearly two hours and only 23.7% of people had access to palliative care services within 30 minutes of motorized access. However, the coverage varies in different regions of the country. Kerala, a state in southern India, with 2.5% of the country's population, performed better than states with similar populations, like Punjab and Assam. This is because 44.5% of all the palliative care centers in the country were present in Kerala. This has resulted in 95.7% of the population in Kerala being within 30 minutes of the nearest palliative care center with a median [IQR] travel time to the nearest center of 14 [8, 28] minutes. Contrary to this the state of Uttar Pradesh with nearly 17% of the country’s population had only 12 (2.3%) palliative care centers with 10.9% of the population within 30 minutes of the nearest palliative care center and a median [IQR] travel time to the nearest center of 111 [74, 152] minutes. Better access in the union territories of Chandigarh and Delhi and the state of Goa compared to the rest of the states/UTs can be explained by the relatively smaller size of the territories, a small population, and greater urbanization. Arunachal Pradesh, Manipur, and Sikkim, states in northeast India, despite having a palliative care center density better than the national average had worse accessibility in terms of median time taken to reach the nearest center. This can be explained by the hilly terrain of the northeastern region of the country which would have increased the travel time to the center. We also noted a stark urban-rural disparity in access to palliative care centers. The median travel time ranged from 1 to 591 minutes in rural areas compared to 3 to 137 minutes in urban areas. Similarly, in states/UTs with palliative care centers, the APC within 30 minutes of the nearest center ranged from 3.3% to 100% in rural areas as compared to 18.8% to 100% in urban areas. This can be explained by the poorer road infrastructure in rural areas, which increases travel times. In 2018-19, the average road density in urban and rural areas was 5296.3 and 1458.1 per thousand-kilometer square, respectively. 33 An urban-rural disparity in the establishment of health centers has also contributed to the difference in travel times in urban and rural areas. As health professionals in India prefer to practice in urban areas, owing to the availability of better amenities and more opportunities for career growth, more centers tend to be established in urban areas. 34 In the scenarios incorporating palliative care at different levels of the health system, the access was noticed to be best in the third scenario which included all the public health centers and the active palliative care centers as per Pallium India’s directory. However, the access parameters were only marginally better than the scenario in which only the public health centers were included. This highlights that the public health system can effectively deliver palliative care in India with a supplementary role from private centers in rural and remote parts of the country where access remains poor despite complete engagement of the public health system. A similar analysis has been attempted to understand access to palliative care services in high-income countries. The accessibility reported in these regions in terms of access population coverage, is significantly better than the Indian scenario. In Switzerland, Germany, Ireland, Spain, and Switzerland, 95%, 86%, 84%, and 79%, of the population, respectively, were reported to live within 30 minutes from the nearest center with specialized palliative care services. 35,36 While Chandigarh (100%), Delhi (99.2%), Kerala (95.7%), and Goa (92.8%) reported better access in terms of APC compared to Germany (86%), all other states/UTs in India reported access poorer than Ireland (84%). Similar to the urban-rural disparity in India, the access to palliative care, in terms of travel times, in rural areas of Virginia Tennessee, and West Virginia in the United States of America was found to be nearly five times that the travel times in the urban areas of the respective states. 37 In this work, we have used multiple measures of geographic accessibility. Density, a commonly used metric, provides information on the geographical distribution of facilities by population. However, it fails to provide information on timely access to facilities. The presence of a road network, its quality, traffic, and the availability of public or personal transport are some of the factors that impact accessibility and can be influenced by policymakers. Our study is the first to calculate travel times and APC for palliative care centers in India. We preferred travel times over distances as pragmatically travel times better incorporate various infrastructural and geographical barriers mentioned previously. However, travel times fail to convey the population falling in the catchment areas of the centers. By combining time with the percentage of the population living around the centers, APC uses the percentage of the population that can access care in a given period. Therefore, APC gives us a more complete picture of the geographical accessibility to care in a region. We recommend that APC be used to guide policy regarding the establishment of future health centers in the country. There is a need to address the disparities in geographical accessibility to palliative care centers through strategic placement of new centers. This can be done by the use of location-allocation models (LAMs). Using these models, policymakers can improve accessibility to centers by opening new centers at optimized locations. 38 Since patients receiving palliative care are home or bedbound, our analysis also shows that the existing center-based approach to palliative care may not be able to universalize its access. Therefore, policymakers need to emphasize the home-based model of palliative care service delivery. Through various scenarios, we also highlight how access to palliative care can be improved using existing public health infrastructure. Once the existing public health infrastructure is equipped with palliative care services, access to the ones in rural areas can be improved by improving road networks through schemes such as the Pradhan Mantri Gram Sadak Yojana (PMGSY). Limitations and Strengths The study has multiple limitations. First, it is possible that Pallium India’s directory missed smaller or less well-known palliative care facilities. This limitation has been addressed by reporting changes in palliative care accessibility through different scenarios considering the delivery of services from different levels of the public health system. Second, our analysis inherited the assumptions and limitations of all the parent/source datasets. Third, to calculate the APC estimates, we did not take into account the access to or ownership of motor vehicles. Only 21% of Indian households owned two-wheelers, and 4.7% owned cars, jeeps, or vans as per the 2011 census. 39 Although India meets WHO’s norm of 1 ambulance per 100,000 people, there are large disparities in the availability of ambulance services among states/UTs. 40 Fourth, health center-related factors like affordability of care, functional timings, and quality of services provided at the centers were not considered while assessing accessibility. Despite these limitations, our study has several strengths. This is the first attempt to understand access to palliative care in a lower-middle-income country. Considering the huge burden of non-communicable diseases in India it becomes essential to understand the access to palliative care. The major strength of our study is that accessibility has been defined using three outcome measurements - palliative care center density, time to reach the nearest center, and access population coverage within multiple time frames. Not only have we reported a state-level analysis on access to palliative care but also done an urban-rural comparison. This will help the policymakers in deciding not only how many more centers are needed in each state but also in identifying the exact locations where building a center would improve geographic accessibility. Conclusion Comprehensive tools like median travel times and Access Population Coverage (APC) can be used to study accessibility to healthcare services. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6535976","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":448415616,"identity":"c767e1c9-6604-4fc3-8114-ca530a70ca76","order_by":0,"name":"Parth Sharma","email":"","orcid":"","institution":"Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India","correspondingAuthor":false,"prefix":"","firstName":"Parth","middleName":"","lastName":"Sharma","suffix":""},{"id":448418015,"identity":"fb8377df-915f-4ec8-b85c-25e31869b1c5","order_by":1,"name":"Harsh Thakkar","email":"","orcid":"","institution":"Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India","correspondingAuthor":false,"prefix":"","firstName":"Harsh","middleName":"","lastName":"Thakkar","suffix":""},{"id":448418016,"identity":"1e666d18-e1f7-4db9-a961-e00908cafb93","order_by":2,"name":"Aryan Patil","email":"","orcid":"","institution":"Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India","correspondingAuthor":false,"prefix":"","firstName":"Aryan","middleName":"","lastName":"Patil","suffix":""},{"id":448418017,"identity":"2f95155b-4a1e-4c93-8b96-8ab97090c399","order_by":3,"name":"Preeti Chauhan","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Preeti","middleName":"","lastName":"Chauhan","suffix":""},{"id":448418018,"identity":"da7ad5d2-fc13-4fd5-888c-19fd6839a15e","order_by":4,"name":"Priya Chembon","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Priya","middleName":"","lastName":"Chembon","suffix":""},{"id":448418019,"identity":"45ca52f0-0802-4147-967a-8d4983717110","order_by":5,"name":"Shalini AJ","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Shalini","middleName":"","lastName":"AJ","suffix":""},{"id":448418020,"identity":"6bb04944-8111-4dab-83af-405505511726","order_by":6,"name":"Smriti Rana","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Smriti","middleName":"","lastName":"Rana","suffix":""},{"id":448418021,"identity":"dd3a4d78-f4c4-4e35-895b-3fb4a8f97725","order_by":7,"name":"Raj Kalady","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Raj","middleName":"","lastName":"Kalady","suffix":""},{"id":448418022,"identity":"8895eb5e-d630-40cc-b870-ed538e548576","order_by":8,"name":"Vidhi Wadhwani","email":"","orcid":"","institution":"Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India","correspondingAuthor":false,"prefix":"","firstName":"Vidhi","middleName":"","lastName":"Wadhwani","suffix":""},{"id":448418023,"identity":"ec25dcfb-8cfb-4320-a7d0-073b4d089d2a","order_by":9,"name":"Gaurav Urs","email":"","orcid":"","institution":"Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India","correspondingAuthor":false,"prefix":"","firstName":"Gaurav","middleName":"","lastName":"Urs","suffix":""},{"id":448418024,"identity":"5da37155-a0ed-44b9-bc38-c8d43ab01dbf","order_by":10,"name":"Padmavathy Krishna","email":"","orcid":"","institution":"Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India","correspondingAuthor":false,"prefix":"","firstName":"Padmavathy","middleName":"","lastName":"Krishna","suffix":""},{"id":448418025,"identity":"240b1afa-cadc-4130-bbf0-cfff39300a55","order_by":11,"name":"Rontu