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NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY

BY Ms. Madhuri Bind M.N.(F)

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INTRODUCTION Over the past few years, the world’s population has

continued on its remarkable transition path from a state of high birth and death rates to low birth and death rates coupled with improvement in health services & standard of living.

At the heart of this transition has been the growth in the number and proportion of older persons.

Such a rapid, large and ubiquitous growth has never been seen in the history of civilization.

The current demographic revolution is predicted to continue well into the coming centuries.

BY Definition….60-69 70-79 80+

Old Old - Old Oldest- Old

60-74 75- 84 85+

Young Old

Middle old

Old-Old

Source: National Policy on Older Person 1999 GOI

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Changing world Scenario The world will have more

people who live to see their 80s or 90s than ever before.

The past century has seen remarkable improvements in life expectancy.

Soon, the world will have more older people than children.

The world population is rapidly ageing.

Low- and middle-income countries will experience the most rapid and dramatic demographic change.

Source :WHO 2010

World Population trend of 60+ Years 1980-2020 (in millions)

1980 1990 2000 2010 2020

World 381.2 484.7 608.7 754.2 1011.6

Developed 173.3 203.6 234.6 232.4 308.2

Developing 207.9 281.8 374.1 491.8 703.4

Asia (excl. Japan) 160 218.2 290 377.7 539.9

China 78.6 101.2 131.7 167.9 238.9

India 44.6 60.2 81.4 107 149.7

United Nations,World Demographic Estimate and Projections

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Ageing: The Indian Scenario…

India is one of the few countries in the world where sex ratio of aged is in favour of males.

Population above 60 years- 10% suffer from impaired

physical mobility. 10% Hospitalized at given

point of time.Age more than 70 years- More than 50% suffer form 1

or more chronic conditions like CHD, Cancer and HT .

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Socio-demographic profile of the elderly in India.

Elderly persons lives in rural area.

Women

Illiterate and dependent.

BPL

Were in vulnerable situation and without

sufficient food.

75%

48%

66%

73%

66%

Source : Census 2001

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States with more than 7% elderly population ( SRS 2010)

Kerala

11.8%

Himachal Pradesh 10.1

%

Tamil Nadu

10.0

%

Maharashtra 9.2%

Punjab

8.9%

Orissa

8.7%

Andhra

Pradesh

7.7%

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STATEWISE ELDERLY POPULATION IN INDIA, CENSUS 2001.

%

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Health risks of elderly

PRONE FOR

INFECTIONS

PRONE FOR

INJURIES

PRONE FOR PSYCHOLO

GICAL PROBLEMSPRONE

FOR DEGENER

ATIVE DISORDER

S

INCREASED RISK

FOR DISEASE

INCREASED RISK OF DISABILITY

INCRASED RISK OF DEATH

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COMMON MORBIDITIES IN ELDERLY IN INDIA

Cataract &Visual impairment- 88%

Psychiatric problems- 9%

Ref – ICMR study 2001Delhi & Hariyana

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Prevalence of common health problems in elderlyGOI study-2007

05101520253035404550

Percentage

Health Problem

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Mortality in elderly

CVD

Respiratory diseases

Infections,TB

Neoplasm

Accidents, poisoning and violencedeaths by chronic diseases by 2015

33%

10%

10%

6%

4%

17%

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Need for Dedicated Health care for elderly ?

Decrease in physical ability / Economic inadequacy

Increase vulnerability to diseases

Chronic, disabling and multiple Health problems

Different approach and management

Degradation in family values

Rising Population

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Major constraints for geriatric health care

Lack of specialized and

trained manpower

Geriatrics not yet a popular

specialty

No dedicated health care

infrastructure

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Major Govt. initiatives

National Policy On Older Persons (NPOP) -1999

Recommendations by working group of planning commission -2006 for national programme

Maintenance and Welfare of Parents and Senior Citizens Act – 2007

Announcement of National programme for Health Care of Elderly during Budget speech (2008-09)

Approval of “National programme for Health Care of Elderly” by Ministry of Finance - June 2010

