Seminar nphce

• 1. NATIONAL PROGRAMME FOR HEALTH CARE OF ELDERLY Dr Abhay Dhanorkar7 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 ofNPHCE Activities under NPHCE at various levels Financial guidelines Evaluation Achievement References7 Aug 20122 3. INTRODUCTION Over the past few years, the worlds populationhas continued on its remarkable transition pathfrom a state of high birth and death rates to lowbirth and death rates coupled with improvementin health services & standard of living. At the heart of this transition has been thegrowth in the number and proportion of olderpersons. Such a rapid, large and ubiquitous growth hasnever been seen in the history of civilization. The current demographic revolution is predictedto continue well into the coming centuries.7 Aug 20123 4. BY Definition.60-6970-79 80+ OldOld - Old Oldest- Old Source: National Policy on Older Person 1999 GOI60-74 75- 84 85+Young Old Middle oldOld-OldSource:http://www.agingstats.gov/agingstatsdotnet/Data/2008_Documents/Population.aspx 5. Global scenario of elderly population16 14.9 13.41412.21211% 10.29.9108 Percentage aged 60 or6 over (%)4202000 2005 2010201520202025 YearSource: United Nations Population Division 2008 (http://esa.un.org/unpp) 7 Aug 2012 5 6. World Population trend of 60+ Years1980-2020 (in millions)19801990200020102020 World381.2 484.7 608.7 754.21011.6 Developed173.3 203.6 234.6 232.4 308.2 Developing 207.9 281.8 374.1 491.8 703.4Asia (excl. Japan) 160218.2 290 377.7 539.9China78.6 101.2 131.7 167.9 238.9India44.660.2 81.4107 149.7 United Nations,World Demographic Estimate and Projections 7. Changing world Scenario The world will have morepeople who live to see their80s or 90s than ever before. The past century has seenremarkable improvementsin life expectancy. Soon, the world will havemore older people thanchildren. The world population israpidly ageing. Low- and middle-income Source :WHO 2010countries will experiencethe most rapid and dramaticdemographic change. 7 Aug 20127 8. Age distribution of population in India over years Census 2001 7 Aug 20128 9. Ageing: The Indian Scenario India is one of the fewcountries in the world wheresex ratio of aged is in favour ofmales.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 IndiaSource: United Nations Population Division 2008 (http://esa.un.org/unpp173.18180m 160 143.24il 140118.1l 120 98.47i83.5810076.6on 80s 604020 20012006 20112016 2021 2026 Year 7 Aug 201210 11. Expectancy of life at birth and future projection inIndia Census 200167.92Age 66.44 64.6562.85Year 7 Aug 2012 11 12. Life Expectancy at 60 years (WHO-2009)30 26 2525 242320 19 17171616151514CountryLife Expectancy in Years10507 Aug 2012 12 13. Socio-demographic profile of theelderly in India. Elderly persons lives in rural75%area.48%Women73%Illiterate and dependent. Source : Census66%BPL 2001 Were in vulnerable situation66% 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 201216 16. Life-course Perspective for maintenance ofhighest possible level of functional capacityFunctional CapacityLife curve of highestFunctional capacityDisability thresholdRangeoffunctionLife curve of reducedFunctional capacityAge* Change in the external environment can lower disability threshold 7 Aug 201217 17. Health risks of elderlyPRONE FOR INCRASED INFECTIONS RISK OF DEATHINCREASED PRONE FORRISK OF DISABILITYINJURIESINCREASEDPRONE FOR RISK FOR PSYCHOLOGICDISEASE AL PROBLEMSPRONE FORDEGENERATIVEDISORDERS 7 Aug 2012 18 18. COMMON MORBIDITIES IN ELDERLY IN INDIACataract &Visualimpairment- 88%Arthritis & locomotiondisorder-40%CVD &HT 18%Neurological problems- 18% Respiratoryproblemsincluding Chronic bronchitis- 16% GIT problems 9%PsychiRef ICMR study 2001atricproblems- 9% 7 Aug 2012 19Delhi & Hariyana 19. Prevalence of common health problems in elderlyGOI study-2007Percentage Health Problem7 Aug2012 20 20. Mortality in elderly33% CVD10%Respiratory diseases10% Infections,TB6%Neoplasm4%Accidents, poisoning and violence17deaths by chronic diseases by% 2015 7 Aug 2012 21 21. Need for Dedicated Health care for elderly ?Decrease in physical ability / Economic inadequacyIncrease vulnerability to diseasesChronic, disabling and multiple