Sangma","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Rontu","middleName":"","lastName":"Sangma","suffix":""},{"id":448418206,"identity":"93534872-3b93-40c0-9456-6a091c64b4bb","order_by":12,"name":"Rajendra Dutt Bijalwan","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Rajendra","middleName":"Dutt","lastName":"Bijalwan","suffix":""},{"id":448418207,"identity":"2655ce87-7c70-4a4b-85dd-1d9a0b849728","order_by":13,"name":"Sunanda Samal","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Sunanda","middleName":"","lastName":"Samal","suffix":""},{"id":448418208,"identity":"6fdf0f21-8333-4d6b-a9fb-306c7235c9f2","order_by":14,"name":"Lalit S","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Lalit","middleName":"","lastName":"S","suffix":""},{"id":448418209,"identity":"3fac5b41-c194-4ff8-9c11-14c41b052814","order_by":15,"name":"Syed Mohammad Askari Naqvi","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Syed","middleName":"Mohammad Askari","lastName":"Naqvi","suffix":""},{"id":448418210,"identity":"78ea52dc-0485-4b20-906d-55290eed3d57","order_by":16,"name":"Jatin Bhukal","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Jatin","middleName":"","lastName":"Bhukal","suffix":""},{"id":448418211,"identity":"c22c6c60-19ad-428a-aa87-e0a7616335c4","order_by":17,"name":"Johnsurya J","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"Johnsurya","middleName":"","lastName":"J","suffix":""},{"id":448418212,"identity":"af40969c-853e-42b6-aa88-cd12942cfd13","order_by":18,"name":"M R Rajagopal","email":"","orcid":"","institution":"Pallium India","correspondingAuthor":false,"prefix":"","firstName":"M","middleName":"R","lastName":"Rajagopal","suffix":""},{"id":448418213,"identity":"caf74376-7b48-429a-8882-87598abc29e9","order_by":19,"name":"Siddhesh Zadey","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYDACZgYDBgY2BgZ+ECehgBQtkg0gLQbE2QPRYnAAyiYI5NuZN3/4UWaTuPn86sQPDwwY5PnFDhCw4jBbgWHPubTEbTfebpYAOsxw5uwEAlqYeQwSeNsOA7Wc3QDSkmBwm4AW+WYeg4N/2/4nbp5xdvMPorQwHOYxbOZtO5C4gb93G3G2AP1SzCxzLtl4xg3ebRYJBhKE/SLff3jzxzdldrL9/Wc33/xRYSPPL03IYVDg2CABVilBnHIQsGfgP0C86lEwCkbBKBhZAADv4UYkiB2G5QAAAABJRU5ErkJggg==","orcid":"","institution":"Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India","correspondingAuthor":true,"prefix":"","firstName":"Siddhesh","middleName":"","lastName":"Zadey","suffix":""}],"badges":[],"createdAt":"2025-04-26 15:48:11","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6535976/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6535976/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":81609614,"identity":"74588c33-bd0c-42b8-9fc6-a28aa6fc86cb","added_by":"auto","created_at":"2025-04-29 06:45:50","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":330610,"visible":true,"origin":"","legend":"\u003cp\u003eState-level access population coverage of PCC-PI at 30-minute and 120-minute time thresholds\u003c/p\u003e","description":"","filename":"Figure1..png","url":"https://assets-eu.researchsquare.com/files/rs-6535976/v1/0a31fe917141556897682e17.png"},{"id":81609615,"identity":"f188bcac-9ca0-42fa-9afd-63bed5cd0dd7","added_by":"auto","created_at":"2025-04-29 06:45:50","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":310154,"visible":true,"origin":"","legend":"\u003cp\u003eRural and urban disparity in access population coverage for PCC-PI at 30-minute time thresh\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-6535976/v1/b0fc6940299aadf53450b579.png"},{"id":81609620,"identity":"ebbc0c5d-f347-4f85-9d52-7eb6e378327f","added_by":"auto","created_at":"2025-04-29 06:45:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":14174342,"visible":true,"origin":"","legend":"\u003cp\u003eHeatmap showing timely access to PCC-PI (A) PCC-PI (B) Scenario I (C) Scenario II (D) Scenario III and (E) Scenario IV with the colors ‘Blue’, ‘Green’, ‘Yellow’ and ‘Red’ highlighting access within 15 mins, 15 to 30 mins, 30 mins to 60 mins and more than 60 mins respectively.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-6535976/v1/12c6ad1c2d5fff507ba11d8f.png"},{"id":81609617,"identity":"1f260105-7641-4e01-9b69-4c2ddee1e39f","added_by":"auto","created_at":"2025-04-29 06:45:50","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":425556,"visible":true,"origin":"","legend":"\u003cp\u003eImprovement in APC in a) rural b) urban and c) total population across different scenarios of access\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-6535976/v1/711f9dd07450f2f27b94fc86.png"},{"id":81610479,"identity":"dbf6dc27-d3af-4dfa-8117-8e347d5f5373","added_by":"auto","created_at":"2025-04-29 07:02:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":18999847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6535976/v1/fe6b559f-307f-4102-bc7a-025cc698253a.pdf"},{"id":81609616,"identity":"2fd18728-46ce-4773-bc03-a994671ac8ca","added_by":"auto","created_at":"2025-04-29 06:45:50","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":39094,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarytables.docx","url":"https://assets-eu.researchsquare.com/files/rs-6535976/v1/a44e9cb5196d0dced2de48b1.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAccess to palliative care in India: situational analysis and modeling of access from public healthcare centers\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe World Health Organization defines palliative care as \u0026ldquo;an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness.\u0026rdquo;\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Realizing the impact of palliative care on the quality of life of patients and caregivers, in 2014, the World Health Organization passed a resolution urging member states to provide palliative care services as a part of comprehensive care.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Four in ten people in India are estimated to have at least one chronic disease and this burden is expected to rise.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e With the rising incidence of chronic diseases, the need for palliative care is also expected to rise in India to address serious health-related suffering which is commonly associated with end-stage chronic diseases.\u003csup\u003e\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePalliative care is most commonly needed for patients suffering from cardiovascular diseases, chronic respiratory diseases, cancer, and neurological illnesses among others. It is estimated that less than 4% of people in need of palliative care have access to it in India.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Specifically in patients with last-stage cancer, who account for nearly one\u0026ndash;third of all palliative care needs, the unmet need for palliative care is 98.3% in India.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e There are various barriers to poor delivery of palliative care in India like poor awareness among healthcare providers and patients, lack of trained workforce, lack of access to essential controlled medicines, and lack of support from policymakers.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Inequitable distribution of services, when available, and poor geographic access to health centers with available services also act as significant barriers to palliative care delivery in India.\u003c/p\u003e \u003cp\u003eThe National Program for Palliative Care (NPPC) was launched in 2012 by the Ministry of Health \u0026amp; Family Welfare in India, to promote palliative care provision in the government infrastructure at all healthcare levels.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The National Health Policy 2017 focused more on the delivery of palliative care from primary health centers and community engagement. It introduced palliative care services to be delivered at the grassroots levels by community health workers and from the primary care unit of public health infrastructure, Health and Wellness Centers (HWC).\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e This enabled a mechanism for the continuum of care. The National Program for Prevention and Control of Non-Communicable Diseases (NPNCD) also reinforced palliative care provision from district hospitals and medical colleges.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Currently, palliative care in India is provided by both public and private healthcare centers. However, private centers are leading the way in service delivery due to the lack of implementation of the existing programs for palliative care in India.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAs per the guidelines of the National Medical Commission, it is not mandatory to have a department for palliative care to establish a medical college.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The limited training courses and limited awareness of palliative care in India also make establishing palliative care departments in public hospitals at all service delivery levels -primary, secondary, and tertiary - challenging.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWith limited centers providing palliative care, it becomes important to understand the geographical distribution of these centers and geographical accessibility i.e., the time taken to reach the nearest center, to plan further scale-up of palliative care services in India.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Since people requiring palliative care are most often bed or homebound, the proximity to the center with palliative care services becomes all the more crucial to understand as poor accessibility will increase the cost of care due to the financial burden of the cost of travel and loss of wages of caregiver.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Since India continues to be predominantly rural with most of the health centers concentrated in urban areas, it also becomes essential to study the differential access to palliative care between rural and urban areas. Even though individual-level barriers to access to palliative care have been studied, the geographical distribution and accessibility to palliative care and its urban-rural disparity in India remain unstudied.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWe aimed to assess the multiple measures of geographic accessibility to palliative care centers including density per 10\u0026nbsp;million people, travel time to the nearest palliative care center, and the access population coverage (APC) of centers at the national and state levels. We provide motorized accessibility estimates for 36 Indian states/union territories (UTs). We also assessed the access disparities for people living in rural and urban areas. Lastly, we also assessed how access to palliative care would change based on different scenarios of palliative care delivery from different levels of the public health system as recommended by NPPC and NPNCD programs.\u003c/p\u003e"},{"header":"2. Methodology","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndia is the seventh-largest and most populated country in the world with a projected population of more than 1.4 billion in 2023.