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NATIONAL POLICY ON OLDER PERSONS (1999)

Components Support for financial security Health Care Shelter Welfare and other needs of older persons Protection against abuse and exploitation Opportunities for development of the potential of

older persons Improving quality of life

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NPOP agenda for health care for the elderly

Geriatric ward for elderly at all DH

Treatment facilities for chronic, terminal and degenerative diseasesProviding Improved medical facilities at CHCs / PHCs / Mobile ClinicsInclusion of geriatric care in the syllabus of medical courses including courses for nursesReservation of beds for elderly in public hospitals

Training of Geriatric Care Givers

Research institutes for chronic elderly diseases such as Dementia & Alzheimer

7 Aug 2012

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Maintenance and Welfare of Parents and Senior Citizens Act - 2007

Article (20) : The State Government shall ensure

The Government hospital or Govt. funded hospitals shall provide beds for senior citizens as far as possible.

Separate queues be arranged for senior citizens.

Facility for treatment of chronic, terminal and degenerative diseases is expanded for senior citizens

Research activities for chronic elderly diseases and ageing is expanded

Earmarked facilities for geriatric patients in every district hospital.

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Extract of Finance Minister’s Budget Speech 2008-09

“The other major intervention will be for the elderly. A

National Programme for the Elderly with a Plan outlay of

Rs. 400 crore will be started in 2008-09. Among other

measures, we will establish, during the XIth Plan Period

two institutes of aging eight Regional Centres and a

Department of Geriatric Medical Care in one of the Medical

Colleges/Tertiary level Hospitals in each State.”

NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY (NPHCE-2010)

NPHCE 2010

The Maintenance and Welfare of Parents and Senior

Citizens Act, 2007.

National Policy on

Older Persons (1999)

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SERVICES FOR ELDERLY ALREADY IN INDIA

Constitutional and legal provisions. Maintenance and welfare of parents

and senior and welfare of parents and senior citizens Bill 2007

Ministry of Social Justice & Empowerment

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National policy on older persons policy on older persons

January, 1999. areas of intervention --

◦Financial security, healthcare and nutrition, shelter, education, welfare, protection of life and property etc. for the wellbeing of older persons in the country.

National Council for Older Persons◦Constituted by the Ministry of Social

Justice and Empowerment to operationalise the National Policy on Older Persons

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The Vision & Objectives of NPHCE

The Vision:To provide accessible, affordable, and high-

quality long-term, comprehensive and dedicated care services to an Ageing population;

Creating a new “architecture” for Ageing;To build a framework to create an enabling

environment for “a Society for all Ages”;To promote the concept of Active and Healthy

Ageing;Convergence of NRHM, AYUSH & all other dept.

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ObjectivesTo provide an easy access to

promotional, preventive, curative and rehabilitative services to the elderly through community based primary health care approach

To identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support.

To build capacity of the medical and paramedical professionals as well as the care-takers within the family for providing health care to the elderly.

To provide referral services to the elderly patients through district hospitals, regional medical institutions

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Core Strategies

Community level -

domiciliary visits by trained

health care workers.

PHC/CHC level - equipment,

training, additional

human resources

(CHC), IEC,

District Hospital -10 bedded

wards, additional human

resources,

8 RMC - PG courses in Geriatric

Medicine, and trainingIEC using mass

media, folk media and other communication

Strategies for NPHCE 2010

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Supplementary Strategies for NPHCE

Promotion of public private

partnerships in Geriatric

Health Care.

Mainstreaming AYUSH and convergence

with programmes of

Ministry of Social Justice

and Empowerment in the field of

geriatrics.

Reorienting medical

education to support geriatric

issues.

