1. NATIONAL PROGRAMME FOR
HEALTH CARE OF ELDERLY
Dr Abhay Dhanorkar
7 Aug 2012 1

2. Scope
 Introduction
 Scenario in World & India
 Need for programme
 Policy & strategic framework for implementation
 Package of services
 Institutional framework for the implementation of
NPHCE
 Activities under NPHCE at various levels
 Financial guidelines
 Evaluation
 Achievement
 References
7 Aug 2012 2

3. 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.
7 Aug 2012 3

4. BY Definition….
60-69 70-79 80+
Old Old - Old Oldest-
Old
Source: National Policy on Older Person 1999
GOI
60-74 75- 84 85+
Young Old Middle old Old-Old
Source:
http://www.agingstats.gov/agingstatsdotnet/Data/2008_Documents/Population
.aspx

5. Global scenario of elderly population
16 14.9
13.4
14
12.2
12 11
% 10.2
9.9
10
8
Percentage
aged 60 or
6
over (%)
4
2
0
2000 2005 2010 2015 2020 2025
Year
Source: United Nations Population Division 2008 (http://esa.un.org/unpp)
7 Aug 2012 5

6. 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 207.9 281.8 374.1 491.8 703.4
Asia (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

7. 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. 7 Aug 2012 7

8. Age distribution of population in India over years
Census 2001
7 Aug 2012 8

9. 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 .
7 Aug 2012 9

10. Elderly population and future projection in India
Source: United Nations Population Division 2008 (http://esa.un.org/unpp
173.18
180
m 160 143.24
i
l 140 118.1
l 120 98.47
i 83.58
100 76.6
o
n 80
s 60
40
20
2001 2006 2011 2016 2021 2026
Year
7 Aug 2012 10

11. Expectancy of life at birth and future projection in
India Census 2001
67.92
Age 66.44
64.65
62.85
Year
7 Aug 2012 11

12. Life Expectancy at 60 years (WHO-2009)
30
26
25
25 24
23
20 19
17 17
16 16
15
15 14
Country
Life Expectancy in Years
10
5
0
7 Aug 2012 12

13. Socio-demographic profile of the
elderly in India.
Elderly persons lives in rural
75% area.
48% Women
73% Illiterate and dependent.
Source : Census
66% BPL 2001
Were in vulnerable situation
66%
and without sufficient food.
7 Aug 2012 14

14. States with more than 7% elderly population
( SRS 2010)
7 Aug 2012 15

15. STATEWISE ELDERLY POPULATION IN INDIA, CENSUS 2001.
%
7 Aug 2012 16

16. Life-course Perspective for maintenance of
highest possible level of functional capacity
Functional Capacity
Life curve of highest
Functional capacity
Disability threshold Range
of
function
Life curve of reduced
Functional capacity
Age
* Change in the external environment can lower disability threshold
7 Aug 2012 17

17. Health risks of elderly
PRONE FOR
INCRASED INFECTIONS
RISK OF DEATH
INCREASED PRONE FOR
RISK OF
DISABILITY INJURIES
INCREASED PRONE FOR
RISK FOR PSYCHOLOGIC
DISEASE AL PROBLEMS
PRONE FOR
DEGENERATI
VE
DISORDERS
7 Aug 2012 18

18. 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%
Psychi
Ref – ICMR study 2001 atric
proble
ms- 9% 7 Aug 2012 19
Delhi & Hariyana

19. Prevalence of common health problems in
elderly
GOI study-2007
P
e
r
c
e
n
t
a
g
e
Health Problem
7 Aug 2012 20

20. Mortality in elderly
33
% CVD
10
%
Respiratory diseases
10
% Infections,TB
6% Neoplasm
4% Accidents, poisoning and violence
17 deaths by chronic diseases by
% 2015
7 Aug 2012 21

21. Need for Dedicated Health care for elderly ?
Decrease in physical ability / Economic inadequacy
Increase vulnerability to diseases
Chronic, disabling and multiple Health problems
Different approach and management
Degradation in family values
Rising Population
7 Aug 2012 22