Health problemsDifferent approach and managementDegradation in family valuesRising Population7 Aug 2012 22 22. Major constraints for geriatric health careLack of specialized and trained manpower Geriatrics not yet a popular No dedicated specialty health care ( MDMadras infrastructureMedicalCollege)7 Aug 201223 23. Major Govt. initiativesNational Policy On Older Persons (NPOP) -1999Recommendations by working group of planningcommission -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 Careof Elderly by Ministry of Finance - June 20107 Aug 201224 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 201225 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. fundedhospitals shall provide beds for senior citizensas far as possible. Separate queues be arranged for seniorcitizens. Facility for treatment of chronic, terminal anddegenerative diseases is expanded for seniorcitizens Research activities for chronic elderly diseasesand ageing is expanded Earmarked facilities for geriatric patients inevery district hospital. 7 Aug 201227 27. Extract of Finance Ministers Budget Speech 2008-09The other major intervention will be for the elderly. ANational Programme for the Elderly with a Plan outlay ofRs. 400 crore will be started in 2008-09. Among othermeasures, we will establish, during the XIth Plan Periodtwo institutes of aging eight Regional Centres and aDepartment of Geriatric Medical Care in one of the MedicalColleges/Tertiary level Hospitals in each State.7 Aug 2012 28 28. NATIONAL PROGRAMME FOR HEALTH CARE OFELDERLY (NPHCE-2010)NPHCE 20107 Aug 201229 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 201230 30. Objectives Provision of dedicated health care facilities atvarious level of State health care delivery systemwith referral support. Human resource development in geriatricHealth. Strengthening of preventive, promotive andrehabilitative 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, trainiresources,courses in ng, additionalGeriatric human resources Medicine, and(CHC), IEC,trainingCommunitylevel -IEC using mass domiciliary Coremedia, folk mediavisits by trained Strategiesand other health carecommunicationworkers. 7 Aug 201232 32. Supplementary Strategies for NPHCE MainstreamingAYUSH and Promotion of convergence with Reorienting public privateprogrammes of medicalpartnerships in Ministry of Social education to Geriatric Justice and support geriatric Health Care. Empowerment in issues. the field ofgeriatrics. 7 Aug 201233 33. Major Components of the programme 1. Geriatric Department in 8 Regional medicalInstitutions/ 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 atsub centers7 Aug 201234 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 201235 35. Package of Services The range of services will include Health promotion Preventive services Diagnosis and management of geriatric medicalproblems (out and in-patient) Day care services Rehabilitative services Home based care Districts will be linked to Regional Geriatric Centers forproviding tertiary level care. Integration with existing primary health care deliverysystem and vertical at district and above as morespecialized health care are needed for the elderly.7 Aug 2012 36 36. ORGANIZATIONAL STRUCTURE 7 Aug 201237 37. Services at Sub-centre Health Education related to healthyageing Domiciliary visits to home bound /bedridden elderly persons . Arrangefor suitable calipers andsupportive devices. Linkage with other support groups andday care centers. 7 Aug 2012 38 38. Services at PHC Weekly geriatric clinic by a trained Medical Officer Conducting a routinehealth assessment(eye, BP, blood sugar & record keeping). Provision of medicines and proper advice on chronicailments Public awareness on promotional, preventive andrehabilitative aspects of geriatrics during health andvillage sanitation day/camps. Referral services.7 Aug 2012 39 39. Services at District Hospital Geriatric Clinic for regular dedicated OPD services tothe 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 201241 41. Institutional framework for the implementation of NPHCEProgram Structure-Integration with NRHM Financial management group (FMG) ofProgramme Management support units