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EXPECTED OUTCOMES OF NPHCE

Regional Geriatric Centres (RGC) in 8 Regional Medical Institutions

Post-graduates in Geriatric Medicine (16) from the 8 regional medical institutions;

Video Conferencing Units in the 8 Regional Medical Institutions to be utilized for capacity building and mentoring;

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District Geriatric UnitsGeriatric Clinics/Rehabilitation

unitsSub-centresTraining of Human Resources

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Operational GuidelinesPackage of Services at different levels

(SC/PHC/CHC/RGC)

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Package of Services

The range of services will include Health promotion Preventive services Diagnosis and management of geriatric medical

problems (out and in-patient) Day care services Rehabilitative services Home based care

Districts will be linked to Regional Geriatric Centers for providing tertiary level care.

Integration with existing primary health care delivery system and vertical at district and above as more specialized health care are needed for the elderly.

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Services at PHCWeekly geriatric clinic by a trained Medical OfficerConducting a routine health assessment (eye, BP,

blood sugar & record keeping).Provision of medicines and proper advice on chronic

ailmentsPublic awareness on promotional, preventive and

rehabilitative aspects of geriatrics during health and village sanitation day/camps.

Referral services.

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ORGANIZATIONAL STRUCTURE

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Services at Sub-centreHealth Education related to healthy

ageing◦Domiciliary visits to home bound / bedridden

elderly persons .◦Arrange for suitable calipers and supportive

devices.◦Linkage with other support groups and day

care centers.

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Services at Community health centre

First Referral Unit (FRU) for the Elderly from PHCs and below.

Geriatric Clinic for the elderly persons twice a week.

Rehabilitation Unit for physiotherapy and counselling

Domiciliary visits by the rehabilitation worker for bed ridden elderly and counselling of the family members on their home-based care.

Health promotion and PreventionReferral of difficult cases to District

Hospital/higher health

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Services at District Hospital

Geriatric Clinic for regular dedicated OPD services to

the Elderly with Lab facility & adequate medicine.

Ten-bedded Geriatric Ward with existing specialties

Provide services to referred by the CHCs/PHCs etc.

Conducting camps for in PHCs/CHCs and other sites.

Referral services to tertiary level hospitals

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Services at Regional Geriatric Centre30-bedded Geriatric Ward for in-

patient care and dedicated beds for the elderly patients in the various specialties.

Laboratory investigation required for elderly with a special sample collection centre in the OPD block.

Tertiary health care to the cases referred from medical colleges, district hospitals and below.

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At Sub Centre level:Health Education related to healthy ageing,

environmental modifications, nutritional requirements, life styles and behavioural changes.

Special attention to home bound / bedridden elderly persons and provide training to the family health care providers in looking after the disabled elderly persons.

Arrange suitable callipers and supportive devices from the PHC.

Linkage with other support groups and day care centres etc. operational in the area.

Activities under NPHCE at various levels

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Following items will be made available at the Sub-centre level:

Walking SticksCalipersInfrared LampShoulder WheelPulleyWalker (ordinary)No additional contractual staff.

Activities at SC level

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At PHC level:

The weekly geriatric clinic by trained medical officer. Coordination with CHC, district hospital, sub

centers, other National Health Programmes/ Departments for medicines, ambulances

Training of manpower & Separate registration counter for elderly.

Public awareness during health and village sanitation day/camps.

Provision of medicine to the elderly for their medical ailments.

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Following items will be made available at the PHC:

NebulizerGlucometerShoulder WheelWalker (ordinary)Cervical traction (manual)Exercise BicycleLumber TractionGait Training ApparatusInfrared Lamp etc.

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At RH/CHC level:

◦ First level medical referral centre for medical care and rehabilitation services

◦ Twice weekly health clinics for the elderly persons

◦ Rehabilitation unit

◦ Domiciliary visits for care of disabled persons by Multi rehabilitation worker

◦ Referral Services to DH

◦ Training of staff

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Following items will be made available at the CHC:

Nebulizer Glucometer ECG Machine Pulse Oximeter Defibrillator Multi - Channel

Monitor Shortwave

Diathermy

Cervical traction (intermittent)

Walking for gait training equipment

Walking Sticks / Calipers

Shoulder Wheel Pulley Walker (ordinary) Cervical traction

(manual).