\u003csup\u003e20\u003c/sup\u003e India has 28 states and 8 union territories. A majority of the Indian population resides in rural areas with less than 30% of the population residing in urban areas. The landscape varies from hilly terrain in the northernmost and north-eastern part of the country, plains in the northern region, to plateau in the southern peninsular region of the country. The terrain is important to remember while trying to understand geographical access to healthcare in the country. India has a mixed healthcare system with both public and private providers.\u003csup\u003e21\u003c/sup\u003e The public health system is multi-layered. Primary care in India is provided through Health and Wellness Centers (sub-centers and primary healthcare centers), secondary care through Community Health Centers (CHCs), and tertiary care through District Hospitals (DH), and Teaching Hospitals (THs). For this study, both public and private THs were included under the public health system as common guidelines of the National Medical Commission, Government of India strictly regulates them. Since morphine can not be prescribed from sub-centers in India, they were not included in assessing access to palliative care. Thus, the smallest unit of the public health infrastructure included was the primary health center (PHC).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Data sources\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.1 Palliative care centers:\u0026nbsp;\u003c/strong\u003eA list of functioning palliative care centers in the country was curated using Pallium India's website directory. Pallium India is India’s leading palliative care non-profit and advocacy organization which was started in 2003. The directory of palliative care centers was created in 2010 with the primary objective of assisting patients, and medical and non-medical professionals to locate a palliative care center in their vicinity. The organization’s regional state/UT-level facilitators support the establishment of new centers and keep track of active palliative care centers in their respective states/UTs. The regional facilitator (RF) reaches out to the head of the center and gets their approval for being part of the directory. After their approval, the RF collects the details about that center's services in a standard form. In addition to the name, address, and contact details of the palliative care center, this form also includes information on the availability of morphine, any specialized palliative care, and the type of services available like Outpatient, Inpatient, or home care. Once this information is received from the center, it's updated to a master database of centers maintained in an Excel sheet. The directory is updated every six months. For our analysis, we used the directory which was last updated in December 2022.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.2 Public health centers:\u0026nbsp;\u003c/strong\u003eTo comprehensively map the public health centers, the study necessitated the collection, extraction, and collation of data from multiple data sources (\u003cstrong\u003eSupplementary\u003c/strong\u003e \u003cstrong\u003eTable 1\u003c/strong\u003e). The geolocation information for the Primary Health Centers (PHCs) and Community Health Centers (CHCs) was obtained from the Geographic Information System (GIS) dataset of the Pradhan Mantri Gram Sadak Yojana (PMGSY).\u003csup\u003e22\u003c/sup\u003e The PMGSY is a fully centrally funded initiative by the Government of India aimed at providing year-round connectivity to previously inaccessible areas as part of a poverty reduction effort. We used the PMGSY GIS dataset from October 2021 to extract geo-coordinates and other relevant geographic details for the health facilities under examination, specifically the PHCs and CHCs. However, GIS data for PHCs were unavailable in 52 districts, and CHC data were missing for 90 districts. The location of District Hospitals (DHs) was extracted from the National Institute for Transforming India (NITI) Aayog’s Report on the evaluation of DHs published in 2021.\u003csup\u003e23\u003c/sup\u003e Lastly, data on the location of Teaching Hospitals (THs) was extracted from the National Health Profile Report 2022 published by the Central Bureau of Health Intelligence.\u003csup\u003e24\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.3 Access outcomes:\u0026nbsp;\u003c/strong\u003eData on motorized friction rasters for every square kilometer were obtained from the Malaria Atlas Project (MAP) 2019, an international research collaboration focusing on mapping the global response to malaria.\u003csup\u003e25\u003c/sup\u003e The friction rasters contain information related to the transport network in the given region and the factors that affect the time taken to move from one location to the other. Road, rail networks, navigable rivers, and shipping lanes are included in the transport networks. Environmental factors, like land cover and slope, affect the travel speed and political factors include national and state/UT boundaries that impact travel time.\u003csup\u003e26\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2.4 Population projections and national and state-level borders:\u0026nbsp;\u003c/strong\u003eHigh-resolution (1 sq. km) United Nations (UN) adjusted population counts from the WorldPop dataset for 2020 for India served as our source of population data.\u003csup\u003e27\u003c/sup\u003e The administrative borders of India were drawn from the publicly available shapefile.\u003csup\u003e28\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe had three primary outcomes for the situational analysis\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eFirst,wereport the density of palliative care centers per 10 million people to understand their geographic distribution relative to the regional population. Second, we report the travel time to the nearest palliative care center. Using the granular estimates of travel time for each 1 km\u003csup\u003e2\u003c/sup\u003e pixel or grid cell, we report the median and interquartile range (IQR) values at aggregate group levels. Lastly, we report the Access Population Coverage (APC) which we defined as the percentage of the population with timely access to the nearest palliative care center. We estimated the timely access for motorized transport and considered timely access as within 30, 60, and 120 minutes. APC combined the population and timeliness aspects of access to care.\u003c/p\u003e\n\u003cp\u003eFor our secondary outcome, we report the same geographical accessibility outcomes mentioned above for different models of palliative care service delivery through public health centers and teaching hospitals. The following models of palliative care delivery from the combination of different levels of the public health system were studied:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eScenario I: Palliative care centers mentioned in Pallium India’s directory (PCC-PI) and public tertiary healthcare system only (THs and DHs (as proposed by the NPNCD))\u003c/li\u003e\n \u003cli\u003eScenario II: PCC-PI and public tertiary and secondary health care systems (THs, DHs, and CHCs).\u003c/li\u003e\n \u003cli\u003eScenario III: PCC-PI and the entire public health system (THs, DHs, CHCs, and PHCs (as proposed by NPPC \u0026amp; Ayushman Bharat program)).\u003c/li\u003e\n \u003cli\u003eScenario IV: Public healthcare system only (THs, DHs, CHCs, and PHCs).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Data analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor the geocoding of the centers, addresses were cleaned manually for improved machine readability. We used the Google Maps Application Programming Interface (API) for geocoding. For locations that returned multiple sets of coordinates, the ones with the most relevant address string were chosen. Geo-coordinates were used to identify and remove duplicates and points extending beyond India's latitude and longitude limits. State-wise population data were extracted by imposing administrative boundaries.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor travel times, the Dijkstra algorithm was utilized to compute the minimum time required to traverse the friction surface from every pixel (grid cell) on the map to the geo-coordinates of every palliative care and public health center. The algorithm was implemented for motorized transport. As walking long distances is not feasible for palliative care patients, we did not calculate travel time for a walking mode of transport. Access time for motorized transport was set at thresholds of 30, 60, and 120 minutes per previously published literature.\u003csup\u003e30–32\u003c/sup\u003e A binary accessibility raster was created with ‘1’s for pixels that fulfilled the timeliness criterion of each proxy variable and ‘NA’s (Not Applicable) for cases otherwise. This raster was then overlaid on the population raster (extent matched). The population figures at each pixel were multiplied with the weights (i.e. ‘1’s and ‘NA’s) to get the population number with timely access.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe main analysis looked at the geographical access to PCC-PI and the secondary analysis looked at the geographical access to the centers as per the scenarios mentioned in Section 2.3.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Situational analysis of access to PCC-PI\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1 PCC-PI Density\u003c/h2\u003e \u003cp\u003eThe Pallium India\u0026rsquo;s directory contained 526 active palliative care centers in 2022. Out-patient, in-patient, and home care were provided in 410 (77.9%), 324 (61.6%), and 381 (72.4%) centers, respectively. Of the 504 centers with available data, morphine was present in 333 (66.1%) centers. At least one trained healthcare worker was present in 477 (90.7%) centers. Services were free at 371 (73%) out of 508 centers with available data and 19 (3.7%) centers provided free service to only those from poor socio-economic backgrounds. Of all centers, 44.5% centers were present in Kerala, and no centers were present in Andaman \u0026amp; Nicobar Islands, Dadra \u0026amp; Nagar Haveli, Daman \u0026amp; Diu, and Ladakh. The PCC-PI density at the national level was 4 centers per 10\u0026nbsp;million population. In states/UTs with palliative care centers, the density was the highest in Lakshadweep with 147 centers for every 10\u0026nbsp;million, followed by Goa (96 centers/10\u0026nbsp;million) and Kerala (66 centers/ 10\u0026nbsp;million) \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePalliative care centers per 10\u0026nbsp;million population in India\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState/UT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProjected population (2022)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of palliative care centers (PCC-PI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePCC-PI per 10\u0026nbsp;million people\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndaman \u0026amp; Nicobar Islands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e402000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndhra Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90879000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eArunachal Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1548000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35378000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBihar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124919000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChandigarh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1219000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChhattisgarh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29836000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDadra \u0026amp; Nagar Haveli and Daman \u0026amp; Diu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1170000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelhi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20965000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGoa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1567000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGujarat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70648000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHaryana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29846000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHimachal Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7431000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJammu \u0026amp; Kashmir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13804000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJharkhand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38969000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKarnataka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e67268000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKerala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35633000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLakshadweep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e68000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e147.