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 Table of Contents  
Year : 2023  |  Volume : 19  |  Issue : 1  |  Page : 54-60

Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly

1 School of Public Health, AIIMS, Jodhpur and Senior Advisor JSPH, Jodhpur, Rajasthan, India
2 Health Economist, Resource Centre, HTA, AIIMS, Jodhpur, Rajasthan, India
3 Consultant Dental Surgeon, SHRC, Jodhpur, Rajasthan, India

Date of Submission05-Feb-2023
Date of Decision04-Mar-2023
Date of Acceptance05-Mar-2023
Date of Web Publication17-Mar-2023

Correspondence Address:
Nitin Kumar Joshi
School of Public Health, AIIMS, Jodhpur, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiag.jiag_9_23

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Background: The National Program for the HealthCare of the Elderly (NPHCE) was adopted by the Ministry of Health and Family Welfare in 2010 to provide promotional, preventive, curative, and rehabilitative health-care services for the fast-growing older population in India. As literature about the assessment of NPHCE is lacking, the present study was conducted to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis of the program. Methods: The SWOT of the NPHCE program is analyzed using available literature and relevant documents. Results: Although this program embraces strategies to provide specialized training and services at primary health center, community health center, and district levels, including dedicated bedded wards, equipment, consumables, and pharmaceuticals but home-based care for the elderly, and the role of caregivers is overlooked in this program. NPHCE program can utilize the framework and take support of various ongoing healthy aging initiatives of international agencies to augment the health-care strategies for the elderly in India. Integrating schemes developed by the government for the upliftment of the elderly and the inclusion of traditional medicine systems in the program can serve as an opportunity for meeting unmet needs and improving the quality of life and well-being of the elderly. However, the growing elderly population, rise in nuclear families, and dual disease burden are significant threats to the program's implementation. Conclusion: This program can be more effective in providing comprehensive health care to the elderly if more emphasis is given to community participation, home-based care, and integrating digital health technologies and other existing welfare schemes.

Keywords: Elderly care, geriatric health, health policy, healthy aging, program

How to cite this article:
Joshi NK, Joshi V, Bajaj K. Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly. J Indian Acad Geriatr 2023;19:54-60

How to cite this URL:
Joshi NK, Joshi V, Bajaj K. Strengths, weaknesses, opportunities, and threats analysis of the national program for health care of the elderly. J Indian Acad Geriatr [serial online] 2023 [cited 2023 Mar 22];19:54-60. Available from: http://www.jiag.com/text.asp?2023/19/1/54/371910

  Introduction Top

India has experienced an almost three times increase in the elder population (aged 60 years or above) in the last 50 years.[1] The elderly population in 1961 was 25 million, and in 2011, it was 103.8 million.[2] As per the 2011 census, the projections for the elderly population were reported as 133.32 million (2021), 178.59 million (2031), 236.01 million (2041), and 300.96 million (2051).[1] With increasing age, the accumulation of health deficits further advances the risk of comorbidities and the challenge of providing medical care for the elderly.[3] As reported in the literature, the morbidity status among the elderly indicates that 24.32% of the older people do not have the obvious disease and need preventive and promotive care only. Rest, 75.68% have one or other illnesses requiring health-care services and 53.63% elderly have one chronic disease and need promotive/assistive care services. About 20.83% of the elderly have two chronic diseases and need curative, and rehabilitation services, and 3.01% of the elderly have three chronic diseases and need long-term or home-based care.[2],[4],[5],[6],[7] The National Program for the Health Care of the Elderly (NPHCE) was undertaken to provide health-care services for the fast-growing older population in India. The NPHCE was adopted by the Ministry of Health and Family Welfare (MOHFW) in 2010 to deal with the health-related problems of the elderly population.[8] The program envisaged providing promotional, preventive, curative, and rehabilitative services to the elderly population in government health facilities, i.e. sub center (SC) (161,829), primary health center (PHC) (31,053), community health center (CHC) (6064), district hospitals (767), and 20 selected regional geriatric centers.[7],[8] The interventional strategies and activities were identified in this program designed to provide a comprehensive health-care setup to cater to the needs of the elderly.[8] Over time these interventions have been streamlined. Currently, these are categorized under different headings, i.e. (a) Develop national policy and plan of action (Legal framework and action on healthy aging, focal point/nodal agency for implementation, developing appropriate Information, Education, and Communication [IEC] Strategy). (b) Align health system to the needs of the older population (Ensure access to Quality integrated health system, Orient system around intrinsic capacity, Ensure sustainable trained workforce). (c) Developing a System for Long-term care (establishes the sustainable long-term care [LTC] System, builds a sustainable LTC workforce, and ensures the quality of integrated LTC). (d) Developing appropriate Human Resources (Developing competency-based training material, Formal and informal caregiver training in geriatric, Promote Healthy Aging in UG and PG). (e) Creating age Friendly Environments Life course approach (Provision for RMNCH + A Program, Promoting noncommunicable diseases (NCDs), MH, and Good practices, Foster age-friendly physical environment). (f) Multisectoral approach and partnership (Involving all relevant government sectors, academia, research organization, civil society, private sector, media, and international organizations). (g) Improve Measurement, Monitoring, and Understanding (Agreeing on metric measure and analysis, Strengthen Research capacity and innovation, Synthesize evidence on healthy aging).[8],[9]

