national programme for the healthcare of the elderly.pptx

community medicine

1. Our Elderly

2. ONE WHO ALWAYS SERVES AND RESPECTS ELDERLY IS BLESSED WITH FOUR THINGS : LONG LIFE , WISDOM, FAME AND POWER MANUSMRITI CHAPTER 2 :121

3. Constitution of India Article 41. “ The state shall, within the limits of its economic capacity and development, make effective provision for securing the right to public assistance in cases of old age”.

4. Contents Geriatric Population Government Initiatives for the Elderly National Programme for Healthcare of the Elderly NPHCE SWOT Analysis National Policy for Senior Citizens March 2011 Senior Citizens Scheme , Karnataka

5. Geriatric Population : Elderly are all those who are 60 years or above by age

6. Magnitude - Facts about Ageing According to WHO : 2 billion – above 60 by 2050 According to UN World Population Ageing 1950-2050 2050 1950 (205 million) (2 billion)

7. Global scenario of elderly population Years Percentage

8. Indian Scenario …… Population over 60yrs has tripled in the last 50 years 2001 - 7.7% Proportion of people aged > 60 yrs In percentages 2011 - 8.14% 2016 - 8.94%

9. Elderly population and future projection in India

10. Expectancy of life at birth and future projection in India 62.85 64.65 66.44 67.92 Age Years

11. Common Health Problems in Elderly Some Common Complaints Poor vision Bowel complaint Hypertension Anaemia Difficulty in hearing Arthritis Diabetes Depression Urinary complaints / Constipation Weight loss Asthma Fall / Fracture COPD Tuberculosis IHD

12. Areas amenable to preventive health care Primary Secondary Tertiarty Health Habits Smoking Alcohol abuse Obesity Nutrition Physical activity Sleep Screening for Hypertension Diabetes Periodontal disease Dental caries Sensory impairment Medication side effects Colo rectal cancer Breast CA Cervical CA Prostatic CA Depression, stress Urinary incontinence Podiatric problems Rehabilitation Physical deficits Cognitive deficits Functional deficits Caretaker support Coronary heart disease risk factors Immunization Influenza Pneumovax tetanus Injury prevention Iatrogenesis prevention Osteoporosis prevention

13. Projected growth ….. Older population growing faster than the rest of the population 1 2 3 Percentage 50’s 70’s 00’s 20’s 40’s Decades By 2025 : Geriatric- 2.8 percent General – 0.8 percent

14. 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

15. 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

16. Maintenance and Welfare of Parents and Senior Citizens Act - 2007 Article (20) : The State Government shall ensure The Government hospital or hospitals funded fully or partially by the Government shall provide beds for all 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 there are earmarked facilities for geriatric patients in every district hospital duly headed by a medical officer with experience in geriatric care.

17. NPHCE outcome of …. UN Convention on the Rights of Persons with Disability UNCRPD National Policy on Older Persons (NPOP) The Maintenance and Welfare of Parents and Senior Citizens Act, 2007

18. NPHCE To provide preventive, curative and rehabilitative services to the elderly persons at various level of health care delivery system of the country

19. VISION Accessible, affordable and high quality long term health care New Architecture for Ageing Framework “ Society for all Ages: Promote Active and Healthy Ageing Convergence with NRHM

20. Easy access to promotional, preventive, curative and rehabilitative services- Community Based PHC Identify health problems in elderly – provide interventions ( community based) with a Strong Referral backup support Capacity building of medical, paramedical and care-takers Referral services – District hospital, regional medical institutions Specific Objectives

21. CORE STRATEGIES Domiciliary visits by trained health care workers Continuous Monitoring & Evaluation . Research in Geriatrics IEC- to reach out to the target population 8 Regional Medical Institutes – PG courses District Hospital – 10bed wards, machinery, drugs, IEC Dedicated PHC services- Machinery,IEC

