Date - 1-30 April 2019
Mathew Cherian, Chief Executive Officer, HelpAge India, speaking with Ratish Jha, discusses key challenges faced by India’s elderly population and the role of society in redressing them.
G’nY. In your view what are the three major issues concerning the aged
in India? kinder to India’s elderly population
The first and foremost problem relates to pension plans as India lacks clarity and transparency in its pension system. Moreover, approximately 90 per cent of the country’s workers are employed in the unorganised sector which includes farmers who are not eligible for pension. More often than not, only government employees and army personnel are able to benefit from this scheme. While some receive remittances from their children, the elderly poor usually do not. The second major area of concern is healthcare. Most elderly people suffer from multiple morbidity or diseases. While women suffer more from bone related issues such as arthritis and osteoporosis, men are susceptible to problems pertaining to the prostate. The third significant issue that afflicts the elderly is loneliness that mostly results from abandonment and may lead to depression. These, along with elderly abuse are the most difficult to address as many such cases go unreported. Even the elderly who admit to being abused hesitate to report the matter to the police.kinder to India’s elderly population
G’nY. What do you think needs to be changed in the current context to assist the rising number of the aged in India?
I think the first step in this direction is to provide free health insurance to older people, particularly the poor who are more vulnerable. The second move should be to implement a social protection policy which would safeguard them from instances of abuse and discrimination. In addition to the above, the rise in elderly population must urge us to reconsider the country’s second demographic dividend. A person’s capacity to work and add value to the economy cannot be solely defined by his/her age. Being designated as ‘retired’ need not necessarily be a mark of one’s potential and productivity. The elderly may be capable of engaging in work that befits their situation. Moreover, this would help propel the second demographic dividend.
G’nY. Various governmental schemes such as those related to pension and healthcare have focused on the elderly but they are not holistic. Do you agree?
Such schemes, despite being in place, suffer from poor or incomplete execution. For instance, while the Indira Gandhi Old Age Pension Scheme (IGOAPS) under the National Social Assistant Programme (NSAP) is in place—but is in want of expansion. At present, merely 20 per cent of older population can reap the benefit of IGOAPS. Moreover, the approximate monthly pension of INR 400—of which the centre offers INR 200 and the state contributes the rest—is inadequate to meet the requirements of most widows. With regards to healthcare, the central government has launched the National Programme for Healthcare of the Elderly (NPHCE) which mandates each of the 707 districts to provide a geriatric centre. However, the reality is far from optimistic.
Major geriatric centres are only operational in institutions such as the All India Institute of Medical Sciences (AIIMS) and Madras Medical College which are located in major urban areas and not in smaller towns. In the rural areas, they are largely absent.
Therefore, we continue to demand for effective universal pension and universal healthcare systems. The policy on senior citizens has been in place since 2011 and in fact, I was one of the members who had drafted the policy. But the fact is that it has not gained complete approval.
I am of the view that the policy should be pushed to the parliament for approval as it concerns 10 per cent of India’s population. Additionally, the Maintenance And Welfare Of Parents And Senior Citizens Act, 2007 caters to pension and healthcare of the older segment but suffers from
weak implementation. kinder to India’s elderly population
G’nY. You spoke of the universal pension system. What do you mean by ‘universal’?
Universal in this context means that old age pension should not be limited to people below the poverty line (BPL) as is the case with India. Moreover, poverty related data of our country is debatable and not always reliable. In many cases, granting funds only on the basis of BPL criterion may exclude elderly in dire need of resources. For instance, there might be an elderly person belonging to, say, Brahmin or Rajput caste whose son, though economically sound, may not be providing any money to them. In such a case, pension becomes a necessity. Hence, the universal pension system espouses the cause of the older population that requires financial assistance. The term ‘universal’, does not mean that the scheme would encompass 100 per cent of the elderly population as the taxpaying segment cannot be included in this system. Under article 14 and 21 of the Indian Constitution, the government is obligated to provide dignity of life to every Indian citizen. It would be incorrect on the part of government to oppose the universal pension system on the grounds of non-feasibility. This is because the government boasts about India being a three trillion-dollar economy. As per our calculation, the scheme, at best, will cost the government merely 1.2 per cent of the gross domestic product (GDP). Therefore, the universal pension system is an economically viable project.
G’nY. In your view, are the infrastructural facilities in India oriented towards the elderly?