atstate and district level, which is establishedunder NRHM, will be responsible forfinancial management Maintenance of accounts Release of funds Expenditure reports Utilization Certificates Audit arrangements7 Aug 2012 42 42. Funding for ProgramFunds from Governmentof India (80%) State Health SocietyState Level Activity District levels Society( NCD Cell ) District Level Activity CHC / PHC /SC7 Aug 201243 43. State Health Society (SHS) Under the NRHM framework differentSocieties of national programmes such asRCH, Malaria, TB, Leprosy, NBCP havebeen merged into a common State HealthSociety. Chief Secretary Chairperson Principal Secretary (H&FW)-vice chair person Mission director - Member -Secretary 7 Aug 201244 44. District Health Society (DHS) All programme societies have beenmerged 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 201245 45. Management StructureNational NCD Cell The NCD Cell constituted at the centrallevel for planning, monitoring andimplementationoftheNationalProgramme for Prevention and Control ofCancer, Diabetes, CVD and Stroke(NPCDCS) will also be responsible forNPHCE.7 Aug 201246 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 201247 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 OrganizingExternal evaluation and coordinating Research in geriatrics and NPHCE 7 Aug 201248 48. State NCD CellComposition: State NCD Cell will besupported by following contractual staff State Programme Officer Programme Assistant Finance cum Logistics Officer Data Entry Operators (2) 7 Aug 201249 49. State contribution 20% of the total expenditure Provision of land Support of lab services Provision of manpower in disciplines other thanmedical specialty Additional support for medicines Maintenance of equipments, wards and OPD 7 Aug 2012 50 50. State NCD contRole and responsibilities of the State NCD Cell: Preparation of State action plan forimplementation. Organize State & district level trainings forcapacity building Liaison with Regional Geriatric Centre for tertiaryCare, Training & Research. Ensure appointment of contractual staffsanctioned for various facilities Release of funds to districts.7 Aug 201251 51. State NCD cont Maintaining State and District level dataon physical and financial progress ofNPHCE Monitoring of the programme throughHMIS,Review meetings, fieldobservations. Publicawareness regarding healthpromotion, prevention and rehabilitationof the elderly and services made availableunder NPHCE. 7 Aug 2012 52 52. District NCD CellComposition: District NCD Cell will be supported byfollowing contractual staff District Programme Officer Programme Assistant Finance cum Logistics Officer Data Entry Operator 7 Aug 201253 53. District NCD Cell contRole 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 201254 54. Provision of health care facilities for elderly at district level and below in100 districts7 Aug 201255 55. Programme Coverage at district level andbelow 100 districts covering 21 states Coverage in each district District Hospital 1All CHCs, PHCs & Sub-centers 7 Aug 201256 56. Phasing of physical targetsPhysical 2010-2011 2011-2012targetEstablishment 8 Regional Inst. Fully functional Geriatricof GeriatricConstruction & Dept in 8 Regional Inst.DepartmentManpowerat 8 Regional deployment etc.Inst.Setting up of 30 Districts 30 DistrictsGeriatricsConstruction and Fully functional GeriatricUnit at 100 equipment &UnitDistrictManpower 70 DistrictsHospitals deployment etc.Construction and equipment -Manpower deployment 7 Aug 2012 57 57. Identified States and 30 districts (2010-11)StatesDistricts StatesDistrictsAndhra Pr.Nellore, Vijayanagram Madhya Pr.RatlamAssam Dibrugarh, Jorhat Maharashtra Washim, WardhaBihar Vaishali, RohtasSikkimEast SikkimCHBilaspurOrissaNaupadaGujarat Gandhi Nagar, SurendranagarPunjabBhatindaHaryana MewatRajasthan Bhilwara, JaisalmerHPChambaUttrakhandNainitalJ&K Leh, UdhampurTamil NaduTheniJharkhand BokaroUttar Pr. Rae Bareli, SultanpurKarnataka Shimoga, KolarWest Bengal DarjeelingKeralaPathanathitta7 Aug 201258 58. 