CONCEPT NOTE ON ELDERLY HEALTH & WELLNESS CARE

INTEGRATING WITH MAINSTREAM INSTIUTITIONS IN ASPIRATIONAL DISTRICTS

1.0.Background:

National Stock Exchange Foundation (NSEF), India has a mandate to promote elderly care in the four operational
districts Viz; Ramanathpuram in Tamil Nadu, Nandurbar in Maharashtra, Karauli, Rajasthan and Birbhum, West
Bengal. As of today, it strives to reach the elderly with the HELPAGE model. Now, it intends to explore the
feasibility of aligning its initiatives with the National Programme for Health Care of the Elderly (NPHCE) and
Ayushman guidelines on Health & Wellness Centre (HWC) in collaboration with the Ministry of Health,
Government of India with the focus on sustainability. Karuna Trust has excelled in the field of Healthcare through
Public Private Partnership model is working for Project Samrakshana: Project for elderly care with social, economic
and health inclusion in Ramanathpuram district besides HELPAGE work in Mandapam blocks. NHPCE has identified
100 potential districts for implementation of its project on elderly health care. Ministry of Health has also come
out with AYUSHMAN guidelines with the comprehensive primary health care through Health and Wellness Centre.
The present project of Karuna Trust has scope for building infrastructure (retrofitting) in Sub Centres / HWC to
enhance the access of health to elderly . None of the districts identified by NSEF come under the National Program
for Health Care for Elderly.

The Concept

This concept note tries to explore the potentiality of adopting the strategies envisaged under NPHCE and
Ayushman guidelines in particular with the elderly care with the perspective of sustainability by mainstreaming
with the HWC system at field level.

2.0.Scope of National Government Guidelines on Elderly Care in Strengthening the Health Care
system

Two guidelines, namely NPHCE Guidelines (2010)and Ayushman guidelines (2019) are taken for
exploring the scope of elderly care:

The basic objective of the NPHCE is to provide dedicated geriatric health care facilities in District
Hospitals, CHCs, PHCs and Sub Centres level in 100 identified districts of 21 States. The Programme
has been initiated in all the 100 selected districts in 21 States (details at Annexure-II) and proposed
to expand further. The strategies are preventive and promotive care , management of Illness, health
manpower development of geriatric services, medical rehabilitation and therapeutic services and
IEC. https://mohfw.gov.in/sites/default/files/8324324521Operational_Guidelines_NPHCE_final.pdf

Table 1 : Provision of Facilities for Eldery Care as per NHPCE

 District level
At every district
hospital, there will be
a provision for
establishing 10 bedded
geriatric wards and
dedicated OPD
services exclusively for
geriatric patients
CHC level PHC level Sub Health Centre
Rehabilitation units Geriatric Clinics at Under Sub health
in Community Health PHC (Population: centres (Population:
Centres for every 4 20000 to 30000) 3000-5000), Auxiliary
PHC’s (Referral weekly by a trained Nurse Midwifery
Centre: Population medical officer weekly (ANM) / Health
80000 to 1.2 lakh) worker will make
with the focus on domiciliary visits to
providing provide treatment of
physiotherapy minor ailments and
biweekly rehabilitation
equipments (suitable
calipers and supportive
devices).

Support to the tune of Rs 1.36 crore comprising of non recurring (64%) and recurring ( 36%) .
Details are furnished about the nature of infrastructure to be housed at the respective centres are
listed in operational guidelines. Deatiled package is given in Annexure -1
https://mohfw.gov.in/sites/default/files/8324324521Operational_Guidelines_NPHCE_final.pdf

Under Ayushman Guidelines, the following package of services is offered under different levels of
the health care system under different levels in the district for Elderly and Pallative Healthcare
Services:

Table 2 : Wellness Component for Elderly care

AT PHC level AT Subhealth Centre Referal Centre

Identification of high risk groups
Support to family in palliative care
Home visits for care to home bound/
bedridden elderly, disabled elderly
persons
Support family in identifying behavioural
changes in elderly and providing care.
Linkage with other support groups and
day care centres etc. operational in the
area.
Community mobilization on promotional,
preventive and rehabilitative aspects of
elderly.
Arrange for suitable supportive Diagnosis, treatment and
devices from higher centres to referral for complications
the elderly /disabled persons 
to make them ambulatory Surgical care

Referral for diseases needing further Rehabilitation through
investigation and treatment, to physiotherapy and
PHC/CHC/DH counselling
Management of common geriatric
ailments; counselling,
supportive treatment
Pain Management and provision of
palliative care with support of ASHA

Community awareness on various social

security schemes for elderly
 Identify and report elderly and abuse
cases, and provide family counselling
Source: Ayushuman Operative Guidelines

3. Relevance of Wellness Centre under KARUNA TRUST project Samrakshana.

The budget allocated under the project is Rs. 7,94,000/= to provide infrastructure for 6 wellness
centres. The unit cost of the Wellness centre is Rs 1,32,333/= spread over three years to have an
incremental enhancement of infrastructure. Exploration was done to understand the status of
infrastructure at Rameshwaram Island along with Mandapam and Thangatchi madam
Panchayats.Based on the need analysis, the following infrastructure is proposed :

Table 3 : Infrastructure required at PHC / Sub Health Centres

S.NO. Particulars Need Amount

1 Community Health Centre, Three toilets are to be 20,000.00
Uchupuli ( Which takes care retrofitted
of 3 PHC’s namely Pamban,
Thangathci madam and
Rameswaram Municipality
2 Sub Health Centres ( Dissertation, Pump repairs, 1,00,000.00
Pamban) toilets and retrofitting
3 Sub Health Centre ( Water, Electricity and Toilet 50,000.00
Thangathci Madam) work
4 Sub Health Centres at No infrastructure available, 4,44,000.00
Rameswaram community infrastructure to
be tapped ( Tsunami Shelter at
Shembai etc ). A letter is given
by the village Panchayat to
make use of a part of the
Tsunami shelter for carrying
out HWC activities.
5 Promotion of Geriatric 10 cots @ Rs 8000/= 80,000.00
wards at PHC
6 Provision of calipers and As per the Ayushman The budget is to be
supportive devices, capacity guidelines worked out and
building activities, e-tablets explored from the
at the sub centre level Collectorate office or
from some CSR bodies
7 HWC – CPHM expanded ,, ,, ,, ,, ,, ,,
activities
Total 7,94,000.00
Request for the same can be sought from the district administration / district health officer in
writing for qualifying the need and acknowledge our contribution. This is in addition to the health
care services aimed to be provided through Mobile vehicle which will periodically visit.

4. Scope for rooting the CPHM in Health and Wellness Centre.

A gap analysis may be carried out based on 9 CPHM activities given below at each of the 6 HWCs;

a. Inception report can be envisaged considering the provisions of NHPC and Ayushmnan
guidelines based on the infrastructure availability for comprehensive health care in
Ramnathpuram district.

b. A similar process can be done in other aspiration districts adopted by NSE.

This calls for visiting all the subhealth centres, PHC, CHC and district hospitals assess the
infrastructure. Hence, an amount of Rs 5.0 lakhs can be allocated for exploring the scope of
Comprehensive Health and Wellness Centres in the five districts.
 Annexure -1

Source
https://mohfw.gov.in/sites/default/files/8324324521Operational_Guidelines_NPHCE_final.pdf