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMadhya Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85548000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaharashtra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e125411000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManipur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3194000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeghalaya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3318000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMizoram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1227000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNagaland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2213000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOdisha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44162000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePuducherry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1608000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePunjab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30535000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRajasthan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80153000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSikkim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e683000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTamil Nadu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e76631000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelangana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37907000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTripura\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4109000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUttar Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233297000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUttarakhand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11518000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWest Bengal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e98604000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 Timely access to PCC-PI\u003c/h2\u003e \u003cp\u003eNationally, the median [IQR] travel time to the nearest palliative care center was 118 [71, 179] minutes. The median (IQR) time was longer for rural (120 [72, 180] minutes) than for urban areas (57 [16, 109] minutes).\u003c/p\u003e \u003cp\u003eNotable differences were noticed in access to the nearest palliative care center at the state/UT level. The median time to reach the nearest PCC-PI was the lowest for Lakshadweep (median [IQR]\u0026thinsp;=\u0026thinsp;1[1, 2] minutes) and the highest for Ladakh (median [IQR]\u0026thinsp;=\u0026thinsp;591 [412, 881] minutes) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. Twenty-nine states/UTs had a median time longer than 30 minutes. The median travel time was worse for rural areas than for urban areas in all states/UTs (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The state/UT with the lowest rural median travel time was Lakshadweep (1 [1, 1] minute) and rural Ladakh had the highest median travel time of 591 [412, 880] minutes. Similarly, the median travel time of urban Chandigarh (3 [2, 5] minutes) was the lowest, and urban Ladakh (137 [137, 145] minutes) was the highest. Compared with the national median travel time, 15 states/union territories did worse.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eState-wise time to reach the nearest palliative care center (PCC-PI) for total, rural, and urban populations.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eS. No.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eState/UT name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c8\" namest=\"c3\"\u003e \u003cp\u003eTime to reach the nearest center (minutes)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTotal population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eRural population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eUrban population\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArunachal Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e715.4 (613.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e505.1 (247.9, 1011.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e713.9 (611.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e504.5 (247.8, 1009.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e67.3 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e34.3 (5.1, 146.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115.4 (100.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.6 (58.2, 142.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117.1 (101.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e92.0 (59.4, 143.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e77.2 (59.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e65.3 (34.7, 97.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChandigarh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.2 (1.9, 5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.9 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.4 (6.1, 9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.5 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.1 (1.8, 4.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKarnataka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e113.5 (56.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108.3 (68.8, 156.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114.5 (56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e109.2 (69.7, 157.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69.5 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61.3 (11.9, 112.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManipur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202.0 (203.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e128.0 (69.4, 270.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e204.8 (203.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e130.7 (71.6, 274.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22.3 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17.7 (6.5, 32.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeghalaya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153.9 (107.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139.0 (77.3, 207.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e154.5 (107.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e139.3 (77.8, 207.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e87.0 (78.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e57.7 (13.8, 170.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMizoram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142.4 (108.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110.1 (60.7, 198.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e142.4 (108.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e110.2 (60.9, 198.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e12.8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.7 (1.9, 36.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNagaland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129.2 (88.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106.8 (72.2, 161.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e129.8 (88.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e107.2 (73.1, 162.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26.2 (33.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.2 (3.3, 52.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePunjab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.4 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.9 (34.6, 69.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53.2 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52.7 (35.4, 70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.9 (25.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.0 (9.4, 50.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRajasthan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158.4 (87.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e143.5 (102.1, 193.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e159.1 (87.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e144.0 (102.6, 194.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101.5 (64.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e107.0 (52.4, 142.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSikkim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e253.8 (262.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169.0 (44.2, 383.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e254.1 (260.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e169.8 (45.2, 384.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.7 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.6 (2.3, 18.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTripura\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94.7 (51.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.8 (60.4, 118.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e96.2 (51.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91.8 (62.6, 119.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53.3 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e49.9 (10.9, 88.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUttarakhand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e330.7 (365.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205.8 (109.6, 361.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e334.3 (366.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e207.9 (111.8, 367.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95.0 (88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e58.3 (16.9, 171.