Background: Nearly 7–10 million people require palliative care (PC) in India, with less than 4% having access to it. This study aimed to assess the geographical accessibility of 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-Pallium India (PCC-PI). We analysed the density of PCC-PIs per ten million population, the median travel time to the nearest centre using a motorised vehicle and the access population coverage. PC delivery scenarios combining primary, secondary and tertiary public healthcare centres were created to evaluate changes in access.

Results: In 2022, India had 526 PCC-PI, with a density of four per ten 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 23.6%, 39.8% 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, Odisha and Bihar had much lower coverage. Access improved significantly when PC was integrated into all levels of the healthcare system.

Conclusion: Access to PC in India is limited, especially in rural areas. Expanding integration with the public health system could enhance access, ensuring more equitable care nationwide.