70 districts added in 2011-12States DistrictsStatesDistrictsHoshangabad, Chindwara, Srikakulam, Chittoor, Cuddapah,Madhya Pr.Andhra Pr.Jhabua , Dhar Krishna, Kurnool, PrakashamGadchiroli, Bhandara,AssamLakhimpur, Sibsagar, KamrupMaharashtraChandrapur, Amaravati Muzaffarpur, Paschim Champaran,Bihar SikkimSouth Sikkim Poorva Champaran, Keimur Jashpur Nagar, RaipurBalangir, Nabrangpur,CHOrissaKoraput, Malkangiri Rajkot, Jam Nagar, Porbandar,Gurdaspur, HoshiarpurGujarat Punjab JunagarhJodhpur, Ganga Nagar, Yamuna Nagar, Kurukshetra ,RajasthanHaryana Bikaner, Barmer, Nagaur AmbalaUttrakhandAlmoraHP Lahaul & Spiti , KinnaurCoimbatore, Virudhnagar,J&KKupwara, Doda (Erstwhile), KargilTamil NaduToothukudi, TirunelveliJharkhandRanchi, DhanbadJhansi, Lakhimpur Kheri, Udupi, Tumkur, Chikmagalur Farookhabad, Firozabad,Karnataka Uttar Pr.Etawah, Lalitpur, Kozikode (Calicut), Allappuzha,JalaunKerala Idukki , ThrishurJalpaiguri, Dakshin DinajpurWest Bengal 7 Aug 201259 59. Activities under NPHCE at various levelsAt Sub Centre level: Provision of walking sticks, calipers & othersupportive equipments to the needy elderly Information on healthy diet, yoga, and life stylediseases through charts, pamphlets Domiciliary visit to the house of elderly by ANM/Male worker and maintenance of record Arrangement of ambulance for disabled bedridden elderly for referral to PHC/CHC.7 Aug 201260 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 201261 61. At PHC level:The weekly geriatric clinicby trained medical officer. Coordination with CHC, district hospital, subcenters, other National Health Programmes/Departments for medicines, ambulances Training of manpower & Separate registrationcounter for elderly. Public awareness during health and villagesanitation day/camps. Provision of medicine to the elderly for theirmedical ailments. 7 Aug 2012 62 62. Following items will be made available at thePHC: 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 beprovided from the stock available at PHCs.7 Aug 201263 63. At RH/CHC level: First level medical referral centre for medical careand rehabilitation services Twice weekly health clinics for the elderly persons Rehabilitation unit Domiciliary visits for care of disabled persons by Multirehabilitation worker Referral Services to DH Training of staff7 Aug 2012 64 64. Additional Staff Sanctioned at CHC level under NPHCEFollowing items will bemade available at Cervical tractionthe CHC:(intermittent) Nebulizer Walking for gait Glucometertraining equipment ECG Machine Walking Sticks / Pulse OximeterCalipers Defibrillator Shoulder Wheel Multi - Channel PulleyMonitor Walker (ordinary) Shortwave Cervical tractionDiathermy (manual). 7 Aug 2012 65 65. At District Hospital level Regular Geriatric OPD with Specialty Care forElderly. Geriatric Ward (10-bedded) for in-patient careto the Elderly. Training to the Medical officers andparamedical staff of CHCs and PHCs Camps for Geriatric Services in PHCs/CHCsand other sites Referral services for severe cases to tertiarylevel hospitals/ Regional Geriatric Centers Drugs 10 Lakhs 7 Aug 201266 66. Additional Staff Sanctioned at DH under NPHCE 7 Aug 2012 67 67. Following items will be made available at theDistrict 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 CentersSrNoRegional InstitutesStates Linked1All India Institute of Medical Sciences, Delhi, Haryana, Uttarakhand, New DelhiPunjab Himachal Pradesh, M.P.2Institute of Medical Sciences, Banaras Uttar Pradesh, Bihar, Jharkhand, Hindu University, Uttar PradeshWest Bengal3Grant Medical College & JJ Hospital, Maharashtra, Goa, Northern Mumbai, Maharashtra, Districts of Karnataka,Chattisgarh4Sher-e-Kashmir Institute of MedicalJammu & Kashmir Sciences, Srinagar, Jammu & Kashmir5Govt. Medical College, Kerala, Southern Districts of Tiruvananthapuram, Kerala, Karnataka & Tamil Nadu6Guwahati Medical College, Guwahati,Assam & NE States Assam7Madras Medical College, Chennai, TN. Tamil Nadu, Andhra Pradesh, Orissa8SN Medical College, Jodhpur, Rajasthan Rajasthan & Gujarat7 Aug 2012 69 69. At Regional Geriatric Centers level Provide tertiary levelservices forcomplicated/serious Geriatric Cases. Post graduate courses in Geriatric Medicine. Training to the trainers of identified Districthospitals and Medical Colleges. Developing evidence based treatmentprotocols for Geriatric