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTelangana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.9 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.5 (43.7, 106.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79.9 (47.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e70.2 (44.6, 107.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e33.9 (36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.1 (5.9, 55.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBihar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.0 (45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.3 (66.4, 127.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e101.0 (46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e98.4 (68.1, 129.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e80.8 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e82.0 (53.8, 105.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKerala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.3 (77.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.4 (7.8, 28.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44.7 (82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.4 (9.1, 34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8.6 (9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.7 (3.4, 11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMadhya Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139.0 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136.1 (98.6, 175.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e139.5 (57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e136.5 (99.0, 175.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101.2 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e107.7 (56.4, 148.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAndaman \u0026amp; Nicobar\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGujarat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e171.3 (147.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133.1 (80.2, 212.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e145.6 (95.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e126.2 (77.5, 192.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e75.7 (66.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e63.8 (16.2, 115.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLakshadweep*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.4 (0.7, 1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9 (0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.8 (0.4, 1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdisha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174.1 (73.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e176.0 (127.0, 219.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e175.3 (72.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e177.0 (128.6, 219.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101.0 (60.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e98.9 (52.9, 153.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDadra and Nagar Haveli and Daman and Diu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e128.1 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e122.4 (115.7, 129.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128.9 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e123.9 (118.2, 131.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e115.2 (27.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e113.0 (99.0, 118.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLadakh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e699.9 (415.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e591.2 (412.3, 880.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e699.8 (415.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e591.1 (412.2, 880.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e144.5 (12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e137.4 (137.2, 144.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJammu \u0026amp; Kashmir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e306.9 (461.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130.1 (57.0, 333.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e315.2 (466.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e137.2 (61.7, 342.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.3 (44.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.2 (7.7, 35.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChhattisgarh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163.2 (89.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e151.3 (93.1, 222.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e164.4 (89.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e152.4 (94.5, 223.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e69.0 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e45.1 (23.2, 93.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelhi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.2 (8.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.7 (4.8, 15.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.7 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.1 (19.7, 27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.1 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.5 (4.3, 12.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGoa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.5 (39.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.3 (12.7, 41.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.6 (39.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25.8 (14.6, 43.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e7.2 (6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.6 (2.1, 11.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaryana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.1 (33.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68.3 (43.6, 94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.5 (32.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e69.6 (45.2, 95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e44.0 (30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e36.9 (17.8, 69.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHimachal Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e342.3 (384.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e182.2 (55.3, 526.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e344.3 (385.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e185.4 (56.0, 530.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e34.2 (22.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.5 (13.3, 48.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJharkhand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120.4 (64.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114.4 (66.7, 168.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e121.6 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e115.8 (68.4, 169.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e81.0 (66.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e55.4 (32.5, 123.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTamil Nadu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.8 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.6 (33.9, 77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.0 (36.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55.8 (35.2, 78.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e32.0 (27.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.2 (6.9, 49.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUttar Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114.8 (54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111.0 (73.9, 152.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e115.9 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e111.8 (75.2, 153.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e94.8 (57.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e94.7 (44.5, 137.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest Bengal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e124.8 (108.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115.0 (70.4, 155.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e128.8 (105.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e119.1 (77.4, 157.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e81.8 (60.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e66.3 (31.5, 122.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAndhra Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.2 (51.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.8 (59.4, 131.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e99.2 (51.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e93.6 (60.5, 131.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e52.2 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e44.4 (17.8, 79.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePuducherry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.5 (36.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.9 (5.6, 84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41.4 (37.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16.8 (8.4, 85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.0 (31.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.0 (2.6, 11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaharashtra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e114.9 (58.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e108.8 (71.8, 154.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e116.0 (57.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e109.5 (73.0, 154.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70.2 (58.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e53.1 (15.5, 119.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e\u003cem\u003e#\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eDoes not have a palliative care center\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003cem\u003e*Does not have an urban population\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Access Population Coverage (APC) of PCC-PI\u003c/h2\u003e \u003cp\u003eNationally, only 23.7% of the population resided within 30 minutes, 39.9% within 60 minutes drive, and 71% within 120 minutes from the nearest PCC-PI. The coverage of PCC-PIs was worse in rural areas with only 11.8% of the population within 30 minutes, 29.3% within 60 minutes, and 65.2% within 120 minutes as compared to the urban areas where 55.6% of the population was within 30 minutes, 68.4% within 60 minutes and 86.3% within 120 minutes of the nearest PCC-PI.\u003c/p\u003e \u003cp\u003eAmong the state/UTs, 30, 22, and 8 states/UTs had less than 50% population within 30 minutes, 60 minutes, and 120 minutes, respectively. Chandigarh, Delhi, Kerala, and Goa had more than 90% of the total population within 30 minutes (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). When compared with the percentage of the population within 30 minutes at the national level, 17 states/UTs did worse. The percentage of the population with access within 30 minutes and 60 minutes was worse for rural areas as compared to urban areas in all states/UTs (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In states/UTs with at least one palliative care center, Madhya Pradesh had only 3.3% of the population with access within 30 minutes as compared to Chandigarh and Kerala where 100% and 93.2% had access to the nearest PCC-PI within 30 minutes. Similarly, the percentage of the population with access within 30 minutes was the lowest for urban Bihar (18.8%) and the highest for urban Sikkim (100%). Rural populations of Chandigarh, Goa, and Kerala had a higher percentage of the population within 30 minutes of access than urban populations of 28 states/UTs (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAccess population coverage of palliative care centers (PCC-PI) for total, rural, and urban populations.