National programme for elderly final


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  • National programme for elderly final

    2. 2. 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. 2
    3. 3. BY Definition…. 60-69 70-79 80+ Old Old - Old Oldest- OldSource: National Policy on Older Person 1999GOI 60-74 75- 84 85+ Young Old Middle old Old-Old
    4. 4. 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 Source :WHO 2010 countries will experience the most rapid and dramatic demographic change. 4
    5. 5. 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 207.9 281.8 374.1 491.8 703.4Asia (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
    6. 6. 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 . 6
    7. 7. Socio-demographic profile of the elderly in India. Elderly persons lives in rural75% area.48% Women73% Illiterate and dependent. Source : Census66% BPL 2001 Were in vulnerable situation66% and without sufficient food. 7
    8. 8. States with more than 7% elderly population ( SRS 2010) 8
    11. 11. COMMON MORBIDITIES IN ELDERLY IN INDIA Cataract &Visual impairment- 88% Arthritis & locomotion disorder-40% CVD &HT – 18% Neurological problems- 18% Respiratory problems including Chronic bronchitis- 16% GIT pro blems 9% PsychiRef – ICMR study 2001 atric proble ms- 9% 11Delhi & Hariyana
    12. 12. Prevalence of common health problems in elderly GOI study-2007Percentage Health Problem 12
    13. 13. Mortality in elderly33% CVD10% Respiratory diseases10% Infections,TB6% Neoplasm4% Accidents, poisoning and violence17 deaths by chronic diseases by% 2015 13
    14. 14. Need for Dedicated Health care for elderly ?Decrease in physical ability / Economic inadequacyIncrease vulnerability to diseasesChronic, disabling and multiple Health problemsDifferent approach and managementDegradation in family valuesRising Population 14
    15. 15. Major constraints for geriatric health care Lack of specialized and trained manpower Geriatrics No dedicated not yet a health care popular infrastructure specialty 15
    16. 16. Major Govt. initiativesNational 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 16
    17. 17. 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 17
    18. 18. NPOP agenda for health care for the elderly Geriatric ward for elderly at all DH Treatment facilities for chronic, terminal and degenerative diseases Providing Improved medical facilities at CHCs / PHCs / Mobile Clinics Inclusion of geriatric care in the syllabus of medical courses including courses for nurses Reservation 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 18
    19. 19. 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. 19
    20. 20. Extract of Finance Minister’s Budget Speech 2008-09“The other major intervention will be for the elderly. ANational Programme for the Elderly with a Plan outlay ofRs. 400 crore will be started in 2008-09. Among othermeasures, we will establish, during the XIth Plan Periodtwo institutes of aging eight Regional Centres and aDepartment of Geriatric Medical Care in one of the MedicalColleges/Tertiary level Hospitals in each State.” 20
    22. 22. 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 22
    23. 23.  National policy on older persons policy on older persons January, 1999. areas of intervention -- ◦ Financial security, healthcare and nutrition, shelter, education, welfare, protectio n 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 23
    24. 24. 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. 24
    25. 25. Objectives To 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. 25
    26. 26. Strategies for NPHCE 2010 District Hospital - 10 bedded PHC/CHC level - wards, additional human 8 RMC - PG equipment, courses in training, resources, Geriatric additional human Medicine, and resources (CHC), training IEC, Community level - IEC using mass domiciliary Core media, folk mediavisits by trained Strategies and other health care communication workers. 26
    27. 27. Supplementary Strategies for NPHCE Mainstreaming AYUSH and Promotion of convergence with Reorienting public private programmes of medical partnerships in Ministry of Social education to Geriatric Justice and support geriatric Health Care. Empowerment in issues. the field of geriatrics. 27
    28. 28. 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; 28
    29. 29.  District Geriatric Units Geriatric Clinics/Rehabilitation units Sub-centres Training of Human Resources 29
    30. 30. Operational Guidelines Package of Services at different levels (SC/PHC/CHC/RGC) 30
    31. 31. 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. 31
