Kewal Kapoor, Director & Creative Strategist, CHAI Kreative and Return of Million Smiles, emphasises on the importance of access to quality healthcare being the responsibility of the state and the need to put central funds to good use and implement healthcare schemes for elderly in all districts
The National Programme for Health Care of the Elderly was launched by the Ministry of Health and Family Welfare in 2010 to provide accessible and affordable healthcare for the elderly. According to the most recent census data, there are over 104 million senior citizens in India, more than half of whom are women. Approximately 71 per cent of them reside in areas with limited access to healthcare. It goes without saying that the incidence of hospitalisation is much higher in the elderly compared to the total population. 27 per cent of people above the age of 80 were found to be home bound or immobile.
Despite the fact that the situation is grave, states have not managed to use more than 7 per cent of the funds disbursed by the centre for the healthcare of the elderly. Only 5 per cent of the funds released for the management of non-communicable diseases have been put to use. This is particularly pitiful considering the fact that the NPHCE is part of the non-communicable diseases flexipool, one of the major components of the National Health Mission (NHM).
Providing access to quality healthcare is the responsibility of the state, and it needs to put central funds to good use and ensure that healthcare schemes for the elderly are implemented in all districts. At present, the implementation is lackadaisical and is marred by cost unwieldy cost overruns. State governments are overwhelmed as it is with their existing healthcare programmes and it is not unreasonable for them to expect a certain amount of flexibility in operations. However, the failure to produce tangible results points towards a lack of planning and organisation. Unless there is a strict oversight mechanism, course correction is difficult.
Where do we stand?
At present, the facilities that are dedicated for geriatric care are sub-standard in quality. In rural and remote areas, where a substantial percentage of the elderly reside, you would be hard pressed to even find a fully functional facility. State governments are not very keen on spending money on programmes like the NPHCE as they use the funds for more immediate requirements like skill training, salary, and infrastructure, all of which are crucial areas that are cash strapped.
Even though the NPHCE is under the NCD flexipool, there are two main reasons behind the underutilisation of funds. Firstly, we suffer a shortage of medical professionals who are trained in geriatric care. Secondly, state treasuries take a lot of time to release to the respective district administration. Both of these factors lead to an underutilisation of capital, preventing the programme from taking flight. Also, depending on the economic condition, a number of state governments cut back on expenditures to trim the fiscal deficits.
Time to address the skill gap
Since the core of the programme focusses on clinical care, it is not possible to ensure effective implementation unless we train the healthcare professionals. Only a handful of medical colleges in India have postgraduate programmes to train undergraduate students in geriatric care, owing to the strict guidelines laid down by the Medical Council of India. Unless medical colleges get the technical and the bureaucratic support they need, it is unrealistic to expect the current state of affairs to improve. Thankfully, the government has woken up to this fact and is now supporting two National Centres for Ageing (NCAs) that are dedicated to train professionals, conduct research, and provide healthcare for the elderly. We also have regional geriatric centres (RGCs) that aim to provide tertiary care through outpatient departments for seniors in addition to providing postgraduate medical courses for students who want to specialise in geriatric medicine. If we open more RGCs and NCAs, particularly in rural and remote areas, it will help improve health outcomes for the elderly.
The need for a multifaceted approach
We also need a shift in societal attitudes towards the elderly if we want better results. Preventing and treating health problems in the elderly requires a multi-pronged approach that incorporates the active involvement of health, urban/rural development, social welfare and legal sectors. We need to expand upon our current geriatric care programme to include non-medical determinants as well. Unless we have an unwavering political commitment coupled with social action, it is difficult to implement customised policies at the grass root level. Seniors must be educated about potential risk factors so that they are empowered to take control of their health. Children must volunteer to look after their ageing parents and we need customised health insurance schemes to take care of their needs. The government must establish more gerontology units to train medical and paramedical professionals on the health needs of the elderly. To sum it up, a joint approach can help address the challenges in geriatric care. Failing to do so will develop into a costly proposition in the future.