Since the launch of NPHCE for the elderly, efforts have been made to provide specialized comprehensive health-care facilities to older people at various levels of the state health-care system.[1],[10] There is a lack of literature about assessing the NPHCE; therefore, a need to perform a strengths, weaknesses, opportunities, and threats (SWOT) analysis was felt. SWOT analysis effectively assesses internal strengths and weaknesses and external opportunities and threats that affect program implementation.[11] The exercise is expected to provide insight into the strategic planning of programs to look at health-care organizations' performance of their functions. SWOT Analysis provides a clear overview of critical metrics that are key for performance and the overall success of the program under consideration.[12] With this background, the present study was conducted to analyze this health-care program for the elderly using SWOT analysis to guide the effective delivery of health-care services to the elderly in the future.

  Methods Top

Literature searches were performed from various sources about the NPHCE program, including peer-reviewed journals, government documents, and gray literature. The documents were searched from the period after the launch of the NPHCE program. After an extensive literature review, the SWOT analysis was performed. SWOT analysis is a strategic planning tool to analyze a policy or program's internal and external variables.[13] While performing the SWOT analysis, each element was looked at very critically. (a) Strength: Each of the identified strategies and activities of the program was analyzed in respect of its performance to achieve the set goals/targets. The focus was on infrastructure, workforce, technology, service delivery, social and political support, and financial support. (b) Weakness: The assessment focused on factors hindering the growth/performance of the program like weak access to service delivery, the inadequacy of infrastructure, old/inflexible technology, poor workforce, lack of communication, and inadequate funds. (c) Opportunity: Analysis looked for new technology, logistic support, new social trend, partnership with sister programs, training, and marketing strategies to identify the existing programs/technologies with better performance scope and yields better results if inducted into the program. (d) Threat. Under this element, an effort was made to identify the hindrance that may impact the program's performance.[12] The SWOT of the NPHCE program were analyzed.

The literature was reviewed from various sources and analyzed through SWOT analysis. The SWOT of the NPHCE program were segregated. The SWOT analysis of this program is mentioned below.

Strengths, weaknesses, opportunities, and threats analysis

Strengths of National Program for the Health Care of the Elderly

NPHCE policy has a robust policy framework to provide health promotion, prevention, curative and rehabilitative services for older people.[8] The program identifies the health problems in older people and helps provide the appropriate community interventions. Expansion of the program to all the Districts Hospitals, CHCs, PHCs, and SCs in the country is planned. Strong referral support for the elderly is also provided through district hospitals and regional medical institutions.[8] The strategies under NPHCE include establishing specialized services at PHC, CHC, and district levels with bedded wards, equipment, consumables and pharmaceuticals, and training. The program proposes using IEC to raise awareness in target communities through mass media, folk media, and other communication channels.[8] Also, Rashtriya Varisth Jan Swasthya Yojana, a tertiary component of NPHCE, was developed in 2016, which intends to provide spiritual therapies along with AYUSH interventions for the elderly population.[14],[15] The program is intended for the capacity building of medical and paramedical staff and providing caregivers to the elderly.[8],[15] Furthermore, geriatric centers are developed in 19 regional medical institutions to strengthen tertiary-level medical facilities. These centers encourage the training of health professionals for geriatrics.[15],[16] Linkage with the Ayushman Bharat Program will increase the reach and health promotion.[14]