22. Supplementary Strategies Promotion PPP Mainstreaming AYUSH Reorienting medical education

23. Institutional Framework …… CHC / PHC Geriatric Clinic on fixed days Sub Centre Home Based Care State NCD District NCD Tertiary Level- Regional Geriatric Centre Geriatric Ward : 30beds District Hospital Daily Geriatric Clinic Geriatric Ward : 10 beds Set up under the NPCDCS- National Programme for Prevention and Control of Cancer, Diabetes , CVD and Stroke National NCD

24. National NCD Cell…… Seeking State Commitment to fund 20% of programme Impart details of the implementation of National Programme Capacity building of individuals from Primary to Tertiary Levels Develop IEC strategy, dissemination through mass media Monitoring and Review of the programme at each level Release of funds and monitoring expenditure External evaluation and coordinating research in geriatrics

25. State NCD Cell…. Composition : Stage Programme Officer Programme Assistant Finance cum Logistics Officer Data Entry Operators (2)

26. Functions State NCD Cell…. Organize State & District level training for capcity building Monitoring through HMIS- review meetings and field observations Appointment of Contractual Staff Liaison with Region Geriatric Centre for tertiary care, Training and Research Public awareness- health promotion, prevention and rehabilitation of the elderly Release of funds to the Districts and Maintaining financial progress Convergence with NRHM

27. District NCD Cell… Composition District Programme Officer Programme Assistant Finance cum Logistics Officer Data Entry Operator

28. Functions District NCD Cell… Update District database Capacity building for Sub-District/CHC level Engage contractual staff Convergence with NRHM activities Ensure availability of Rehabilitative services for the elderly Maintain fund flow – Maintain financial progress

29. Activities under NPHCE at various levels

30. Sub centre level ….. ANM / Health Worker Education – ageing, environment modification, nutritional requirement, lifestyle changes Special Attention – Home Bound , bed ridden patients- Training to relatives Provide suitable supportive devices from the PHC Linkage with other support groups and day care centres

31. Items to be available at the Sub Centre level …… Walking Stick Calipers Infrared Lamp Shoulder Wheel Pulley Walker ( Ordinary)

32. Primary Health Centre Level – PHC MO Weekly Geriatric Clinic organized by Medical Officer Health Assessment – Record Updated Public awareness in health sanitation day and camps Advise on Chronic Ailments – Arthritis, Diabetes, Hypertension Provision of medicine to the elderly Referral to Community Health Centre or District Hospital

33. Items to be available at the Primary Health care Level …… Nebulizer Glucometer Shoulder Wheel Walker ( Ordinary) Cervical traction (Manual) Exercise Bicycle Gait Training Apparatus Infrared Lamp

34. Community Health Centre….. First Referral Unit from PHC ‘s Geriatric Clinic twice a week Data compilation of all the data from the PHC forwarding to the District Programme Officer Rehabilitation services to be provided- Domiciliary visits for the bed ridden Further referral to District hospital and Medical Colleges

35. Nebulizer ECG Machine Pulse oximeter Defibrillator Multi channel monitor Shortwave diathermy Cervical traction intermittent/manual Walking Sticks Shoulder pulley Walker ( ordinary) Items to be available at Community Health Centre ……

36. District Hospital ….. Dedicated regular OPD fro Geriatrics 10 bedded Geriatric ward – 2 of which for bed ridden Provisions – Lab investigation, dispensing drugs Specialist services – General Medicine Orthopaedics, Ophthalmology ENT Services. Training to MO and paramedical staff of CHC’s and PHC’s. Training to MO and paramedical staff of CHC’s and PHC’s. Conducting camp Referral services to tertiary level hospitals

37. Items to be available at District Hospital…… Nebulizer Glucometer ECG Machine Defibrillator Multi-Channel Monitor Non Invasive Ventilator Shortwave Diathermy Ultrasound Therapy Cervical traction (intermittent) Pelvic traction (intermittent) Adjustable walker Tran electric Nerve Stimulator