22. Major constraints for geriatric health care
Lack of
specialized and
trained
manpower
Geriatrics not
yet a popular
No dedicated
specialty
health care
( MD–Madras
infrastructure
Medical
College)
7 Aug 2012 23

23. 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
7 Aug 2012 24

24. 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
7 Aug 2012 25

25. 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 26

26. 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.
7 Aug 2012 27

27. Extract of Finance Minister’s Budget Speech 2008-09
“The other major intervention will be for the elderly. A
National Programme for the Elderly with a Plan outlay of
Rs. 400 crore will be started in 2008-09. Among other
measures, we will establish, during the XIth Plan Period
two institutes of aging eight Regional Centres and a
Department of Geriatric Medical Care in one of the Medical
Colleges/Tertiary level Hospitals in each State.”
7 Aug 2012 28

28. NATIONAL PROGRAMME FOR HEALTH CARE OF
ELDERLY (NPHCE-2010)
NPHCE 2010
7 Aug 2012 29

29. 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;
7 Aug 2012 30

30. Objectives
 Provision of dedicated health care facilities at
various level of State health care delivery system
with referral support.
 Human resource development in geriatric
Health.
 Strengthening of preventive, promotive and
rehabilitative services.
 Promotion of Research in geriatric health care
 Convergence of NRHM,Aug 2012 & all other dept.
7
AYUSH 31

31. Strategies for NPHCE 2010
District Hospital -
10 bedded
wards, additional
PHC/CHC level - human 8 RMC - PG
equipment, traini resources, courses in
ng, additional Geriatric
human resources Medicine, and
(CHC), IEC, training
Community
level - IEC using mass
domiciliary Core media, folk media
visits by trained Strategies and other
health care communication
workers.
7 Aug 2012 32

32. 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.
7 Aug 2012 33

33. Major Components of the programme
1. Geriatric Department in 8 Regional medical
Institutions/ State Medical Colleges
2. Dedicated Health Care in 100 Districts(21 states)
 Geriatric unit at district hospitals
 Rehabilitation Units at CHCs
 Weekly Geriatric Clinic at PHCs
 Provision of supportive devices/equipments at
sub centers
7 Aug 2012 34

34. Operational Guidelines
 Package of Services at different levels
(SC/PHC/CHC/RGC)
 Institutional framework for implementation
◦ Integration with NRHM
◦ State Health Society
◦ District Health Society
 Management Structure
◦ National/ State / District NCD cell composition
& responsibilities
 Activities at various levels (SC/PHC/CHC/RGC)
7 Aug 2012 35

35. 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.
7 Aug 2012 36

36. ORGANIZATIONAL STRUCTURE
7 Aug 2012 37

37. 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.
7 Aug 2012 38

38. 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.
7 Aug 2012 39

39. 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
7 Aug 2012 40

40. Services at Regional Geriatric Centre
 Geriatric Clinic (Specialized OPD)
 30-bedded Geriatric Ward.
 Laboratory investigation with a special
sample collection centre in OPD block.
 Tertiary health care to the cases referred
from medical colleges, district hospitals
and below.
7 Aug 2012 41

41. Institutional framework for the
implementation of NPHCE
Program Structure-Integration with NRHM
 Financial management group (FMG) of
Programme Management support units at
state and district level, which is established
under NRHM, will be responsible for
financial management
◦ Maintenance of accounts
◦ Release of funds
◦ Expenditure reports
◦ Utilization Certificates
◦ Audit arrangements
7 Aug 2012 42

42. Funding for Program
Funds from Government
of India (80%)
State Health Society State Level Activity
District levels Society
( NCD Cell ) District Level Activity
CHC / PHC /SC
7 Aug 2012 43

