PasteETHICS IN PUBLIC HEALTH
Case Study: The National Programme for Health Care Of Elderly
The national policy on older persons by the government of India defines senior citizen or elderly as a person who is 60 years old or above. In India, the elderly population accounts for 100 million and is expected to triple by 2050 constituting 20% of the population, projecting a demographic change with implication on the socio economy of the country. The 2011 census shows that almost 13% of the population of Kerala are elderly and is ranking first in the proportion of elderly in the country.
The NSSO data 1995, Kerala ageing survey (2005) says almost 50% of the elderly are ill and two by third of them have more than two co morbidities. Irrespective of the socio economic status non communicable diseases are common in elderly. The other important facts about elderly are
• The old age dependency ratio is 13.1%
• Only 32% of the elderly avail pensions of any kind
• About 65% of the aged depend on others for the day to day maintenance. Among economically dependent elderly men 6-7% was financially supported by their spouses, almost 85% by their own children, 2% by grand children and 6% by others. Of elderly women, less than 20% depended on their spouses, more than 70% on their children, 3% on grand children and 6% or more on others
• The 2002 data shows a minimum monthly per capita expenditure of RS 420 in rural and Rs 665 in urban elderly per year
• Statistical data published by Govt. of India on elderly shows that cardio vascular disorders account for one-third of elderly mortality. Respiratory disorders account for 10% mortality while infections including tuberculosis account for another 10%. Neoplasm accounts for 6% and accidents, poisoning, and violence constitute less than 4% of elderly mortality
• More than 50% of the elderly suffer from one or more disabilities and the most common disability is the loco motor disability
• In a need assessment survey conducted among urban elderly by the HelpAge India nearly 42% of the elderly reported need for physical assistance for their medical needs including medicine purchase
• The average life expectancy of females in Kerala is higher than that of males and thus females form the majority of the aged population. Due to this and because of the difference in the age of marriage 58% of the aged women above 60 years are widows.
The factors which make the elderly not seeking health care are the problems with accessibility, affordability and other social barriers including gender and lack of support. The general health care system of India is taking care of the elderly and there is less sensitization to the needs of the elderly. There is no adequate coverage of Geriatrics in the medical curriculum. Also there is huge gap in the manpower of geriatrics. An urban rural difference in health care is also evident in the country. In this context, it is a need to give emphasis on a policy to address different aspects of vulnerability and to ensure the basic support to them.
National program for health care of elderly
The central government came out with the National Policy for Older Persons in 1999 to promote the health and welfare of senior citizens in India. The national programme for health care of elderly was launched during the 11th Five-Year Plan period. The NPHCE is an expression of the International and national commitments of the Government as envisaged under the UN Convention on the Rights of Persons with Disabilities, National Policy on Older Persons adopted by the Government of India in 1999 and Section 20 of “The Maintenance and Welfare of Parents and Senior Citizens Act, 2007”, with the vision of providing accessible, affordable, and high-quality long-term, comprehensive and dedicated care services to an ageing population and to promote the concept of Active and Healthy Ageing. The main objective of the programme is to provide preventive, curative and rehabilitative services to the elderly persons at various levels of health care delivery system of the country. Its other objectives are to strengthen referral systems, to develop specialised manpower and to promote research in the field of diseases related to old age.
Core Strategies to achieve the Objectives of the programme are:
1) Community based primary health care approach including domiciliary visits by trained health care workers.
2) Dedicated services at PHC/CHC level including provision of machinery, equipment, training, additional human resources (CHC), IEC, etc.
3) Dedicated facilities at District Hospital with 10 bedded wards, additional human resources, machinery & equipment, consumables & drugs, training and IEC.
4) Strengthening of 8 Regional Medical Institutes to provide dedicated tertiary level medical facilities for the Elderly, introducing PG courses in Geriatric Medicine, and in-service training of health personnel at all levels.
5) Information, Education & Communication (IEC) using mass media, folk media and other communication channels to reach out to the target community.
As part of the National Programme for the Health Care for the Elderly (NPHCE), the National Rural Health Mission (NRHM) launches clinics for geriatric care across the state. The programme also stresses on providing high quality services through geriatric special care and especially to build capacity at the local level for geriatric care to support elderly and capacity building at the local level for comprehensive geriatric care. The implementation of the schemes is multi structured with different players from state, regional, districts and primary levels with more community participation. The program stresses on ensuring the participation of the different layers of federal structure in management, implementation and fund allocation at different levels. It addresses most of the health care problems in an institutional framework.
Ethical/Moral Dilemma
The high priority area of the programme is the institutionalised care. The medical framework of the program is insufficient to address the disabilities and chronic illnesses that more than 50% of the elderly suffers and who are in need of everyday home care rather than specialised institutional care. Since India still has family as the primary care giver to the elderly a trade off between institutional care and home based long term care need exists. Family support and informal long term care are also needed to be addressed in the programme. The programme focuses on providing institutional care, but not on how they will access it and how more than half of the elderly who are economically dependent on others will afford the care. Thus the program does not address the economic dependency of the elderly and no economic support is given to the health care providers at home.
Apart from non communicable diseases there are mental health problems, malnutrition, various communicable diseases such as tuberculosis which are prevalent among the elderly. A comprehensive programme is needed which prioritises the health needs accordingly. Indian elderly differ vastly in their socio-cultural, economic aspects as well as in health parameters and needs. Hence, a single uniform approach in solving problems of majority needs remains as a question and a decentralised approach sensitizing the regional needs has to be put forward. The elderly people who are destitute, institutionalised elderly, people living alone are not mentioned and totally left out from the program. Considering the fact that 58% of the aged women above 60 years are widows, the program is not gender sensitive. The quality of life being the relevant issue in elderly, the freedom of choice and the autonomy also needs to be addressed.
Questions
1. How the program does addresses the differentials of elderly based on gender?
2. What are the programme implications for the elderly in special situations such as institutionalised elderly and people living alone?
3. How are the needs be addressed in the programme in terms of long term home based care?
4. Are the programme provisions adequate to meet the diverse needs of the elderly?
• diversity of diseases such as NCDs, mental illness etc
• differences in social situation, living conditions
• diversity in physical needs such as nutrition
your essay in here…