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The Neighbourhood Network in Palliative Care (NNPC) is a community-led initiative aiming to provide home-based palliative care to all those in need in Kerala, south India. It attempts to counter what some see as the increasingly biomedical model seen in palliative care by involving the community in designing, delivering and evaluating services, to ensure social, spiritual and emotional needs are met along with providing excellent symptom control. The service has grown to a large network seeing over 2500 patients per week and attaining coverage of over 60% in many areas. It enjoys support from the community, local and national government, schools, universities, religious groups and non-governmental organisations. This article traces the development of the initiative and looks at the challenges this new model raises.