43. State Health Society (SHS)
 Under the NRHM framework different
Societies of national programmes such as
RCH, Malaria, TB, Leprosy, NBCP have
been merged into a common State Health
Society.
◦ Chief Secretary – Chairperson
◦ Principal Secretary (H&FW)-vice chair person
◦ Mission director - Member -Secretary
7 Aug 2012 44

44. District Health Society (DHS)
 All programme societies have been
merged into the District Health Society
(DHS).
 The Governing Body
◦ Chairperson - Chairman of the Zillah Parishad.
◦ Member -Secretary - DHO
 Executive Body
◦ Chair person - District Collector
◦ Member -Secretary - DHO.
7 Aug 2012 45

45. Management Structure
National NCD Cell
 The NCD Cell constituted at the central
level for planning, monitoring and
implementation of the National
Programme for Prevention and Control of
Cancer, Diabetes, CVD and Stroke
(NPCDCS) will also be responsible for
NPHCE.
7 Aug 2012 46

46. Management Structure cont…
Main functions of National NCD cell
 MOU with the States/UTs seeking their
commitments to implement and partially
fund (20%) the programme.
 Preparation and dissemination of technical
& operational guidelines.
 Plan for capacity building of health
functionaries of Health care system at
Primary, Secondary and Tertiary levels.
7 Aug 2012 47

47. Management Structure cont…
 Development of IEC strategy.
 Coordination and liaison
with all stakeholders.
 Monitoring and review of programme
activities at each level through
MIS, review meetings and field
observations.
 Release of funds and monitoring of
expenditure under NPHCE
 Organizing External evaluation and
coordinating Research in geriatrics and
NPHCE 7 Aug 2012 48

48. State NCD Cell
Composition: State NCD Cell will be
supported by following contractual staff
 State Programme Officer
 Programme Assistant
 Finance cum Logistics Officer
 Data Entry Operators (2)
7 Aug 2012 49

49. State contribution
 20% of the total expenditure
 Provision of land
 Support of lab services
 Provision of manpower in disciplines other than
medical specialty
 Additional support for medicines
 Maintenance of equipments, wards and OPD
7 Aug 2012 50

50. State NCD cont…
Role and responsibilities of the State NCD Cell:
 Preparation of State action plan for
implementation.
 Organize State & district level trainings for
capacity building
 Liaison with Regional Geriatric Centre for tertiary
Care, Training & Research.
 Ensure appointment of contractual staff
sanctioned for various facilities
 Release of funds to districts.
7 Aug 2012 51

51. State NCD cont…
 Maintaining State and District level data
on physical and financial progress of
NPHCE
 Monitoring of the programme through
HMIS, Review meetings, field
observations.
 Public awareness regarding health
promotion, prevention and rehabilitation
of the elderly and services made available
under NPHCE.
7 Aug 2012 52

52. District NCD Cell
Composition:
 District NCD Cell will be supported by
following contractual staff
◦ District Programme Officer
◦ Programme Assistant
◦ Finance cum Logistics Officer
◦ Data Entry Operator
7 Aug 2012 53

53. District NCD Cell cont…
Role and responsibilities of the District NCD Cell
 Preparation of District action plan.
 Maintain and update district database &
Conduct sub-district/ CHC level trainings for
capacity building
 Engage contractual personnel sanctioned for
various facilities in the district
 Maintain fund flow and submit UC.
 Convergence with NRHM activities & Other
Depts.
 Ensure availability of rehabilitative services
for the Elderly.
7 Aug 2012 54

54. Provision of health care facilities for
elderly at district level and below in
100 districts
7 Aug 2012 55

55. Programme Coverage at district level and
below
100 districts covering 21 states
Coverage in each district
 District Hospital – 1
All CHCs, PHCs & Sub-centers
7 Aug 2012 56

56. Phasing of physical targets
Physical 2010-2011 2011-2012
target
Establishment 8 Regional Inst. Fully functional Geriatric
of Geriatric Construction & Dept in 8 Regional Inst.
Department Manpower
at 8 Regional deployment etc.
Inst.
Setting up of 30 Districts 30 Districts
Geriatrics Construction and Fully functional Geriatric
Unit at 100 equipment & Unit
District Manpower 70 Districts
Hospitals deployment etc. Construction and
equipment
-Manpower deployment
7 Aug 2012 57