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eS. No\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eState/UT name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"9\" nameend=\"c11\" namest=\"c3\"\u003e \u003cp\u003eAccess population coverage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eTotal population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eRural population\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c11\" namest=\"c9\"\u003e \u003cp\u003eUrban population\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWithin 30 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWithin 60 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWithin 120 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWithin 30 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eWithin 60 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eWithin 120 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eWithin 30 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eWithin 60 minutes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eWithin 120 minutes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArunachal Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e71.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e81.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e87.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e34.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e33.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e55.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e84.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChandigarh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e99.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e99.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e99.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKarnataka\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e71.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e64.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e67.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e89.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManipur\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e89.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e27.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e60.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e84.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e84.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e99.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeghalaya\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e57.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e54.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e69.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e76.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e79.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMizoram\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e79.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e53.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e76.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e92.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNagaland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e81.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e75.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e81.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e94.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePunjab\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e24.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e89.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRajasthan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e48.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e43.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e65.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSikkim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e80.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e95.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTripura\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e89.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e38.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e86.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e62.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e79.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e97.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUttarakhand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e32.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e47.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e50.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e64.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e66.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTelangana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e92.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e90.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e80.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e89.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e97.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBihar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e78.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e89.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eKerala\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e93.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e97.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e98.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e98.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e99.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMadhya Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e41.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e43.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e67.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAndaman \u0026amp; Nicobar\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGujarat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e70.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e67.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e72.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e88.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLakshadweep*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdisha\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e39.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e28.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e63.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDadra and Nagar Haveli and Daman and Diu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e64.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e89.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLadakh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJammu \u0026amp; Kashmir\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e81.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e76.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e92.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e98.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChhattisgarh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e26.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e63.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e59.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e79.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e95.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelhi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e80.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e99.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGoa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e98.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e90.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e98.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e99.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e97.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHaryana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e56.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e96.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e47.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e94.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e76.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHimachal Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e92.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e91.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e54.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e92.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJharkhand\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e25.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e55.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e42.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e87.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTamil Nadu\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e65.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e98.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e73.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e90.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUttar Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e30.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e72.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWest Bengal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e52.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e49.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e64.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e85.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAndhra Pradesh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e85.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e42.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e82.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e71.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e95.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePuducherry\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e61.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e63.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e92.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e92.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e99.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaharashtra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e43.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e59.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e65.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e75.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e83.