Policy, Programs and Future Directions for Ageing Population

Abstract

India is home to about 110 million aged persons who account for 8.6% of total India’s population and represent country’s fastest growing segment. Projections estimate 55% increase in general population from year 2000 to 2050 while 60 + and 80 + persons will increase by 325% and 700% respectively in this period. 2/3rd of India’s aged are rural and 1/3rd are poor. Average social parameters for India’s aged indicate a 43.5% literacy rate, 14.2 as old age dependency and 5.2% living alone. Health parameters like life expectancy at age 60, physical immobility and chronic disease prevalence among the aged are 17 years, 7.8% and 45% respectively. A sizable proportion of aged persons perceive their health as poor and complain of some recent ailment. Recognizing diverse needs of such vast population, the Indian Government launched a National Policy of Older Persons (NPOP) in 1999 addressing several issues including their health and socio-economic security. Although the policy highlights the role of many non-state actors including NGOs and the aged persons themselves, it is heavily weighted in favour of delivering programs through strengthening its already existing inter-sectorial infrastructure. An inter-ministerial Committee and a National Council for Older Persons (NCOP) were constituted for its implementation. However, in the absence of clear time bound Plans of Action and proper budgetary provision, implementation of the policy has remained slow. Inadequate reach of services to rural end users, failure to harness the benefits of new and emerging Indian economic order and changing socio-demographic scenarios are other limiting factors. In 2010, the Government constituted a Committee to review this policy with emphasis on 4 major areas namely the oldest old, Female elderly, rural elderly and harnessing the technological advances. Currently, many Ministries are involved in implementing various components of NPOP but there are 4 core Ministries which provide large chunk of services and these are Ministry of Health & Family Welfare (MOHFW), Ministry of Social Justice & Empowerment (MOSJE), Ministry of Rural Development (MORD) and Ministry of Panchayat Raj (MOPR). This paper provides insight into various national programs and services for aged persons in India. A brief description of activities running in Indian States and Union Territories with specific examples of India’s smallest state, the capital city of Delhi has been included. Towards the end, future directions with proposals for innovation to serve the aged better have been provided. National Programs described below include National Social Assistance Programme (NSAP), Integrated Programme for Older Persons (IPOP), National Programme for the Health Care of the Elderly (NPHCE), Maintenance and Welfare of Parents and Senior Citizens (MPWSC) Act of 2007, Rashtriya Swasthya Bima Yojna, a health insurance scheme and other programs. NSAP (MORD) was launched in 1995 and among other schemes; it includes Indira Gandhi National Old Age Pension Scheme (IGNOAPS) and Annapurna Scheme. It was revised in 2014. The Programme provides a pension of Rs.200/- per month for 60 + aged persons and Rs.500/- for 80 + belonging to BPL (below poverty line) category. As of 2013–2014, there were 21 million beneficiaries under IGNOAPS with more than half a million rupees as expenditure. Recent figures under NSAP stand at about 32 million beneficiaries. Shortcomings of NSAP include low awareness of programme, inadequate pension amount, difficulties in beneficiary identification and need for complex administrative machinery. Under Annapurna Scheme, 10 kg of food grains is given monthly to those eligible aged persons who have remained uncovered under IGNOAPS. IPOP (MOSJE) was launched in 1992 and was revised in 2008 and 2016. It pioneers multiple services including old age homes, day care centres and health in rural and remote areas through NGOs and other Bodies without day to day involvement of the government but its poor awareness and time consuming monitoring of its projects are some of the limitations. NPHCE (MOHFW) was launched in 2011 on a pre-existing administrative base of National Health Mission and infrastructure for Non-Communicable diseases and has good financial outlay. However it seems to have multiple objectives on a weak public health structure and slow development, sluggish fund flow and deficiency of services and trained staff are its limitations. MWPSC ACT (MOSJE) notified in 2007 is a step towards welfare and dignity of the aged persons and holds children responsible to care for their aged. Its low awareness and slow progress about its health facilities and old age homes are the limitations. RSBY (MOHFW) is a PPP model and its new Avtar, National Health Protection Scheme (NHPS) is for providing health insurance for millions of Indian families where aged persons can also get coverage. Rashtriya Vayoshri Yojna is meant to provide physical aids to BPL aged persons for age related disabilities while other national programs covering cancer, diabetes, cardiovascular disease, stroke, blindness, deafness, mental health, oral health, etc. are also available although not exclusive for the aged. Several NGOs in the country also provide services to aged persons at their doorsteps and try to link them with institution based public services. They run programs for their empowerment, shelter, rehabilitation, income generation, social engagement, respite and palliative care and provide health care to those afflicted with cataracts, dementia, cancer and other ailments. Programs from States and Union Territories Almost every State supplements IGOAPS old age pension by providing its own pension for their aged. The amount varies. For Delhi, it is Rs.2000/- for 60–70 years old and Rs.2500/- for 70 + . States also participate in various above-mentioned national programs. Delhi’s major hospitals provide separate queues, registration counters, OPD rooms, out of turn laboratory test facilities and Sunday special clinics for their aged persons. In addition, Delhi government runs recreation centres, old age homes and security and helpline services with assistance from Police and NGOs. Future Directions These include (i) innovating for better convergence and decentralized delivery of multiple services for the end user, (ii) creating strong public private partnerships as substitute for some poorly functioning public services, (iii) harnessing the benefits of statuary provisions from the corporate world for elderly services, (iv) capitalizing on the useful services provided by NGOs and (v) tapping the potentials of the aged persons themselves.