57. Identified States and 30 districts (2010-11)
States Districts States Districts
Andhra Pr. Nellore, Vijayanagram Madhya Pr. Ratlam
Assam Dibrugarh, Jorhat Maharashtra Washim, Wardha
Bihar Vaishali, Rohtas Sikkim East Sikkim
CH Bilaspur
Orissa Naupada
Gujarat Gandhi Nagar, Surendranagar
Punjab Bhatinda
Haryana Mewat
Rajasthan Bhilwara, Jaisalmer
HP Chamba
Uttrakhand Nainital
J&K Leh, Udhampur
Tamil Nadu Theni
Jharkhand Bokaro
Uttar Pr. Rae Bareli, Sultanpur
Karnataka Shimoga, Kolar
West Bengal Darjeeling
Kerala Pathanathitta
7 Aug 2012 58

58. 70 districts added in 2011-12
States Districts States Districts
Hoshangabad, Chindwara,
Srikakulam, Chittoor, Cuddapah, Madhya Pr.
Andhra Pr. Jhabua , Dhar
Krishna, Kurnool, Prakasham
Gadchiroli, Bhandara,
Assam Lakhimpur, Sibsagar, Kamrup Maharashtra
Chandrapur, Amaravati
Muzaffarpur, Paschim Champaran,
Bihar Sikkim South Sikkim
Poorva Champaran, Keimur
Jashpur Nagar, Raipur Balangir, Nabrangpur,
CH Orissa
Koraput, Malkangiri
Rajkot, Jam Nagar, Porbandar, Gurdaspur, Hoshiarpur
Gujarat Punjab
Junagarh
Jodhpur, Ganga Nagar,
Yamuna Nagar, Kurukshetra , Rajasthan
Haryana Bikaner, Barmer, Nagaur
Ambala
Uttrakhand Almora
HP Lahaul & Spiti , Kinnaur
Coimbatore, Virudhnagar,
J&K Kupwara, Doda (Erstwhile), Kargil Tamil Nadu
Toothukudi, Tirunelveli
Jharkhand Ranchi, Dhanbad Jhansi, Lakhimpur Kheri,
Udupi, Tumkur, Chikmagalur Farookhabad, Firozabad,
Karnataka Uttar Pr.
Etawah, Lalitpur,
Kozikode (Calicut), Allappuzha, Jalaun
Kerala
Idukki , Thrishur Jalpaiguri, Dakshin Dinajpur
West Bengal
7 Aug 2012 59

59. Activities under NPHCE at various levels
At Sub Centre level:
◦ Provision of walking sticks, calipers & other
supportive equipments to the needy elderly
◦ Information on healthy diet, yoga, and life style
diseases through charts, pamphlets
◦ Domiciliary visit to the house of elderly by ANM/
Male worker and maintenance of record
◦ Arrangement of ambulance for disabled bed
ridden elderly for referral to PHC/CHC.
7 Aug 2012 60

60. 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.
7 Aug 2012 61

61. 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. 7 Aug 2012 62

62. 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.
The medicines for general treatment will be
provided from the stock available at PHCs.
7 Aug 2012 63

63. 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
7 Aug 2012 64

64. Additional Staff Sanctioned at CHC level under NPHCE
Following items will be
made available at  Cervical traction
the CHC: (intermittent)
 Nebulizer  Walking for gait
 Glucometer training equipment
 ECG Machine  Walking Sticks /
 Pulse Oximeter Calipers
 Defibrillator  Shoulder Wheel
 Multi - Channel  Pulley
Monitor  Walker (ordinary)
 Shortwave  Cervical traction
Diathermy (manual).
7 Aug 2012 65

65. 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
 Drugs – 10 Lakhs 7 Aug 2012 66

