The National Programme for the Health Care for the Elderly (NPHCE) is an articulation of the International and national commitments of the Government as envisaged under the UN Convention on the Rights of Persons with Disabilities (UNCRPD), National Policy on Older Persons (NPOP) adopted by the Government of India in 1999 & Section 20 of “The Maintenance and Welfare of Parents and Senior Citizens Act, 2007” dealing with provisions for medical care of Senior Citizen.
The NPHCE has been approved by the Minister of Finance on 10th June, 2010 at an expenditure of Rs.288.00 crore for the remaining period of the 11th Five Year Plan. This includes 20% share of State Governments (excluding the expenditure on Regional Medical Institutes) amounting to Rs.48.00 crore. The Government’s share would be Rs.240.00 crore(2010-12). The programme has been implemented in 30 districts of 21 States during the year 2010-11 and 70 will be added during 2011-12. The programme is expected to be expanded to the entire country during the 12th Plan.
Main objective of the programme is to provide preventive, curative and rehabilitative services to the elderly persons at various level of health care delivery system of the country. Other objectives are, to strengthen referral system, to develop specialized man power and to promote research in the field of diseases related to old age.
Following strategies will be adopted to achieve the above mentioned objectives:Preventive and promotive care: The preventive and promotive health care services such as regular physical exercise, balanced diet, vegetarianism, stress management, avoidance of smoking or tobacco products and prevention of fall, etc will be provided by expanding access to healthy practices through domiciliary visits by trained health workers. They will impart health education to old persons as well as their family members on care of older persons. Besides, regular monitoring and assessment of old persons will be carried out for any infirmity or illness by organizing weekly clinic at PHCs.
Management of Illness: Dedicated outdoor and indoor patients services will be developed at PHCs, CHCs, District Hospitals and Regional Geriatric Centres for management of chronic and disabling diseases by providing central assistance to the State Governments.
Health Man Power Development for Geriatric Services: To overcome the shortage of trained medical and para-medical professionals in geriatric medicine, in service training will be imparted to the health manpower using standard training modules prepared with the help of medical colleges and regional institutions. The post graduate courses in geriatric medicine will be introduced in Regional Medical Colleges for which additional teaching and supportive faculties will be provided to these institutions.
Medical Rehabilitation & Therapeutic Intervention: By arranging therapeuticmodalities like therapeutic exercises, training in activities of daily life (ADL) & treatment of pain and inflammation through physiotherapy unit at CHC, district hospital and Regional medical college levels for which necessary infrastructure, medicine and equipment will be provided to these identified units.
Information, Education & Communication (IEC): Health education programmes using mass media, folk media and other communication channels will be promoted to reach out to the target community for promoting the concept of healthy ageing, importance of physical exercise, healthy habits, and reduction of stress. Camps for regular medical check-up will be organised at various level where IEC activities will be specifically promoted.
Coverage and Major Components Of TheProgramme
Major components of the programme are to establish geriatric department in eight regional geriatric centers of the country and strengthening health care facilities for elderly at various level of 100 identified districts of the country. All the 8 regional medical colleges and 30 districts will be covered during the current financial year and rest 70 district will be covered during 2011-12.
The regional institutions will provide technical support to the geriatric units at district hospitals whereas district hospitals will supervise and coordinate the activities down below at CHC,PHC and sub centres.
Detail of the geriatric setup and activities under the programme at various health Care level will be as below:
Department of Geriatric at 8 Super Specialized Institutions: Geriatric Department will be developed at the following Regional medical institutions located in various regions of the country:- All India Institute of Medical Sciences, New Delhi, Institute of Medical Sciences, Banaras Hindu University, Uttar Pradesh, Sher-e-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, Govt. Medical College, Tiruvananthapuram, Kerala, GuwahatiMedical College, Guwahati, Assam, Madras Medical College, Chennai, Tamil Nadu, SN Medical College, Jodhpur, Rajasthan and Grants Medical College & JJ Hospital, Mumbai, Maharashtra.
Apart from providing referral treatment, research and manpower development, these institutions will be actively involved in developing and updating training materials for various levels of health functionaries, developing IEC material, guidelines, etc. Funds will be provided for manpower, equipments, medicines, construction of building, training etc.
Geriatric Unit at 100 District Hospitals
The programme will be implemented in 100 districts, covering 21 States/UTs. There is provision for establishing 10 bedded geriatric ward and dedicated OPD services exclusively for geriatric patients. Grant will be provided for contractual manpower, equipments, medicines, construction of building, training etc.
Rehabilitation Units at CHCs Falling Under 100 Identified Districts
There is provision for dedicated health clinics for the elderly persons twice a week. A rehabilitation unit will also be set up at all the CHCs falling under identified districts. Grant will be provided for manpower, equipments, training. The multi rehabilitation worker will provide physiotherapy to the needy elderly persons
Activity at PHCs under 100 Identified Districts
Weekly geriatric clinics will be arranged at the identified PHCs by a trained Medical Officer. The medical officer will conduct complete health assessment of the elderly persons on their first visit and then maintain a record of them in a register for future use. The elderly person attending the clinics will be provided medicines for their ailments. For diseases needing further investigation and treatment, persons will be referred to the first referral unit i.e. the Community Health Centre or District Hospital as per need.
One-time grant will be given to PHCs for procurement of equipment like: Nebuliser; BP Monitor; Glucometer; ECG Machine; Pulse oximeter, etc; which are essential for geriatric care. The Medical Officer will also liaison with the blindness control programme, CVD programme, Cancer and other programmes under NCD for arranging medicines, ambulance and other items needed for geriatric clinic etc.
The MO will provide training to the ANMs / Male Health Workers posted in SubCentres.
Activity at Sub-centre under 100 Districts
The ANMs/Male Health Workers posted in sub-centres will be suitably trained to provide information and advice on proper nutrition, life style diseases and the benefit of physical exercise to the elderly parsons. She/he will make domiciliary visits to the elderly persons in areas under their jurisdiction. She/he will arrange suitable calipers and supportive devices from the PHC and provide the same to the elderly disabled persons to make them ambulatory. Sensitization of community/family health care providers in geriatric health care will also be done by the ANM/MHWs. There will also be provision for treatment of minor ailments and rehabilitation equipments at the identified sub centres.
Operational and Financial Guidelines for implementation of the programme has beenfinalised and put on the web-site of this Ministry (http://www.mohfw.nic.in).
An amount of Rs.60.00 crore has been allocated for the programme during the year 2010-11. Funds from the Government will be released to the State Health Society. State Health Society will retain funds for state level activities and release GIA to the District Health Societies. However, funds for the 8 Regional Geriatric Centres will be released directly to the concerned Institute/Medical College after getting them registered under the Central Plan Scheme Monitoring System (CPSMS).
The NCD Cells constituted at the Centre, State and district level under the NationalProgramme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) will implement and monitor NPHCE also. (PIB Features)