National Programme for Health care of the Elderly.pptx

community medicine

1. National Programme for Health care of the Elderly Presenter: Dr.Usha Rani Moderator: Dr.N UdayaKiran 1

2. Learning Objectives: 1.To Know the Objectives , Strategies and services under National Programme’s for Health care of the elderly. 2. NGO working for elders. 2

3. Contents Introduction. National policies for Older Persons. NPHCE-Goals Objectives and Strategies Services Non governmental Organizations 3

4. Introduction Aging is an inevitable phenomenon. Sir James Sterling Ross- ‟ You do not heal old age.You protect it;you promote it;you extend it ”. In year 2002 there were around 605 million old persons in the world,400 million were living in low income countries. By 2025,expected to rise more than 1.2 billion with about 840 million of these in low income countries. 4

5. In India according to 2001 census there were 76.6 million aged 60 years and above constituting 7.7% of the total population. The projections for next five censuses till the year 2051 are: 96.30 million (2011), 133.32 million (2021), 178.59 (2031), 236.01 million (2041) and 300.96 million (2051). 5

6. Rapid urbanization, globalization and international migration as lead to withering of the joint family systems. Lack of emotional, physical and financial support. 6

7. Health problems of the aged Major causes of morbidity according to ICMR survey: 7

8. Study conducted by Sharma 2003,lena2009 showed Hypertension(39.53%-59.1%) Cataract(35.3%) Arthritis(33.67%-41.3%) COPD(19.92%),CHD(18.85%),BPH(16.23%) Diabetes Mellitus(10.3%-15.23%) Dyspepsia(11.03%),Irritable bowel syndrome(9.2%) Depression(8.5%) 8

9. National policies for older persons The government of India announced a National policy for Older persons in January 1999. Goal: To improve asses to promotive,preventive,curative and emergency health care among elderly persons. 9

10. Continued… Objectives: 1.Provide comprehensive health care to the elderly by preventive, curative and rehabilitative services. 2.Train health professionals in geriatrics including supportive care and rehabilitation. 3.Promote research- to develop a scientific solutions to health problems of the elders. 10

11. Strategies: Level 1: A home based health service-to detect health problems and provide psychological support. Level 2:A community health centre for the elderly- Providing a base for educational and preventive activities and outpatient services. Level 3:An Improved hospital- based service with focused health care needs, at the institute. 11

12. National programme for the healthcare of Elderly The National Programme for the Health Care for the Elderly (NPHCE) envisaged under the- UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons (NPOP) & Section 20 of “The Maintenance and Welfare of Parents and Senior Citizens Act, 2007” dealing with provisions for medical care of Senior Citizen . 12

13. The National Programme for Health Care of the Elderly (NPHCE) forms part of the Non Communicable Division . The Ministry of Health & Family Welfare launched NPHCE during the year 2010, in the 11th Plan period, to address various health related problems of elderly people. 13

14. 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. 14

15. To build a framework to create an enabling environment for “a Society for all Ages”. To promote the concept of Active and Healthy Ageing. 15

16. Specific Objectives: 1.To provide an easy access to promotional, preventive, curative and rehabilitative services to the elderly through community based primary health care approach 2.To identify health problems in the elderly and provide appropriate health interventions in the community with a strong referral backup support. 16

17. 3 . 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. 4.To provide referral services to the elderly patients through district hospitals, regional medical institutions. 5. Convergence with National Rural Health Mission , AYUSH and others like Ministry of Social Justice and Empowerment. 17

18. Core Strategies: Community based primary health care approach including domiciliary visits by trained health care workers. Dedicated services at PHC/CHC level-provision of machinery, equipment, training, additional human resources (CHC), IEC. Dedicated facilities at District Hospital with 10 bedded wards, additional human resources, machinery & equipment, consumables & drugs, training and IEC. 18

19. 4. Strengthening of 8 Regional Medical Institutes to provide dedicated tertiary level medical facilities for the Elderly PG courses in Geriatric Medicine, in-service training of health personnel at all levels. 19

20. 5. IEC using mass media, folk media and other communication channels to reach out to the target community. 6. Continuous monitoring and independent evaluation of the Programme and research in Geriatrics and implementation of NPHCE. 20

21. Supplementary strategies: 1. Promotion of public private partnerships in Geriatric Health Care. 2. Mainstreaming AYUSH – revitalizing local health traditions, and convergence with programmes of Ministry of Social Justice and Empowerment in the field of geriatrics. 3. Reorienting medical education to support geriatric issues. 21

22. Expected outcome 1.Regional Geriatric Centers (RGC) in 8 Regional Medical Institutions- setting up RGC with a dedicated Geriatric OPD and 30-bedded Geriatric ward for management of specific diseases of the elderly, Training of health personnel in geriatric health care and conducting research. 2. Post-graduates in Geriatric Medicine (16) from the 8 regional medical institutions. 22

23. 3.Video Conferencing Units in the 8 Regional Medical Institutions to be utilized for capacity building and mentoring. 4. District Geriatric Units with dedicated Geriatric OPD and 10-bedded Geriatric ward in 80-100 District Hospitals. 5. Geriatric Clinics/Rehabilitation units set up for domiciliary visits in Community/PHC in the selected districts 23