66. Additional Staff Sanctioned at DH under NPHCE
7 Aug 2012 67

67. 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.
7 Aug 2012 68

68. Regional Geriatrics Centers
Sr
No Regional Institutes States Linked
1 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 Bengal
3 Grant Medical College & JJ Hospital, Maharashtra, Goa, Northern
Mumbai, Maharashtra, Districts of Karnataka,Chattisgarh
4 Sher-e-Kashmir Institute of Medical Jammu & Kashmir
Sciences, Srinagar, Jammu & Kashmir
5 Govt. Medical College, Kerala, Southern Districts of
Tiruvananthapuram, Kerala, Karnataka & Tamil Nadu
6 Guwahati Medical College, Guwahati, Assam & NE States
Assam
7 Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa
8 SN Medical College, Jodhpur, Rajasthan Rajasthan & Gujarat
7 Aug 2012 69

69. 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.
7 Aug 2012 70

70.  Specialized OPDs in all the specialties
available with them for the benefit of the
Elderly.
 Deployment of Specialists: Additional
contractual staff for Regional Geriatric
Centre recruitment will be made by the
Medical Institution.
 Drugs & consumables – 20 lakhs
 30 bedded geriatrics ward
7 Aug 2012 71

71. 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 country
Sr No State Medical College
1 Punjab PGIMER, Chandigarh
2 Uttar Pradesh KGIMS, Lucknow
3 Jharkhand Ranchi Medical College, Ranchi
4 West Bengal Kolkatta Medical College, Kolkata
5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd.
6 Karnataka Bangalore Medical College, Bangluru
7 Gujarat B.J.Medical College, Ahmadabad
8 Maharashtra Government Medical College, Nagpur
9 Orissa S.C.B.Medical College, Cuttack
10 Tripura Agartala Medical College, Agartala
11 Madhya Pradesh Gandhi Medical College, Bhopal
12 Bihar Patna Medical College, Patna
7 Aug 2012 72

72. Machinery and equipment required at RGC
7 Aug 2012 73

73. Additional Staff Sanctioned at RGC under NPHCE
7 Aug 2012 74

74. Activities at State level
A. Community awareness.
B. Planning, Monitoring & Supervision.
C. Training
D. Financial Management
7 Aug 2012 75

75. Responsibility of reporting, flow of
information and frequency of reporting
7 Aug 2012 76

76. Training of Human Resources
 Plan for training institutions, duration, broad
curriculum & preparation of training
calendar for
◦ Doctors
◦ Nurses
◦ Physiotherapist/ Rehabilitation Workers
◦ Medico-social Worker
◦ ANM, and Male Health Worker
 Training guidelines and financial norms
developed under NPCDCS will be applied for
training under NPHCE.
 Financial Management for various
components.
7 Aug 2012 77

77. Detailed training plan of staff
7 Aug 2012 78

78. Training at various level
MOHFW – Nodal Agency
Regional Training / PHI
TOT - DPO / MO
DTT/DH – District level
training
CHC – Health worker training
7 Aug 2012 79

79. Activities at Central level
A. Selection of States and Districts
B. Information, Education & Communication
C. Support to Regional Geriatric Centers
D. Training through RGC & along with
NPCDCS
E. Monitoring, Evaluation and Research
through State & Independent
7 Aug 2012 80

80. FINANCIAL GUILDEINES
 Financial management groups (FMG) of
Programme Management are established
under NRHM
 The funds will be released to States/UTs
through the State Health Society. Funds
release from State to District Health
Society for CHCs, PHCs and Sub- centers
to cover the entire District.
7 Aug 2012 81

81. Financial Guidelines contd…
 State shall have the flexibility for inter-
usability of funds from one component to
another limited to a ceiling of 10%.
 NPHCE would operate through NCD Cells
constituted under NPCDCS at State and
District levels.
 A separate bank account in a nationalized
bank should be opened for NPHCE.
7 Aug 2012 82

