Integrating Home-Based Palliative Care Into Primary Healthcare in Jodhpur, Rajasthan: Stakeholder-Perceived Barriers, Facilitators, and System Needs.

Background and objective Home-based palliative care (HBPC) can reduce suffering and improve the quality of life for patients with serious chronic illnesses. However, its integration into routine government primary healthcare remains limited. Understanding health system readiness and provider perspectives is essential for its feasible integration. This study aimed to explore the barriers, facilitators, and stakeholder recommendations for integrating HBPC into urban Primary Healthcare Centers (PHCs) in Jodhpur, Rajasthan. Methods A qualitative study was conducted using purposive sampling. Data were collected through Key Informant Interviews (KIIs) with district health administrators and a palliative care physician, In-Depth Interviews (IDIs) with Medical Officers, and Focus Group Discussions (FGDs) with frontline workers, including Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). A total of 30 participants were included. Data were analyzed using thematic analysis. Results Barriers were identified at two levels. Knowledge and behavioral barriers included limited awareness and confidence among providers, low community awareness, sociocultural hesitation, and follow-up challenges. Structural barriers included a lack of formal PHC-level programs, weak referral pathways, limited availability of essential medicines such as morphine, high workload among frontline workers, and logistical constraints. Facilitators included community trust in ASHAs and ANMs, availability of basic medicines, referral linkages with tertiary care centers, and willingness for training and integration. Conclusion Integration is limited by gaps in provider capacity, medicine access, and service structure. Existing community trust and referral linkages provide a foundation for integration. Strengthening structured pathways, workforce capacity, and access to essential medicines is required for effective integration.