Weaknesses of National Program for the Healthcare of the Elderly

NPHCE primarily focuses on delivering health-care services for the elderly at the institutional level. The home-based care for older people is not addressed properly in this program.[17] Regardless of socioeconomic status, family members care for their elder relatives in India. In 2017, around three-quarters of the elderly population was reported as financially dependent on family members in India, and this dependence increases with age.[14] Mainly, family members provide LTC and support to older people.[18] However, still, the role of family members or caregivers is overlooked in the NPHCE program. There is a need to develop strategies that provide training, incentives, and support to caregivers for their older relatives.[1],[17],[19] The policies under NPHCE have limited focus on quality and access to health care for the elderly. The program lacks health-care services based on the needs of the population residing in different regions or locations.[1],[17] There is a lack of facilities for geriatric care in rural or remote areas where a substantial number of the elderly live.[19],[20] The program does not address the challenges bedridden people face who cannot access the health-care services available at regional geriatric centers.[1] In the program, the strategies are more focused on treating medical conditions. There is a need for awareness programs for elders and their families to prevent the comorbidities or prepare them for eventualities.[1] The program lacks community participation in promoting health care for the elderly. Community engagement is an effective way of enhancing community empowerment, improving health, and reducing health inequalities.[21] The strategies are required to develop skills that promote community participation in health care. NPHCE established the financial management group units at state and district levels to manage funds, expenditure reports, utilization certificates, and audit arrangements.[8] Despite budget allocation for geriatric care, the underutilization of funds is observed in the states.[22] The share of funds for geriatric care is not well-described in the program.[22],[23] Most of the funds get utilized in states for training, salaries, and infrastructure instead of geriatric health care.[24] Poor program implementation in rugged terrain, hilly, and far-furlong areas has been observed.[17] The specialized workforce is inadequate. Other public health hospitals such as ESIC, medical colleges, defense health-care hospitals, railways health-care system, and AYUSH health-care system are not involved. The private sector and nonprofit organizations important for the health care of older people are also not involved. There is no active integration and partnership with other national programs of the MOHFW and no collaboration with other line ministries. Popular political and social support for the program is also lacking.[15],[25]

Opportunities of National Program for the Health Care of the Elderly

Different international agencies are developing various programs to provide support and guidance for the well-being of the elderly population. The UN initiative “The decade of Healthy Aging 2020–2030” provides a framework for healthy aging considering the collaboration of governments, civil society, International agencies, professionals, and the private sectors.[26],[27] This program intends to improve the lives of older people, their families, and the communities by mainstreaming the issues and difficulties related to the elderly.[26],[27] NPHCE program can utilize the framework and support of these initiatives to augment the health-care strategies for the elderly in India.[27]

The digital app launched by the World Health Organization (WHO) is intended to improve health and address the various health problems in the elderly. This app also provides a platform for training health-care workers to address the health needs of older people. This digital health application benefits older people with health problems such as malnutrition, vision and hearing loss, depression, and mobility limitations.[28] Such digital health technologies could be integrated into the NPHCE program to expand the locus of health care for the elderly.