82. Assistance for Sub Centre
Assistance for Primary Health
Centre
7 Aug 2012 83

83. Assistance to Community Health Centers
7 Aug 2012 84

84. Assistance to District Hospital
7 Aug 2012 85

85. Assistance for Regional Geriatric Centre
7 Aug 2012 86

86. Financial Assistance to States
 Construction of Building
 Equipments
 Drugs and consumables
 Manpower recruitment
 IEC and Research
 Training of manpower
7 Aug 2012 87

87. Proposed Financial Assistance
during 11th plan
Items RMI DH CHC PHC S. C
construction 2 crore 80 lakh - - -
Equipments 1.7 crore 10 lakh 1 lakh Rs.50000 Rs.32000
Drugs 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
7 Aug 2012 88

88. Achievements
 Developed operational guidelines
 1st installment released to 27districts in
2010-11 and 48 districts in 2011-12
 1st installment released to all the 8 RMI
 MOU signed with – 18 States
 Submitted 12th plan proposal- all the
States/districts proposed to be covered
7 Aug 2012 89

89. Issues for consideration
• Create awareness among
policy maker & programme
officers
• Training of manpower
• Utilization of released Budget
• Monitoring & Maintenance of
database
7 Aug 2012 90

90. Release of Fund
Amount Amount
No. of No. of
Year released released
districts RMI
(crore) (crore)
2010-11 27 60 4 41.15
2011-12 48 75 4 30.31
Total 75 135 8 71.46
7 Aug 2012 91

91. Manpower provision at RGC
Sr. Staff Salary No Total (in
No (per month ) thousands)
1. Professor in Geriatrics Rs. 75,000/- 1 75
2. Asstt. Professor Geriatrics Rs. 50,000/- 2 100
3. Medical Officer Rs. 40,000/- 4 160
3. Nurses Rs. 15,000/- 16 240
4. Physiotherapist (3) and OT (1) Rs. 15,000/- 4 60
5. Medical Social Worker Rs. 15,000/- 1 15
6. Lab Technician Rs. 15,000/- 1 15
7. Program Assistant Rs. 12,000/- 1 12
8. Hospital Attendant Rs. 7,500/- 4 30
9. Sanitary Attendant Rs. 7,500/- 4 30
Total 38 737
7 Aug 2012 92

92. Manpower at District Hospital
and CHC
Sr. Staff Salary per No. Total
No. month (per month)
(Rs.) (In thousands)
1 Consultant in Medicine 50, 000 /- 2 100
2. Nurses 15,000/- 6 90
3. Physiotherapist 15,000/- 1 15
4. Hospital Attendants 7,500/- 2 15
5. Sanitary Attendants 7,500/- 2 15
Total 13 235
Rehabilitation Unit at CHC
1 Multi rehabilitation Worker-1 15,000/- 1 15
Total 1 15
7 Aug 2012 93

93. EXPENDITURE ON CONSTRUCTION AND FURNITURE
(Rs. In crore)
Component Sr. Activity level Unit 2010-11 2011-12 Total
No. Cost
1 District 0.8 25.60 38.40 64.00
Construction
cost with
furniture 2 Regional 2.00 08.00 08.00 16.00
Institutions
Total 33.60 46.40 80.00
7 Aug 2012 94

94. EXPENDITURE ON MACHINERY AND EQUIPMENT
(Rs. In crore)
S. Activity
Component Unit Cost 2010-11 2011-12 Total
No. level
1 PHC 0.005 6.40 9.60 16.00
CHC
2 0.01 3.20 4.80 8.00
Machinery &
Equipments
District
3 0.1 3.20 4.80 8.00
Regional
4 1.7 6.80 6.80 13.60
institutions
Total 19.70 26.00 45.60
7 Aug 2012 95

95. Expenditure on central and state activities
(Rs. In crore)
ACTIVITY
COMPONET Year Wise Cost TOTAL
LEVEL
2010-11 2011-12
Monitoring &
Evaluation Central 1.20 0.93 2.13
(Recurring)
Total 2.13
Office Expenses
State 0.55 0.55 1.10
(Recurring )
Total 1.10
7 Aug 2012 96