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At District Hospital levelRegular Geriatric OPD with Specialty Care for

Elderly.Geriatric Ward (10-bedded) for in-patient care

to the Elderly.Training to the Medical officers and paramedical

staff of CHC’s and PHC’sCamps for Geriatric Services in PHCs/CHCs and

other sitesReferral services for severe cases to tertiary

level hospitals/ Regional Geriatric Centers

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Following items will be made available at the District Hospital:

NebulizerGlucometerECG MachineDefibrillatorMulti-channel MonitorNon invasive VentilatorShortwave DiathermyUltrasound TherapyCervical traction (intermittent)Pelvic traction (intermittent)Tran electric Nerve stimulator (TENS)Adjustable Walker.

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Regional Geriatrics CentersSr No Regional Institutes States Linked

1 All India Institute of Medical Sciences, New Delhi

Delhi, Haryana, Uttarakhand, Punjab Himachal Pradesh, M.P.

2 Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh

Uttar Pradesh, Bihar, Jharkhand, West Bengal

3 Grant Medical College & JJ Hospital, Mumbai, Maharashtra,

Maharashtra, Goa, Northern Districts of Karnataka,Chattisgarh

4 Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir

Jammu & Kashmir

5 Govt. Medical College, Tiruvananthapuram, Kerala,

Kerala, Southern Districts of Karnataka & Tamil Nadu

6 Guwahati Medical College, Guwahati, Assam

Assam & NE States

7 Madras Medical College, Chennai, TN.

Tamil Nadu, Andhra Pradesh, Orissa

8 SN Medical College, Jodhpur, Rajasthan

Rajasthan & Gujarat

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Provide tertiary level services for complicated/serious Geriatric Cases.

Post graduate courses in Geriatric Medicine.Training to the trainers of identified District

hospitals and Medical Colleges.Developing evidence based treatment

protocols for Geriatric diseases prevalent in the country.

Developing/and updating Training modules & guidelines and IEC materials.

Research on specific elderly diseases.

At Regional Geriatric Centers level

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Developing Geriatric Department in Medical college of each States/UTs

It is proposed to develop 12 additional Regional Geriatric Centers in selected Medical Colleges of the country

7 Aug 2012

Sr No State Medical College

1 Punjab PGIMER, Chandigarh

2 Uttar Pradesh KGIMS, Lucknow

3 Jharkhand Ranchi Medical College, Ranchi

4 West Bengal Kolkatta Medical College, Kolkata

5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd.

6 Karnataka Bangalore Medical College, Bangluru

7 Gujarat B.J.Medical College, Ahmadabad

8 Maharashtra Government Medical College, Nagpur

9 Orissa S.C.B.Medical College, Cuttack

10 Tripura Agartala Medical College, Agartala

11 Madhya Pradesh Gandhi Medical College, Bhopal

12 Bihar Patna Medical College, Patna

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Proposed Financial Assistance during 11th plan

Items RMI DH CHC PHC S. C

construction 2 crore 80 lakh - - -

Equipments 1.7 crore 10 lakh 1 lakh Rs.50000 Rs.32000

Drugs 20 lakh 10 lakh - - -

Training 5 lakh Rs. 70000 1.15 lakh Rs.32000 -

IEC activities - 5 lakh - - -

Research 50 Lakh - - - -

Manpower recruitment

88.4 lakh 28 .2 lakh 1.8 lakh - -

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Financial mangement

Financial management groups (FMG) of Programme Management support units at state and district level, which are established under NRHM, will be responsible of maintenance of accounts, release of funds, expenditure reports, utilization certificates and audit arrangements.

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State level

State will monitor release of funds and expenditure incurred under various components of the programme in the State.

Submit monthly statement of expenditure in the prescribed format to the State Health Society.

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Active advocacy at various levels of planning

Need for reorganization of the facilities and approach

Efforts to be made to revive cultural values and reinforce the traditional practice of interdependence among generations

Surveillance of the ongoing programmes and evaluate for effectiveness.

HOW TO ACHIEVE OPTIMUM ELDERLY CARE?

537 Aug 2012

Thank you!!!