24. 6.Sub-centres provided with equipment for community outreach services. 7. Training of Human Resources in the Public Health Care System in Geriatric Care. 24

25. Institutional framework 25

26. Services : A. Sub-centre: Health Education Domiciliary visits for attention and care to home bound / bedridden elderly persons and provide training to the family care providers Arrange for suitable callipers and supportive devices from the PHC to the elderly disabled persons to make them ambulatory. Linkage with other support groups and day care centres. 26

27. B. PHC: Weekly geriatric clinic run by a trained Medical Officer Maintain record of the Elderly using standard format during their first visit Conducting a routine health assessment of the elderly persons based on simple clinical examination relating to eye, BP, blood sugar . 27

28. 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 for diseases needing further investigation and treatment. 28

29. C.CHC: 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. 29

30. 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 care facility. 30

31. D. District Hospital: Geriatric Clinic for regular dedicated OPD services. Facilities for laboratory investigations for diagnosis and provision of medicines for geriatric medical and health problems. Ten-bedded Geriatric Ward for in-patient care. 31

32. Provide services for the elderly patients referred by the CHCs/PHCs. Conducting camps for Geriatric Services in PHCs/CHCs and other sites. Referral services for severe cases to tertiary level hospitals. 32

33. E. Regional centres: 30-bedded Geriatric Ward for in-patient care. 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. 33

34. FUNDING: The Programme has been initiated in all the 100 selected districts in 21 States. In Karanataka-Tumkur,Udupi,Shimoga,Kolar,Chikamagalur. The Centre will bear 75% of the total budget and the State Government will contribute 25 % of the budget. The NPHCE is sponsored and its implementation is monitored by the MOHFW. 34

35. A total amount of Rs. 1710.13 crore has been approved for XII Five Year Plan for NPHCE. A total of Rs.181.41 crore was released to the States and the RGCs during the 11th Plan. It is proposed to cover 225 more districts during the 12th Five Year Plan in a phased manner and develop 12 additional RGC in selected Medical Colleges of the country. 35

36. Non Governmental Organizations A. Help Age India: Largest voluntary organization working for the cause and care of the disadvantaged older people. Around 6 million senior citizens are covered through 3084 projects. 36

37. Programmes covered under Help Age India- free cataract operations, Mobile medicare units, Income generation and microcredit, Old age homes and day care centres, Adopt-a-Gran, Disaster mitigation 37

38. B.KMC chaithanya-Day Care Centre was started in 2002 To provide day care for sick elderly. To promote active ageing by exercise,yoga. To use their expertise for teaching. To provided job opportunities for the needy elderly. To create opportunities for social service. 38

39. Beneficiaries: Any senior citizen healthy or sick. Anybody with chronic life style diseases. Anybody who wants to age actively. Membership fee of Rs 500/life time. Or Annual membership of Rs 100. 8 day care centres are started in Mangalore. 39

40. Geriatric Health services at St.Johns Medical College: The RURAL program (2003) at Mugalur Village, the rural field practice area of St John’s. the URBAN program (2005), at St Johns Medical College and Hospital. 40

41. Functions under 4 service arms: The Rural Elderly Health Program The Home Health Service The Institutional/ Old Age Home Support Service The Division of Geriatric Medicine at St Johns Medical College Hospital 41

42. Services : Health Education sessions. Baseline investigations and quality generic drugs provided at subsidized rates. Patient notebook as a record of illness and treatment. Clinic based record card. 42

43. Home Visits between clinics by trained Community Health Workers. Resident medical staff render follow-up/ emergency treatment. Thrice weekly OPD services and in patient care in the Institute. Monthly home visits by a doctor and nurse for elders staying close to St.Johns . 43

44. Monthly check ups at 3 old age homes (housing around 350 elderly. Includes health education and Low cost generic drugs. Specialty visits facilitated – Ophthalmology, Psychiatry, Orthopedics. 44

45. OASIS Project : An Old Age Social and Income Security project was launched under NPOP. Eight member expert committee is nominated To comprehensively examine policy questions concerned with Old age home Income security. Recommendations for young workers to make enough savings –which can serve as a shield against poverty. 45

46. Travel related concessions are provided to the older people by Indian Railways, Indian Airlines and State transport corporations. Health care- Bhavishya Aroghya Mediclaim,Rural Group Life Insurance Schemes. Indira Gandhi National Old Age pension scheme to people over 65 years and BPL. 46

47. Summary: NPOP was initiated in 1999. The MOHFW launched NPHCE during the year 2010, in the 11th Plan period. To provide an easy access to promotive , preventive, curative and rehabilitative services through community based primary health care approach 10 bedded geriatric units in District hospitals and 30 bedded in RGC. Medical rehabilitation through Physiotherapy units . Provision of MDs in Geriatric medicine in 8RGC. IEC through Mass media,folk . 47

48. References Park.K.Text book of Preventive and Social medicine.India:Bhanot publishers;2015(23):594-96 J.Kishore’s:National Health Program’s of India:Century Publications;2014(11):570-74 MOHFW:Operational guidelines_NPHCE_final.pdf Prabha Adhikari : Day Care Centres of Active Ageing and Effect on NCDs.KMC Mangalore Preetesh: Health care delivery for rural elderly – Opportunities and challenges.St Johns Medical College 48

49. THANK YOU 49