96. Year wise cost on Drugs and Consumables
(Rs. In crore)
Units Nos.
Activity
Components Unit cost Total cost
level
2010-11 2011-12
District
32 80 0.1 11.20
Drugs and
Consumable
s Regional
4 8 0.2 2.40
Institutes
Total 13.60
7 Aug 2012 97

97. Year wise cost on training at each level of activities
(Rs. In crore)
Units Nos.
Compone Activity Total
2010- Unit cost
nt level 2011-12 cost
11
PHC 1280 1920 0.0032 10.24
Training CHC 320 480 0.0115 9.20
(Recurring) Districts 32 48 0.007 0.56
Regional
4 4 0.05 0.40
Institutes
Total 20.40
7 Aug 2012 98

98. Year wise cost on Research and IEC activities and
Miscellaneous Expenditure (Rs. In crore)
Units No
Activity
Componen Unit Cost Total
Level 2010-11 2011-12
t
Regional
Research 4 8 0.5 6.00
Institutes
Awareness
& IEC District 32 80 0.05 5.60
(Recurring)
Miscellaneous
Expenditure Sub-Centre 6400 9600 0.0032 51.20
on Calipers
7 Aug 2012 99

99. Cost on Manpower
Units Nos.
Unit cost Total cost
Component Activity
(crore) (crore)
s level
2010-11 2011-12
CHC 320 800 0.018 20.16
District 32 80 0.282 31.58
Manpower
Cost
Regional
(Recurring) 4 8 0.8844 10.61
Institutes
Total 62.36
7 Aug 2012 100

100. Proposed MONITORING strategy
◦ Integrated monitoring by NCD Cells at centre , States,
districts and CHCs.
◦ Monthly Progress Report to be submitted by NCD cells.
◦ RDs of the respective states to coordinate in monitoring
activities between centre and state nodal officers
◦ Half yearly progress review meeting for assessing the
status of implementation of the programme activities.
◦ Yearly Combined field visit by Central and State Cells for
on the spot assessment of progress of the activities.
7 Aug 2012 101

101. REFERENCES
 National Program for Health Care of the Elderly (NPHCE) :
Towards active and healthy ageing. Operational Guidelines.
Director General of Health Services, MOHFW, Government of
India.
 Situation Analysis of The Elderly In India, June 2011. Central
Statistics Office, Ministry of Statistics & Programme
Implementation, Government of India
 Rajan SI. Population ageing and health in India. The Centre for
Enquiry into Health and Allied Themes (CEHAT), Mumbai. July
2006.
 National Policy on Older Persons (1999). Ministry of Social
Justice and Empowerment, Government of India, Shastri
Bhawan, New Delhi.
 Maintenance and Welfare of Parents and Senior Citizens Act –
2007, Ministry of Social Justice and empowerment Government
of India
 Morbidity, Health care and the Condition of the aged. NSSO
(64th round)Jan-June 2004, National Sample Survey
Organization, Ministry of Statistics and Programme
Implementation, Government Aug India, March 2006.
7 of 2012 102

102.  Two years (2009-2011) Achievements and New
Initiatives. NRHM, Ministry of Health and Family
Welfare, Government of India.
 Ingle GK, Nath A. Geriatric Health in India:
Concerns and Solutions. Indian J Comm Med,
2008; 33 (4); 214-18.
 Prevention & Control of Non-Communicable
Diseases (NCDs): Proposal for the 12th Plan,
Report of the Working Group on Disease Burden:
Non-Communicable Disease (NCDs), Director
General of Health Services, MOHFW, Government
of India.
 Planning Commission. 11th five year plan (Draft),
Government of India; Accessed on 27/02/2012 at
URL: http://www.planningcommission.nic.in
7 Aug 2012 103

103. Thank you!!!