38. 8 Regional Geriatrics Centres….. Colleges States Linked All India Institute of Medical Sciences, New Delhi Delhi, Haryana, Uttarakhand , Punjab Himachal Pradesh, Madhya Pradesh Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh Uttar Pradesh, Bihar, Jharkhand, West Bengal Sher -e-Kashmir Institute of Medical Sciences, Srinagar Jammu & Kashmir Jammu & Kashmir Govt. Medical College, Tiruvananthapuram , Kerala Kerala, Southern Districts of Karnataka & Tamil Nadu Guwahati Medical College, Guwahati Assam Assam & NE States Madras Medical College, Chennai, Tamil Nadu Tamil Nadu, Andhra Pradesh, Orissa SN Medical College, Jodhpur Rajasthan & Gujarat Grants Medical College & JJ Hospital, Mumbai, Maharashtra Maharashtra, Goa, Northern Districts of Karnataka, Chattisgarh

39. Functions of Regional Medical Centres ….. 30 bedded Geriatric Ward - Services to complicated / serious Geriatric patients Providing Training to trainers of identified District Hospitals and Medical Colleges Conducting post graduate course in Geriatric Medicine Developing Training modules, guidelines and IEC materials Research on specific elderly diseases. Evidence based treatment protocols for Geriatric diseases

40. Compositions – Regional Medical Centres….. Professor Geriatric Medicine 1 Assistant Professor 2 Senior Resident/ Medical Officers 4 Nurses 16 Physiotherapist (3) + Occupational Therapist (1) 4 Medical Social Worker 1 Lab Technician 1 Program Assistant 1 Hospital Attendant 4 Sanitary Attendant 4 Total per month 38

41. Activities at State Level Community Awareness – TV, radio , print media Planning, Monitoring and Supervision – monthly reporting Training of Human Resources – Doctors, Nurses, Physiotherapist, MSW, ANM and Health Worker Financial Management - Monitoring flow and utilization of funds

42. Activities at Central Level Selection of States and Districts Prototype of IEC material will be conceptualized and disseminated to the States P rovide support to 8 Regional Medical Centre Prepare a plan for Central Level Training at the Regional Medical Centres Monitoring Evaluation and Research : Standards formats to report and evaluate the functioning of the programme.

43. Identified States and 30 districts (2010-11) States Districts Andhra Pr. Nellore, Vijayanagram Assam Dibrugarh , Jorhat Bihar Vaishali , Rohtas CH Bilaspur Gujarat Gandhi Nagar, Surendranagar Haryana Mewat HP Chamba J&K Leh , Udhampur Jharkhand Bokaro Karnataka Shimoga , Kolar Kerala Pathanathitta States Districts Madhya Pr. Ratlam Maharashtra Washim, Wardha Sikkim East Sikkim Orissa Naupada Punjab Bhatinda Rajasthan Bhilwara, Jaisalmer Uttrakhand Nainital Tamil Nadu Theni Uttar Pr. Rae Bareli, Sultanpur West Bengal Darjeeling

44. 70 districts added in 2011-12 States Districts Andhra Pr. Srikakulam , Chittoor , Cuddapah , Krishna, Kurnool, Prakasham Assam Lakhimpur , Sibsagar , Kamrup Bihar Muzaffarpur , Paschim Champaran , Poorva Champaran , Keimur CH Jashpur Nagar, Raipur Gujarat Rajkot, Jam Nagar, Porbandar , Junagarh Haryana Yamuna Nagar, Kurukshetra , Ambala HP Lahaul & Spiti , Kinnaur J&K Kupwara , Doda (Erstwhile), Kargil Jharkhand Ranchi, Dhanbad Karnataka Udupi , Tumkur , Chikmagalur Kerala Kozikode (Calicut), Allappuzha , Idukki , Thrishur States Districts Madhya Pr. Hoshangabad , Chindwara , Jhabua , Dhar Maharashtra Gadchirola , Bhandara , Chanderpur , Amaravati Sikkim South Sikkim Orissa Balangir , Nabrangpur , Koraput , Malkangiri Punjab Gurdaspur , Hoshiarpur Rajasthan Jodhpur, Ganga Nagar, Bikaner, Barmer , Nagaur Uttrakhand Almora Tamil Nadu Coimbatore, Virudhnagar , Toothukudi , Tirunelveli Uttar Pr. Jhansi, Lakhimpur Kheri , Farookhabad , Firozabad, Etawah , Lalitpur , Jalaun West Bengal Jalpaiguri , Dakshin Dinajpur