Most of the health initiatives in India tend to use vertical, disease-specific strategies that concentrate on a small number of outcomes rather than addressing a person's overall health.[14] MOHFW can take the opportunity to integrate specific national programs such as the national NCDs program, national mental health program, and national program for control of blindness and hearing impairment.[15],[25] These programs are providing effective health-care delivery to adequate proportions of older people. There is an untamed health sector of CGHS dispensaries/hospitals, ESIC hospitals/dispensaries, national institutes, defense health-care facilities, railway dispensaries/hospitals, AYUSH, and medical colleges Government and private) that can be considered for the extension of program activities. Equally or even more than the public health sector is the private health care sector of multispecialty hospitals, specialty hospitals, nursing homes, and private clinics.[1],[14] This private health system has plenty of scope for serving older persons. Many nonprofit health-care organizations such as charitable trusts, dispensaries, hospitals, and nongovernmental organizations (NGOs) run clinics and outreach services. Furthermore, there are dedicated NGOs and more than 1000 old-age homes nationwide.[1],[15] These institutions can play a significant role in outreach health-care work for older persons. The Umbrella scheme named Atal Vayo Abhyudaya Yojana has been implemented by the Department of Social Justice and Empowerment for the welfare of older people in India. This program integrates schemes, plans, strategies, and targets that focus on health-care needs, financial security, food, and the dignity of the elderly.[29] The government of India has initiated the “Rashtriya Vayoshri Yojana” scheme to provide physical aids and assisted-living devices for an elderly population that belongs to the Below Poverty Line (BPL) category. Assisting living devices such as walking sticks, elbow crutches, walkers/crutches, tripods, hearing aids, wheelchairs, and dentures are free to the beneficiaries.[15],[30] Integrating such schemes with the NPHCE program can serve as an opportunity for well-being, meeting unmet needs, and improving the quality of life of the elderly.

The concept of wellness centers proposed by the MOHFW in “Ayushman Bharat” facilitates holistic health services at the community level. In which a health-care worker, two female, and one male staff work together with five Accredited Social Health Activist workers.[31] In conjunction with NPHCE, this program provides an opportunity to enhance health-care services for the elderly.

The collaboration of the NPHCE program with research institutes or programs can benefit in developing evidence-based research, which will help policymakers make evidence-based decisions about aging-related problems.[32]

The outbreak of COVID-19 adversely affected elders. It became difficult for elders to get routine medical care at home. The importance of developing basic health-care skills in older persons was realized in this crisis. These skills can help the elders to take care of their well-being.[33] Integrating the strategies that advocate basic health-care skills for the elderly could serve as an opportunity for the NPHCE program.

Threats of National Program for the Health Care of the Elderly

Population aging is widely observed across the world. This demographic transition significantly affects the country's health and socioeconomic conditions. Therefore, achieving healthy aging in developing countries like India is challenging.[34],[35] The growing number of the elderly population is a significant concern for implementing the NPHCE program, as there is a need to adopt health services on par with the increasing demands of the elderly population.

The rise in nuclear families in India can pose challenges for the NPHCE program as changing social conditions from joint to nuclear families is expected to be responsible for emotional, financial, and physical insecurities in the elderly population.[34]

The epidemiological shift of disease patterns from acute infections to chronic diseases has posed a dual disease burden among the elderly population.[34],[36] This requires provision for a large quantum of health and social maintenance as the disability in the elderly resulting from NCDs can lead to poor access to health services at geriatric centers under the NPHCE program.[1] Poor accessibility to health services and lack of health and welfare rights awareness also threatens the program.[37] The pandemics like COVID-19 are also seen as a threat to the NPHCE program, as the recent pandemic has exposed health and social vulnerabilities among the elderly population.[15],[38] Lack of a social and structural support system restricts the elderly population from accessing the service provider of this program. A summary of the SWOT analysis of the NPHCE program is shown in [Table 1].
Table 1: Summary of strengths, weaknesses, opportunities, and threats analysis of the National Program for Health Care of the Elderly program

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  Discussion Top

As motioned above, the NPHCE envisages promotive, preventive, assistive, curative, and rehabilitation along with long-term care services.[8] Through SWOT analysis, we analyzed the internal strengths and weaknesses as well as external opportunities and threats of the NPHCE program.