diseases prevalent in thecountry. Developing/and updating Training modules &guidelines and IEC materials. Research on specific elderly diseases.7 Aug 2012 70 70. Specialized OPDs in all the specialtiesavailable with them for the benefit of theElderly. Deployment of Specialists: Additionalcontractual staff for Regional GeriatricCentre recruitment will be made by theMedical Institution. Drugs & consumables 20 lakhs 30 bedded geriatrics ward 7 Aug 201271 71. Developing Geriatric Department in Medical collegeof each States/UTsIt is proposed to develop 12 additional Regional GeriatricCenters in selected Medical Colleges of the country Sr No StateMedical College 1 Punjab PGIMER, Chandigarh 2 Uttar PradeshKGIMS, Lucknow 3 JharkhandRanchi Medical College, Ranchi 4 West BengalKolkatta Medical College, Kolkata 5 Andhra Pradesh Nizam Institute of Medical Sciences, Hyd. 6 KarnatakaBangalore Medical College, Bangluru 7 GujaratB.J.Medical College, Ahmadabad 8 MaharashtraGovernment Medical College, Nagpur 9 Orissa S.C.B.Medical College, Cuttack 10TripuraAgartala Medical College, Agartala 11Madhya Pradesh Gandhi Medical College, Bhopal 12BiharPatna 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 201274 74. Activities at State levelA. Community awareness.B. Planning, Monitoring & Supervision.C. TrainingD. Financial Management7 Aug 2012 75 75. Responsibility of reporting, flow ofinformation and frequency of reporting 7 Aug 201276 76. Training of Human Resources Plan for training institutions, duration, broadcurriculum & preparation of trainingcalendar for Doctors Nurses Physiotherapist/ Rehabilitation Workers Medico-social Worker ANM, and Male Health Worker Training guidelines and financial normsdeveloped under NPCDCS will be applied fortraining under NPHCE. Financial Management forvariouscomponents. 7 Aug 2012 77 77. Detailed training plan of staff 7 Aug 2012 78 78. Training at various level MOHFW Nodal AgencyRegional Training / PHITOT - DPO / MO DTT/DH District level trainingCHC Health worker training7 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 withNPCDCS E.Monitoring, Evaluation and Researchthrough State & Independent 7 Aug 201280 80. FINANCIAL GUILDEINES Financial management groups (FMG) ofProgramme Management are establishedunder NRHM The funds will be released to States/UTsthrough the State Health Society. Fundsrelease from State to District HealthSociety for CHCs, PHCs and Sub- centersto 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 toanother limited to a ceiling of 10%. NPHCE would operate through NCD Cellsconstituted under NPCDCS at State andDistrict levels. A separate bank account in a nationalizedbank should be opened for NPHCE. 7 Aug 2012 82 82. Assistance for Sub Centre Assistance for Primary HealthCentre 7 Aug 201283 83. Assistance to Community Health Centers7 Aug 2012 84 84. Assistance to District Hospital 7 Aug 2012 85 85. Assistance for Regional Geriatric Centre 7 Aug 201286 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 Assistanceduring 11th planItemsRMI DHCHC PHCS. Cconstruction2 crore 80 lakh- - -Equipments 1.7 crore10 lakh 1 lakh Rs.50000 Rs.32000Drugs20 lakh10 lakh- - -Training5 lakh Rs. 70000 1.15 lakh Rs.32000-IEC activities -5 lakh - - -Research 50 Lakh-- - -Manpower 88.4 lakh 28 .2 lakh1.8 lakh- -recruitment7 Aug 2012 88 88. Achievements Developed operational guidelines 1st installment released to 27districts in2010-11 and 48 districts in 2011-12 1st installment released to all the 8 RMI MOU signed with 18 States Submitted 12th plan proposal- all theStates/districts proposed to be covered7 Aug 2012 89 89. Issues for consideration Create awareness amongpolicy maker & programmeofficers Training of manpower Utilization of released Budget Monitoring & Maintenance ofdatabase 7 Aug 2012 90 90. Release of Fund Amount AmountNo. of No. ofYear released released districtsRMI(crore)(crore) 2010-112760 4 41.15 2011-124875 4 30.31Total 75 135 8 71.467 Aug 2012 91 91. Manpower provision at RGCSr.Staff Salary NoTotal (inNo(per month ) thousands)1.Professor in Geriatrics Rs. 75,000/-1 752.Asstt. Professor Geriatrics Rs. 50,000/-2 1003.Medical Officer Rs. 40,000/-4 1603.NursesRs. 