By and large, the infrastructure in India is not elderly-friendly. At the moment, HelpAge India is running a campaign in Kerala wherein we are generating awareness on the importance of making public buildings, including hospitals and shopping malls, more accessible to those with hampered mobility. We have also emphasised on the need to minimise the waiting period at public places, create separate and shorter queues and upgrade the country’s transport system in a way that accommodates the special requirements of this segment. Most of the buses require people to climb a narrow and steep flight of stairs which proves exceedingly cumbersome and risky for the elderly. However problems do not end even with low floor buses as they stop 20 m away from the pavement which one needs to jump from in order to board the vehicle. This defies the very purpose of low-floor buses. Lack of coordination and mismanagement is yet another problem in this regard. For instance, the Indian Institute of Technology, Delhi once had ramps built near buses in an effort to make it accessible to those with limited mobility. However, it was soon demolished. Such redundancy and abortive projects usually result from a lack of coordination between the various departments. Owing to such glaring impediments, wheelchair bound individuals, especially the elderly, cannot move about in the city. In smaller cities, the situation is even grimmer. Thus, there is an urgent need for public buildings, hospitals and public transportation to be designed keeping in mind the physical constraints of a fair share of
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G’nY. There is a lot of talk going on about digital India. Will the elderly benefit from the country’s increased digitalisation?
Unfortunately, digital India does not cater to the elderly population. In fact, it is becoming the source of social exclusion. We, at HelpAge India, are teaching such people to access internet and use smart phones so that they may readily acquire patta—a title deed to a property and other such crucial documents. We have a digital India inclusion centre in Nagapattinam where we enable digital inclusion of the elderly people by teaching them to use smartphones and digital equipment. Although this field has immense potential, it faces several problems. To name a few of them, none of the smartphones are age-friendly, either in terms of their design, user-interface or software application. If these impediments are not addressed, the resultant digital divide will create many digital illiterates. Despite telemedicine having a broad scope in India, low bandwidth speed in rural areas prevent patients from accessing telehealth programmes.
G’nY. Given the composition of elderly population where women outnumber men, do females encounter discrimination on account of their gender?
Gender discrimination and biases, undoubtedly, exist. The situation exacerbates when widowed women become vulnerable to exploitation arising from property transfers. I would like to highlight the plight of elderly widows in Vrindavan who are time and again harassed for property. The intervention of HelpAge India was sought in this matter to protect these widows against ill-treatment. We continue our work in this field even today. But the reality is that unless we work to change the attitude towards the elderly women, particularly widows in rural India, the situation may not alleviate. kinder to India’s elderly population
Another difficulty is that most activists advocating gender equality are restricted to the urban sector. There is a need to organise similar movements in villages and begin work in this field.
Discriminatory attitude against women and the elderly women is also evidenced in informal employment. The Indian government usually does not recognise a woman as a farmer. Hence, if a male farmer commits suicide, it becomes a national headline but if a woman farmer takes her own life when farming proves unsustainable, the matter gets largely ignored.
Home-care, too, forms a pertinent issue among the elderly. We firmly believe that elderly should be taken care of in their homes as old-age homes in India are beset with a host of problems. Issues relating to an inadequate number and poor maintenance of old age centres are all pervasive. Additionally, the elderly often do not wish to live in such institutions and therefore, we must aim to provide the requisite care at home itself. A geriatric cadre ought to be created to attend to the needs of the elderly at their homes. Another solution is to train widows—in a manner similar to the way in which many women had been trained as accredited social health activists (ASHAs) to educate their respective communities in the matter of health. Further, health financing and health insurance policies should become more popular—as is being done in China. kinder to India’s elderly population
G’nY. Are the aged becoming a liability in India?
The fact is that old age, in itself, is not a liability. The challenge primarily lies in encouraging them to remain productive after 60 years. This requires channelling their skills, intelligence and immense experiences so as to add value to the second demographic dividend as earlier discussed. The Indian government must give considerable thought to such concerns. The suggestion to enhance employment among the elderly does not entail snatching opportunities from the country’s youth. The idea is merely to help make the elderly more resourceful. In this respect, they can engage in career advisory services or even work as mentors at various organisations.
G’nY. What do feel about social security for the elderly?
Social security is one significant area that the government must learn to tackle efficiently. Secondly, the state of primary health centres in rural India is deplorable and they are in need of well-trained nurses. While policies and welfare programmes for the aged do exist, they lack proper implementation. Largely speaking, the elderly do not receive the monetary and material benefits they should be entitled to. Hence, effectiveness of the present schemes need to be ensured by seeing to their proper implementation. Moreover, post-retirement policies need to be redrawn carefully and rules regarding elderly abuse should become more stringent. Simultaneously, sensitising school children to the problems of the elderly in India should be attempted through real life examples. Today’s young generation needs to be coached in matters of elderly support. The issue may be alleviated if the youth starts to assume responsibility of their aged parents.
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