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India is home to one-fifth of the global population. This review aims to explore the structures, functions and relevance of palliative care services in India. Although palliative care has been initiated in India almost 3 decades ago, development of services has been patchy and inadequate. Some of the regions are well covered, but most are not. The Indian palliative care scene, with its diversity in approach and delivery of services, can offer valuable lessons to service development in low-income and middle-income countries.The number of people dying each year in India is more than 9.8 million. The number of people in need of palliative care will be around six million if we assume that 60% of all those who die would benefit from palliative care. Less than 2% of the needy have access to palliative care in India. The available services are very unevenly distributed with the state of Kerala with 3% of the country's population having more than 90% of the palliative care services in the country.The state of palliative care in India is discussed with particular attention to the successful Kerala Model in palliative care. Lessons learned from the experiment in Kerala are listed.