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003csup\u003e\u003cem\u003e#\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eDoes not have a palliative care center\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003cem\u003e*Does not have an urban population\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Scenarios of Palliative Care Delivery from PCC-PI and Public Health Centers\u003c/h2\u003e \u003cp\u003e \u003cb\u003e3.2.1 Scenario I: PCC-PI and public tertiary healthcare system only (teaching and district hospitals (as proposed by the NPNCD))\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTravel times\u003c/strong\u003e \u003cp\u003eNationally, the median [IQR] travel time to the nearest center using a motorized vehicle was 51 [30, 82] minutes. The travel duration was longer for rural (51 [31, 83] minutes) than for urban areas (14 [4, 32] minutes).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong state/UTs, Lakshadweep had the shortest median [IQR] travel time of 1 [1, 1] minutes and Ladakh had the longest, 1770 [1770, 1770] minutes. Travel times for rural areas were longer than for urban areas in all states/UTs (\u003cb\u003eSupplementary Table\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAPC\u003c/strong\u003e \u003cp\u003eAbout 54.5% of the national population resided within 30 minutes, 86.4% within 60 minutes and 98.4% within 120 minutes of their nearest center. Rural areas had lower APC than urban areas for access within 30 minutes (42.5% vs 87.2%), 60 minutes (82.0% vs 98.4%), and 120 minutes (97.8% vs 100.0%).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong state/UTs, Delhi (100%), Chandigarh (100%), Puducherry (97.7%), Kerala (95.9%), Goa (93.5%), and Dadra \u0026amp; Nagar Haveli and Daman \u0026amp; Diu (93.1%) had more than 90% of the population within 30 minutes of the nearest center. When compared with the percentage of the population within 30 minutes at the national level, 15 states/UTs did worse. The percentage of the population within 30 minutes was worse for rural areas than for urban areas in all states/UTs (\u003cb\u003eSupplementary Table\u0026nbsp;3\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2.2 Scenario II: PCC-PI and public tertiary and secondary health care systems (Medical colleges, district hospitals, and community health centers).\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTravel times\u003c/strong\u003e \u003cp\u003eNationally, the median [IQR] travel time for the total population to the nearest center was 31 [15,54] minutes. The travel duration was longer for rural (32 [18, 56] minutes) than for urban populations (8 [3, 19] minutes).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong the state/UTs, Lakshadweep had the shortest median [IQR] travel time of 1 [1, 1] minutes and Ladakh had the longest time of 350 [171, 634] minutes. Travel times for rural areas were longer than for urban areas in all states/UTs (\u003cb\u003eSupplementary Table\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAPC\u003c/strong\u003e \u003cp\u003eAbout 76.7% of the national population resided within 30 minutes, 95.2% within 60 minutes, and 99.1 within 120 minutes from the nearest center. Rural areas had lower APC compared with urban areas for 30 minutes (69.7% vs 95.8%), 60 minutes (93.5% vs 100%), and 120 minutes (98.7% vs 100%).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong the state/UTs, Delhi (100%), Chandigarh (100%), Puducherry (97.7%), Haryana (97.4%), Punjab (96.4%), Kerala (96.4%), Goa (93.6%), and Dadra \u0026amp; Nagar Haveli and Daman \u0026amp; Diu (93.3%) states/UTs had APC of more than 90% for 30 minutes. When compared with the APC for 30 minutes for the national population, 19 states/UTs did worse. The APC for 30 minutes was worse for rural areas as compared to urban areas in all states/UTs, except Chandigarh where 100% of both rural and urban populations were within 30 minutes of the nearest center \u003cb\u003e(Supplementary Table\u0026nbsp;3)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2.3 Scenario III: PCC-PI and entire public health system (medical colleges, district hospitals, community health centers, and health and wellness centers (as proposed by NPPC))\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTravel times\u003c/strong\u003e \u003cp\u003eNationally, the median [IQR] travel time to the nearest center was 16 [7, 33] minutes. The travel duration was longer for rural (16 [7, 33] minutes) than for urban areas (4 [2, 8] minutes).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong states/UTs, Lakshadweep had the shortest median [IQR] travel time of 1 [1, 1] minutes while Ladakh had the longest time of 301 [117, 515] minutes. Travel times for rural areas were longer than for urban areas in all states/UTs (\u003cb\u003eSupplementary Table\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAPC\u003c/strong\u003e \u003cp\u003eAbout 92.8% of the national population resided within 30 minutes, 98% within 60 minutes, and 99.3% within 120 minutes of their nearest center. Rural areas had lower APC than urban areas for 30 (90.3% vs 100%), 60 (97.3% vs 100%), and 120 minutes (99.0% vs 100%).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eNineteen states/UTs had over 90% of their population within 30 minutes of the nearest center by motorized transport \u003cb\u003e(Supplementary Table\u0026nbsp;3)\u003c/b\u003e. When compared with the percentage of the population covered within a 30-minute drive at the national level, 19 states/UTs did worse.\u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2.4 Scenario IV: Public healthcare system only (medical colleges, district hospitals, community health centers, and health and wellness centers)\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTravel times\u003c/strong\u003e \u003cp\u003eNationally, the median [IQR] travel time to the nearest center was 16 [7, 33] minutes. The travel duration was longer for rural (16 [7, 33] minutes) than for urban areas (4 [2, 8] minutes).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong the state/UTs, Lakshadweep had the shortest travel time of 1 [1, 1] minute and Ladakh had the longest travel time of 300 [117, 585] minutes. Travel times for rural areas were worse than for urban areas in all states/UTs (\u003cb\u003eSupplementary Table\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAPC\u003c/strong\u003e \u003cp\u003eAround 92.8% of the total population resided within 30 minutes, 98.0% within 60 minutes, and 99.3% within 120 minutes from the nearest center. Rural areas had lower APC than urban areas for 30 minutes (90.3% vs 100%), 60 minutes (97.3% vs 100%), and 120 minutes (99.0% vs 100%).\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAmong the state/UTs, 19 states/UTs had a population of more than 90% within 30 minutes of the nearest center (\u003cb\u003eSupplementary Table\u0026nbsp;3\u003c/b\u003e). When compared with the APC of the national population for 30 minutes, 20 states/UTs did worse.\u003c/p\u003e \u003cp\u003eA comparison of all four scenarios revealed a progressive improvement in access in terms of time to reach the nearest center and the APC at all time thresholds, i.e., 30, 60 and 120 minutes \u003cb\u003e(Supplementary Table\u0026nbsp;3\u0026ndash;5).\u003c/b\u003e Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows heatmaps of access to PCC-PI and centers in Scenario I-IV. The progressive reduction in area shaded \u0026lsquo;Red\u0026rsquo; (highlighting region in which time taken to nearest center would be more than one hour) visually highlights the improvement in access. When compared to the APC of PCC-PI, the APCs from scenario I to IV were progressively improved \u003cb\u003e(\u003c/b\u003eFig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e. The travel times and APC of scenario III were the same or nearly similar to scenario IV highlighting that the public health system alone could provide adequate access to palliative care in India.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIndia has only four palliative care centers per 10 million people. The median time to reach the nearest palliative care center was nearly two hours and only 23.7% of people had access to palliative care services within 30 minutes of motorized access. However, the coverage varies in different regions of the country. Kerala, a state in southern India, with 2.5% of the country\u0026apos;s population, performed better than states with similar populations, like Punjab and Assam. This is because \u0026nbsp;44.5% of all the palliative care centers in the country were present in Kerala. This has resulted in 95.7% of the population in Kerala being within 30 minutes of the nearest palliative care center with a median [IQR] travel time to the nearest center of 14 [8, 28] minutes. Contrary to this the state of Uttar Pradesh with nearly 17% of the country\u0026rsquo;s population had only 12 (2.3%) palliative care centers with 10.9% of the population within 30 minutes of the nearest palliative care center and a median [IQR] travel time to the nearest center of 111 [74, 152] minutes.\u003c/p\u003e\n\u003cp\u003eBetter access in the union territories of Chandigarh and Delhi and the state of Goa compared to the rest of the states/UTs can be explained by the relatively smaller size of the territories, a small population, and greater urbanization. Arunachal Pradesh, Manipur, and Sikkim, states in northeast India, despite having a palliative care center density better than the national average had worse accessibility in terms of median time taken to reach the nearest center. This can be explained by the hilly terrain of the northeastern region of the country which would have increased the travel time to the center.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe also noted a stark urban-rural disparity in access to palliative care centers. The median travel time ranged from 1 to 591 minutes in rural areas compared to 3 to 137 minutes in urban areas. Similarly, in states/UTs with palliative care centers, the APC within 30 minutes of the nearest center ranged from 3.3% to 100% in rural areas as compared to 18.8% to 100% in urban areas. This can be explained by the poorer road infrastructure in rural areas, which increases travel times. In 2018-19, the average road density in urban and rural areas was 5296.3 and 1458.1 per thousand-kilometer square, respectively.\u003csup\u003e33\u003c/sup\u003e An urban-rural disparity in the establishment of health centers has also contributed to the difference in travel times in urban and rural areas. As health professionals in India prefer to practice in urban areas, owing to the availability of better amenities and more opportunities for career growth, more centers tend to be established in urban areas.\u003csup\u003e34\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn the scenarios incorporating palliative care at different levels of the health system, the access was noticed to be best in the third scenario which included all the public health centers and the active palliative care centers as per Pallium India\u0026rsquo;s directory. However, the access parameters were only marginally better than the scenario in which only the public health centers were included. This highlights that the public health system can effectively deliver palliative care in India with a supplementary role from private centers in rural and remote parts of the country where access remains poor despite complete engagement of the public health system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA similar analysis has been attempted to understand access to palliative care services in high-income countries. The accessibility reported in these regions in terms of access population coverage, is significantly better than the Indian scenario. In Switzerland, Germany, Ireland, Spain, and Switzerland, 95%, 86%, 84%, and 79%, of the population, respectively, were reported to live within 30 minutes from the nearest center with specialized palliative care services.