Upasana Hembram
The disabilities experienced by the elderly often hinder their daily activities. This morbidity is particularly high in case of chronic diseases. When compared to countries with a similar economic and demographic transition, prevalence of depression, arthritis, asthma, blood pressure, and diabetes is significantly higher in India.
Is a dedicated healthcare programme necessary?
Data reveals that an estimated 70% of the elderly population in the country suffers from at least one chronic disease. Data on disability discomfort among the elderly is also startling. Since a massive chunk of the elderly in India belongs to socioeconomically disadvantaged and poor backgrounds, there is an urgent need to address these issues with an affordable, accessible and comprehensive healthcare system in India. It was in this context that the Government of India launched the National Programme for Health Care of the Elderly (NPHCE) in 2010 under the National Rural Health Mission (NRHM). It is Indias first national programme developed specifically for elderly healthcare.
How will the NPHCE function?
The NPHCE aims to provide easy access to health services, promote health, prevent diseases. They plan to cure and rehabilitate people above the age of 60 with ill-health through primary healthcare institutions, in conjunction with Ayush and other social justice programmes. The programme is implemented in 21 states spread over 100 districts at all three levels of the public healthcare systemprimary, secondary, and tertiary. They provide medical and paramedical human resources support, creation of special infrastructure facilities and referral services. The programme integrates elderly medical care services with Primary Health Care(PHC) delivery systems vertically at the district level and above, and horizontally below district levels.
Under the NPHCE, states are expected to establish regional geriatric centres at regional health care institutions with a certain number of district geriatric units. Under the 12th National Plan, two National Institutes of Ageing were also supposed to be set up. The supervision, control, coordination and monitoring of NPHCE is undertaken by Non-Communicable Diseases (NCD) cells. Guidelines to implement the NPHCE have been provided by the Centre. Funds for the programme are distributed in two ways. Union government allots funds to State governments for employing manpower and obtaining equipment in order to set up district units. Funds are also allotted to regional centres headed by medical colleges to pursue research and training programmes in geriatrics.
Injudicious distribution or ineffective utilisation?
States have utilised only Rs. 40 crores out of the total Rs. 155 crores allotted. Of the Rs. 18.55 crores allotted to UP, none of it was utilised and Andhra Pradesh has also used only Rs. 1.37 lakh of the total funds of nearly Rs. 15 crores. Even Tamil Nadu, the state that pioneered geriatric healthcare, failed to implement NPHCE. Assam, Rajasthan and Madhya Pradesh used almost 20%-50% of the funds allotted while Kerala and Maharashtra seem to have been more successful in spending the funds allocated under this scheme. In most instances, the 20% funds to be released to state governments have either not been released by the Centre or have been delayed. Due to centralised guidelines and waiting for decisions from the Centre, funds allotted to State governments end up being unused.
Roadblocks to effective medical management
Besides ineffective expenditure of funds, other larger systemic issues such as handling the logistics of drugs and medicine, human resource training, flow of funds, decision-making mechanisms dilute the efficacy of the scheme. Even though the infrastructure is in place, it is not fully operational. No specific standards were followed during the construction of these buildings. This has often rendered bathrooms and surroundings not very age-friendly.
The staff is untrained with no system in place to provide the required training. Due to delayed salary and other remunerations, staff lacks enthusiasm resulting in less than satisfactory rehabilitative and home-based palliative medical care. Besides, salaries paid to contract staff vary for different states. Contractual hiring was found to be an unreliable mechanism. This resulted in positions not being filled or having an inadequate number of staff members which eventually harmed the continuity of the programme. However, the weakest aspect of the NPHCE has to be the lack of proper monitoring due to improper maintenance of required follow-up data. The data gathered currently is very limited in nature and not very handy for computing indicators.
Care of the elderly has always been perceived as a responsibility of the families to which they belong, which has not proven to be a reliable option. It is estimated that India will be home to an elderly population of 300 million by 2050. It is necessary that there is a formal institution in place to pay heed to their problems. In its absence, the country will be plagued with a large occurrence of degenerative diseases, severe gaps in the geriatric medical ecosystem and a change in societal structure discriminatory towards the elderly without any structural relief.
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