15,000/-162404.Physiotherapist (3) and OT (1)Rs. 15,000/-4 605.Medical Social Worker Rs. 15,000/-1 156.Lab TechnicianRs. 15,000/-1 157.Program Assistant Rs. 12,000/-1 128.Hospital AttendantRs. 7,500/- 4 309.Sanitary AttendantRs. 7,500/- 4 30Total 38737 7 Aug 2012 92 92. Manpower at District Hospitaland CHCSr.Staff Salary per No. TotalNo. month (per month)(Rs.) (In thousands) 1Consultant in Medicine 50, 000 /- 2100 2. Nurses 15,000/- 6 90 3. Physiotherapist15,000/- 1 15 4. Hospital Attendants 7,500/- 2 15 5. Sanitary Attendants 7,500/- 215Total 13 235 Rehabilitation Unit at CHC 1 Multi rehabilitation Worker-115,000/-115Total 115 7 Aug 201293 93. EXPENDITURE ON CONSTRUCTION AND FURNITURE(Rs. In crore)ComponentSr. Activity levelUnit2010-11 2011-12 Total No. Cost 1District 0.825.60 38.4064.00Construction cost with furniture 2Regional2.0008.00 08.0016.00 Institutions Total33.60 46.4080.007 Aug 2012 94 94. EXPENDITURE ON MACHINERY AND EQUIPMENT(Rs. In crore)S.Activity Component Unit Cost2010-11 2011-12 Total No. level1PHC0.0056.409.60 16.00 CHC20.013.204.80 8.00Machinery &EquipmentsDistrict30.1 3.204.80 8.00Regional41.7 6.806.80 13.60institutionsTotal19.70 26.0045.60 7 Aug 201295 95. Expenditure on central and state activities (Rs. In crore)ACTIVITY COMPONET Year Wise Cost TOTAL LEVEL 2010-11 2011-12 Monitoring &Evaluation Central 1.200.93 2.13(Recurring)Total 2.13Office ExpensesState0.550.55 1.10(Recurring )Total 1.10 7 Aug 2012 96 96. Year wise cost on Drugs and Consumables(Rs. In crore) Units Nos.ActivityComponentsUnit costTotal cost level2010-112011-12District32 80 0.1 11.20 Drugs andConsumable s Regional480.22.40 Institutes Total13.607 Aug 201297 97. Year wise cost on training at each level of activities(Rs. In crore) Units Nos.Compone Activity Total 2010-Unit cost ntlevel2011-12cost11PHC1280 1920 0.003210.24TrainingCHC320 480 0.0115 9.20(Recurring) Districts 32 480.0070.56 Regional4 4 0.050.40InstitutesTotal20.40 7 Aug 201298 98. Year wise cost on Research and IEC activities andMiscellaneous Expenditure(Rs. In crore)Units NoActivityComponen Unit Cost Total Level 2010-11 2011-12 t Regional Research4 80.56.00InstitutesAwareness& IECDistrict32 80 0.055.60(Recurring)MiscellaneousExpenditure Sub-Centre6400 9600 0.0032 51.20 on Calipers7 Aug 2012 99 99. Cost on ManpowerUnits Nos.Unit cost Total costComponent Activity (crore) (crore)slevel 2010-112011-12CHC 320800 0.01820.16 District32800.28231.58 Manpower Cost Regional(Recurring)480.8844 10.61InstitutesTotal 62.36 7 Aug 2012100 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 monitoringactivities between centre and state nodal officers Half yearly progress review meeting for assessing thestatus of implementation of the programme activities. Yearly Combined field visit by Central and State Cells foron the spot assessment of progress of the activities. 7 Aug 2012101 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 ofIndia. Situation Analysis of The Elderly In India, June 2011. CentralStatistics Office, Ministry of Statistics & ProgrammeImplementation, Government of India Rajan SI. Population ageing and health in India. The Centre forEnquiry into Health and Allied Themes (CEHAT), Mumbai. July2006. National Policy on Older Persons (1999). Ministry of SocialJustice and Empowerment, Government of India, ShastriBhawan, New Delhi. Maintenance and Welfare of Parents and Senior Citizens Act 2007, Ministry of Social Justice and empowerment Governmentof India Morbidity, Health care and the Condition of the aged. NSSO(64th round)Jan-June 2004, National Sample SurveyOrganization, Ministry of Statistics and ProgrammeImplementation, Government Aug India, March 2006.7 of 2012 102 102. Two years (2009-2011) Achievements and NewInitiatives. NRHM, Ministry of Health and FamilyWelfare, 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-CommunicableDiseases (NCDs): Proposal for the 12th Plan,Report of the Working Group on Disease Burden:Non-Communicable Disease (NCDs), DirectorGeneral of Health Services, MOHFW, Governmentof India. Planning Commission. 11th five year plan (Draft),Government of India; Accessed on 27/02/2012 atURL: http://www.planningcommission.nic.in7 Aug 2012103 103. Thank you!!!