The program's strengths include implementing NPHCE activities through comprehensive public health-care infrastructure.[1] This tempo needs to be sustained by consistent support for program implementation in both rural and urban areas through existing primary health care health facilities.[1],[15] The local area staff is encouraged to ensure proper health-care delivery to the beneficiaries.[8] Awareness generation among older persons about their rights toward healthy aging and the facilities being provided should be prioritized. While the program has several strengths, weaknesses, such as limited coverage, inadequate funding, shortage of trained workforce, and poor implementation, were identified in this study.[22],[25] The NPHCE program suffers from poor implementation in many areas due to inadequate coordination at different health-care system levels, limited coverage in remote, hilly, and geographically unapproachable areas, and lack of monitoring and evaluation mechanisms, and a general lack of political will.[25] These weaknesses can be converted into strengths by taking proactive steps to expand the NPHCE activities across all segments of the public health-care infrastructure. The Ayushman Bharat scheme has identified geriatric and palliative care as important components.[31]

Many opportunities are there to involve private sector health-care infrastructure, nonprofit health-care organizations, and old-age homes run by NGOs. Opportunities also exist for NPHCE to consider a partnership with a national NCDs program, a national mental health program, a national program for control of blindness and hearing impairment, lifestyle change program for making NPHCE effective in the delivery of health care.[1],[15],[25] The program has an opportunity to adequately train informal human resources using skill development agencies to provide health care to bedridden older persons at home.[1] Effective communications for awareness generation are the keys to the successful outcome of any health program, and thus the involvement of experienced professional communication and media agencies should be considered. Key vacant positions of financial managers should be filled on priority to handle the program funds more effectively in procurements of equipment, drugs, and logistics.[1],[8]

AYUSH (an acronym for five traditional systems of medicine in India: Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy), the conventional systems of medicine are recognized by the Government of India and are included in the country's health-care system.[39] In recent years, there has been an effort to integrate AYUSH into the mainstream health-care system in India, including the NPHCE program. Integrating such programs has helped strengthen the NPHCE program for providing a more holistic approach to health care for the elderly population.[14]

International agencies have initiated various other programs to promote the health care of the elderly such as the WHO, United Nations Population Fund, and United Nations Development Program, which provide opportunities for integrating their best practices and evidence-based approaches in NPHCE program for delivering comprehensive elderly care.[26],[40],[41] Apart from these international programs, various national welfare programs can be integrated with NPHCE program for better outcomes.[29],[30],[42]

Though integrated health services directly contribute to a better distribution of health outcomes, the integration is highly context dependent. It can only be effective if it takes the specific requirements and characteristics of the people it is intended to serve into account.[43],[44] There are regional disparities in the availability of health-care services in India. This disparity could impact the NPHCE program's effectiveness, particularly in areas with limited health-care services.[15]

The major threats observed in the study are demographic and epidemiological shifts, with an increasing trend toward nuclear families in India undoubtedly posing a threat to the NPHCE program.[15] These changes will impact the physical and mental health of the elderly population.[45]

Public health emergencies of international concern may also be considered a threat to the program. These threats to the program should be addressed by a coordinated effort of the Government, health-care professionals, and the public at large.[25] There is a need to involve research institutes, academia, and international agencies to support research to find solutions to the caveats. It is crucial to ensure that NPHCE receives adequate funding and that efforts are made to raise awareness about the program's benefits. In addition, addressing issues related to health-care infrastructure and workforce shortages should be a top priority.[25] The recommendations are summarized in [Table 2].
Table 2: Summary recommendations for the National Program for Health Care of the Elderly program

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  Conclusion Top

The NPHCE program is an effective approach to providing comprehensive health-care facilities at various levels. The NPHCE program has made some progress in achieving its objectives at the primary health-care level, such as access to essential drugs and medical supplies.[15] Furthermore, creating regional geriatric centers has been a significant step in developing specialized health-care services for the elderly.[15] However, there is a need for further investment in infrastructure and resources to improve the availability and quality of specialized care at primary, secondary as well as tertiary health-care levels.[25] This program has a limited focus on the participation of the community in health care for the elderly. Strategies for community participation are required to achieve health care for the elderly. In addition, digital health technologies need to be integrated into the program for healthy aging. Digital technologies help address health problems and provide a platform for training health-care workers for older people's health needs. Further, the development of the health-care workforce is required to achieve the health needs and well-being of the elderly population.

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Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2]


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