\u003csup\u003e35,36\u003c/sup\u003e While Chandigarh (100%), Delhi (99.2%), Kerala (95.7%), and Goa (92.8%) reported better access in terms of APC compared to Germany (86%), all other states/UTs in India reported access poorer than Ireland (84%). Similar to the urban-rural disparity in India, the access to palliative care, in terms of travel times, in rural areas of Virginia Tennessee, and West Virginia in the United States of America was found to be nearly five times that the travel times in the urban areas of the respective states.\u003csup\u003e37\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn this work, we have used multiple measures of geographic accessibility. Density, a commonly used metric, provides information on the geographical distribution of facilities by population. However, it fails to provide information on timely access to facilities. The presence of a road network, its quality, traffic, and the availability of public or personal transport are some of the factors that impact accessibility and can be influenced by policymakers. Our study is the first to calculate travel times and APC for palliative care centers in India. We preferred travel times over distances as pragmatically travel times better incorporate various infrastructural and geographical barriers mentioned previously. However, travel times fail to convey the population falling in the catchment areas of the centers. By combining time with the percentage of the population living around the centers, APC uses the percentage of the population that can access care in a given period. Therefore, APC gives us a more complete picture of the geographical accessibility to care in a region. We recommend that APC be used to guide policy regarding the establishment of future health centers in the country.\u003c/p\u003e\n\u003cp\u003eThere is a need to address the disparities in geographical accessibility to palliative care centers through strategic placement of new centers. This can be done by the use of location-allocation models (LAMs). Using these models, policymakers can improve accessibility to centers by opening new centers at optimized locations.\u003csup\u003e38\u003c/sup\u003e Since patients receiving palliative care are home or bedbound, our analysis also shows that the existing center-based approach to palliative care may not be able to universalize its access. Therefore, policymakers need to emphasize the home-based model of palliative care service delivery. Through various scenarios, we also highlight how access to palliative care can be improved using existing public health infrastructure. Once the existing public health infrastructure is equipped with palliative care services, access to the ones in rural areas can be improved by improving road networks through schemes such as the Pradhan Mantri Gram Sadak Yojana (PMGSY).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eLimitations and Strengths\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study has multiple limitations. First, it is possible that Pallium India\u0026rsquo;s directory missed smaller or less well-known palliative care facilities. This limitation has been addressed by reporting changes in palliative care accessibility through different scenarios considering the delivery of services from different levels of the public health system. Second, our analysis inherited the assumptions and limitations of all the parent/source datasets. Third, to calculate the APC estimates, we did not take into account the access to or ownership of motor vehicles. Only 21% of Indian households owned two-wheelers, and 4.7% owned cars, jeeps, or vans as per the 2011 census.\u003csup\u003e39\u003c/sup\u003e Although India meets WHO\u0026rsquo;s norm of 1 ambulance per 100,000 people, there are large disparities in the availability of ambulance services among states/UTs.\u003csup\u003e40\u003c/sup\u003e Fourth, health center-related factors like affordability of care, functional timings, and quality of services provided at the centers were not considered while assessing accessibility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite these limitations, our study has several strengths. This is the first attempt to understand access to palliative care in a lower-middle-income country. Considering the huge burden of non-communicable diseases in India it becomes essential to understand the access to palliative care. The major strength of our study is that accessibility has been defined using three outcome measurements - palliative care center density, time to reach the nearest center, and access population coverage within multiple time frames. Not only have we reported a state-level analysis on access to palliative care but also done an urban-rural comparison. This will help the policymakers in deciding not only how many more centers are needed in each state but also in identifying the exact locations where building a center would improve geographic accessibility.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eComprehensive tools like median travel times and Access Population Coverage (APC) can be used to study accessibility to healthcare services. Our study found that Chandigarh, Delhi, Kerala, and Goa had good access to palliative care while most other states/UTs, especially in the north and northeastern parts of the country need to improve accessibility to palliative care in the region. We also found a significant urban-rural disparity in access to palliative care. Future research should assess access to specific palliative care services like morphine availability among others and also assess accessibility for different demographic groups along with its impact on quality of life and disease outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData sharing statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData will be made available upon reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any funding.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePalliative Care. World Health Organization [Internet]. [cited 25 Dec 2024] Available: https://www.who.int/news-room/fact-sheets/detail/palliative-care\u003c/li\u003e\n\u003cli\u003eWorld Health Assembly, 67. (\u0026lrm;2014)\u0026lrm;. 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Available: https://forobs.jrc.ec.europa.eu/gam/description\u003c/li\u003e\n\u003cli\u003eSchool of Geography and Environmental Science, University of Southampton; Department of Geography and Geosciences, University of Louisville; Departement de Geographie, Universite de Namur, Center for International Earth Science Information Network (CIESIN), Columbia University (2018). WorldPop. 22 Jun 2020 [cited 1 Jan 2025]. Available: https://dx.doi.org/10.5258/SOTON/WP00671\u003c/li\u003e\n\u003cli\u003eMeyers J. India Official Boundaries 2019. 2020 [cited 1 Jan 2025]. Available: https://github.com/justinelliotmeyers/India_Official_Boundaries_2019\u003c/li\u003e\n\u003cli\u003ePallium India. Directory of Palliative Care Services - Pallium India [Internet]. [cited 1 Jan 2025] Available: https://palliumindia.org/clinics\u003c/li\u003e\n\u003cli\u003eSchuurman N, Fiedler RS, Grzybowski SC, Grund D. Defining rational hospital catchments for non-urban areas based on travel-time. 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A Comparison of Hospice Care Utilization Between Rural and Urban Children in Appalachia: A Geographic Information Systems Analysis. Am J Hosp Palliat Care. 2024 Mar;41(3):288-294. doi: 10.1177/10499091231173415. Epub 2023 Apr 28. PMID: 37115718; PMCID: PMC10826679.\u003c/li\u003e\n\u003cli\u003eRahman S, Smith DK. Use of location-allocation models in health service development planning in developing nations. Eur J Oper Res 2000;123(N/A):437\u0026ndash;452; doi: 10.1016/S0377-2217(99)00289-1.\u003c/li\u003e\n\u003cli\u003eMinistry of Statistics and Program Implementation. Government of India. Motor Vehicles - Statistical Year Book India 2015 [Internet]. [cited 1 Jan 2025] Available: https://mospi.gov.in/statistical-year-book-india/2015/189\u003c/li\u003e\n\u003cli\u003eRahman P, Mehnaz S. Public Policy in Bangladesh: Balancing Change and Stability. IJFMR. SSRN Electron J 2024; doi: 10.2139/ssrn.5054029.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Palliative care, access to care, geographical access, health policy","lastPublishedDoi":"10.21203/rs.3.rs-6535976/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6535976/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e:\u003cstrong\u003e \u003c/strong\u003eNearly 7-10 million people require palliative care in India with less than 4% having access to it. This study aimed to assess the geographical accessibility of palliative care (PC) in India and estimate changes in accessibility based on its delivery from different levels of the public health system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Pallium India’s 2022 directory provided a list of active palliative care centers (PCC-PI). We analyzed the density of PCC-PIs per ten million population, the median travel time to the nearest center using motorized vehicle and the access population coverage. Palliative care delivery scenarios combining primary, secondary, and tertiary public healthcare centers were created to evaluate changes in access.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In 2022, India had 526 active palliative care centers, with a density of 4 per 10 million population. The highest densities were in Lakshadweep, Goa, and Kerala. The median [IQR] travel time to the nearest PCC-PI was 118 [71,179] minutes, and 23.7%, 39.9%, and 71% of people lived within 30, 60, and 120 minutes, respectively. Rural areas had worse access than urban areas, with considerable variation across states. States like Kerala and Chandigarh had near-universal access, while Madhya Pradesh and Bihar had much lower coverage. Access improved significantly when palliative care was integrated into all levels of the healthcare system.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Access to palliative care in India is limited, especially in rural areas. Expanding integration with the public health system could enhance access, ensuring more equitable care nationwide.\u003c/p\u003e","manuscriptTitle":"Access to palliative care in India: situational analysis and modeling of access from public healthcare centers","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 06:45:46","doi":"10.21203/rs.3.rs-6535976/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ad616b80-c0ca-4342-899e-4de17568959d","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-29T06:45:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 06:45:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6535976","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6535976","identity":"rs-6535976","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}