45. Days …. 1999 – International Year of Older persons 1 st October – World Elders Day 7th April 2012 - Good Health Adds Life to Years

46. Strengths….. First model of healthcare for the elderly Preventive, curative and rehabilitative services Integration alternative forms of medicine Multilayered functioning

47. Weakness….. Huge shortage of training facilities Shortage of manpower Undergraduate Training lacking in Geriatric Care Large population - chronic debilitating disease – economic burden Lack of family based care approach

48. Opportunities…. Increase in growth rate of the elderly in developing countries Increased scope for setting services dedicated to the elderly – wards, healthcare personnel Social Security Schemes for the elderly Family Based care

49. Threats…. No emphasis on family care- might lead to failure of the programme Lack of awareness among people about the programme Lack of integration with private schemes

50. National Policy for Senior Citizens March 2011 Advancement in Medical Technology Changing Social Environments Demographic explosion of the Elderly High levels of destitution among elderly poor Focus on how they are an Asset to society and bring their topic to mainstream discussion in Parliament Debates

51. National Policy for Senior Citizens March 2011 Income Security in Old Age Indira Gandhi Old Age Pension Scheme- Rs . 1000 / month Microfinance Income Tax HealthCare Affordable and heavily subsidized health services Tiered National level Geriatric health care services Twice a year screening of the 80+ by ASHA- geriatric and palliatve Tax incentive for those taking care of old Rashtriya Swasthya Bima Yojana – Health Insurance

52. National Policy for Senior Citizens March 2011 Restoration of eyesight – NPCB Special Programmes to raise awareness about – Dementia and Alzheimers . National and Regional Institutes of Ageing Further expansion of NPHCE Palliative care for the terminally ill Safety and Security Stringent punishments for the abuse of the elderly Friendly vigil and monitoring of the elderly

53. National Policy for Senior Citizens March 2011 Housing 10% housing schemes for the elderly- Indira Awas Yojana Age friendly facilities – Bureau of Indian Standards Housing complexes – single men and women Employment Post retirement opportunities Multigenerational Bonding Incorporate care of elderly in School curriculum ADHAAR Unique Identification Number is the first step

54. Directorate of Welfare of Disable and Senior Citizens Financial Assistance to NGO’s to run Old Age Homes Monthly pension of Rs . 400/- : ( Sandhya Suraksha Scheme) Above 65years of age Combine annual income < Rs . 20,000/- Deposit < Rs . 10,000/- Beneficiaries:      Small farmers Marginal farmers Agricultural labourers . Weavers Fishermen

55. Identity Card – Deputy Director Women and Child Development will identify NGO’s Rs . 25 /- can be collected by the NGO ‘s Application form 2 photographs, Age proof, Address Proof Directorate of Welfare of Disable and Senior Citizens

56. Concessional Bus Pass Above 65 years of age- eligible for KSRTC bus fee concession HelpLine Number in 14 places. Day Care Centre – Bangalore, Hubli , Gulbarga, Belgaum Directorate of Welfare of Disable and Senior Citizens

57. References Park K. Preventive and Social Medicine. 22 nd ed. Jabalpur: Banarsidas Bhanot ; 2013. p. 550 Giri M, Sabharwal M, Gangadharan K, Sreenivasan S. National Policy for Senior Citizens March 2011. http://www .who.int/ageing/en/index.html Source: United Nations Population Division 2008 http :// esa.un.org/unpp

58. References Report of the Working Group on Disease Burden for 12th Five Year Plan – Working Group 3 – Non Communicable disease Situation Analysis of the Elderly in India June 2011. Central Statistics Office. Ministry of Statistics and Programme Implementation. Government of India Operational Guidelines: National Programme for the Healthcare of the Elderly , Directorate General of Health Serviecs , Ministry of Health and Family Welfare, Government of India. August 2011

59. World Health Day 2012 Good Health Adds Life to Years THANK YOU