    32. 32. Services at PHC Weekly geriatric clinic by a trained Medical Officer Conducting a routine health assessment (eye, BP, blood sugar & record keeping). Provision of medicines and proper advice on chronic ailments Public awareness on promotional, preventive and rehabilitative aspects of geriatrics during health and village sanitation day/camps. Referral services. 32
    34. 34. Services at Sub-centre Health 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. 34
    35. 35. 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 Prevention Referral of difficult cases to District Hospital/higher health 35
    36. 36. 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 36
    37. 37. Services at Regional GeriatricCentre 30-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. 37
    38. 38. Activities under NPHCE at various levelsAt 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. 38
    39. 39. Activities at SC level Following items will be made available at the Sub-centre level:  Walking Sticks  Calipers  Infrared Lamp  Shoulder Wheel  Pulley  Walker (ordinary) No additional contractual staff. 39
    40. 40. 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. 40
    41. 41. Following items will be made available at the PHC: Nebulizer Glucometer Shoulder Wheel Walker (ordinary) Cervical traction (manual) Exercise Bicycle Lumber Traction Gait Training Apparatus Infrared Lamp etc. 41
    42. 42. 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 42
    43. 43. Following items will be  Cervical traction made available at (intermittent) the CHC:  Walking for gait Nebulizer training equipment Glucometer  Walking Sticks / ECG Machine Calipers Pulse Oximeter  Shoulder Wheel Defibrillator  Pulley Multi - Channel  Walker (ordinary) Monitor  Cervical traction Shortwave (manual). Diathermy 43
    44. 44. At District Hospital level Regular 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’s Camps for Geriatric Services in PHCs/CHCs and other sites Referral services for severe cases to tertiary level hospitals/ Regional Geriatric Centers 44
    45. 45. Following items will be made available at the District Hospital: Nebulizer Glucometer ECG Machine Defibrillator Multi-channel Monitor Non invasive Ventilator Shortwave Diathermy Ultrasound Therapy Cervical traction (intermittent) Pelvic traction (intermittent) Tran electric Nerve stimulator (TENS) Adjustable Walker. 45
    46. 46. Regional Geriatrics CentersSrNo Regional Institutes States Linked1 All India Institute of Medical Sciences, Delhi, Haryana, Uttarakhand, New Delhi Punjab Himachal Pradesh, M.P.2 Institute of Medical Sciences, Banaras Uttar Pradesh, Bihar, Jharkhand, Hindu University, Uttar Pradesh West Bengal3 Grant Medical College & JJ Hospital, Maharashtra, Goa, Northern Mumbai, Maharashtra, Districts of Karnataka,Chattisgarh4 Sher-e-Kashmir Institute of Medical Jammu & Kashmir Sciences, Srinagar, Jammu & Kashmir5 Govt. Medical College, Kerala, Southern Districts of Tiruvananthapuram, Kerala, Karnataka & Tamil Nadu6 Guwahati Medical College, Guwahati, Assam & NE States Assam7 Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa8 SN Medical College, Jodhpur, Rajasthan Rajasthan & Gujarat 46
    47. 47. At Regional Geriatric Centers level 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. 47
    48. 48. 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 countrySr No State Medical College1 Punjab PGIMER, Chandigarh2 Uttar Pradesh KGIMS, Lucknow3 Jharkhand Ranchi Medical College, Ranchi4 West Bengal Kolkatta Medical College, Kolkata5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd.6 Karnataka Bangalore Medical College, Bangluru7 Gujarat B.J.Medical College, Ahmadabad8 Maharashtra Government Medical College, Nagpur9 Orissa S.C.B.Medical College, Cuttack10 Tripura Agartala Medical College, Agartala11 Madhya Pradesh Gandhi Medical College, Bhopal12 Bihar Patna Medical7College, Patna Aug 2012 48
    49. 49. Proposed Financial Assistance during 11th planItems RMI DH CHC PHC S. Cconstruction 2 crore 80 lakh - - -Equipments 1.7 crore 10 lakh 1 lakh Rs.50000 Rs.32000Drugs 20 lakh 10 lakh - - -Training 5 lakh Rs. 70000 1.15 lakh Rs.32000 -IEC activities - 5 lakh - - -Research 50 Lakh - - - -Manpower 88.4 lakh 28 .2 lakh 1.8 lakh - -recruitment 49
    50. 50. Financial mangementFinancial management groups (FMG) ofProgramme Management support units at stateand district level, which are established underNRHM, will be responsible of maintenance ofaccounts, release of funds, expenditurereports, utilization certificates and auditarrangements. 50
    51. 51. 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. 51
    52. 52. HOW TO ACHIEVE OPTIMUM ELDERLY CARE? 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. 52
    53. 53. 7 Aug 2012 53
    54. 54. Thank you!!!