A community-based intervention to promote healthy ageing in southern Rajasthan

Background

According to population projections, by 2050, the global population of older persons will double to 1.5 billion, while in India, they will increase from 8.6% to 19.5% of the population. With rapid reduction in fertility and increase in life expectancy, the proportion of older persons in the population will increase, leading to a change in the dependency ratio. There need to be systems in place to ensure that older persons remain healthy, have access to health care as needed and go through life’s journey with good quality of life.
In rural-tribal areas of southern Rajasthan, awareness of and access to health care for older persons is limited. ARTH has worked on health of older persons in the region since 2018, providing access to care for chronic illness via fixed-site monthly health camps, referral to higher institutions and home care by outreach workers. Our experience reveals an evident lack of self-care and a dominant societal narrative that as people become older, they are expected to progressively decline, fall prey to illness and fight a losing battle with life. Meanwhile, the current focus of health systems is on facility-based geriatric care at regional, district and block levels, with less attention to prevention, rehabilitation or community care. We experienced the need to introduce a positive narrative within our effort to ensure that older persons enjoy a safe, healthy and dignified life and remain productive members of the community. On 1 Oct 2023, International Day of Older Persons, ARTH launched ‘Prabal Yatra’ – a community based approach to promote and enable healthy ageing among older persons in southern Rajasthan. The healthy ageing intervention is meant to facilitate timely access to clinical care as and when needed.

The objectives of this intervention are:

1. To maintain or enhance functional capacities of older persons living in towns and villages of 8 blocks of southern Rajasthan
2. To develop and pilot a community-based model for enabling healthy ageing, elements of which could be replicated in similar parts of the country

Six internal capacities are key to ensuring healthy ageing – they include mobility, nutrition, vision, mood/loneliness, hearing and cognition. In the launch phase of our intervention we will work only on the first four domains.
All activities under this programme will be undertaken via the Prabal Yatra Manch – a village based platform of older persons, where all older persons of the village will connect with each other and with ARTH and any similar agency that wishes to help improve their lives or health. Prabal Yatra is being implemented in in select villages of 8 rural blocks of Udaipur and Rajsamand districts of southern Rajasthan.
This intervention has been started in 104 villages, with a total population of around 2 lakhs, where we estimate around 14,000 older persons reside. We plan to establish the intervention in these villages before expanding to other villages. We also connected with political representatives and government officials in the area through the events and received an enthusiastic response, stating that this intervention has begun at the right time.

Key Activities:

1. Selection of villages and building awareness and ownership among panchayat representatives and officials about the intervention
2. Encouraging older persons to register as members of the Prabal Yatra Manch (PYM)
3. Baseline and periodic assessments of PYM members (home environment & safety assessment, family & social support assessment, personal health assessment) through home visits and village camps
4. Monthly and ad hoc community meetings of PYM members to generate awareness, trigger group action (exercise, dietary changes, social interaction, financial inclusion), self help & mutual support among members, deliver common interventions and track progress
5. Referral to ARTH’s monthly health camps, Health & Wellness Centres, PHCs and CHCs for primary care, and to labs and hospitals for specialized care of chronic conditions
6. Generate ownership among members and community stakeholders for using the group platform to improve social inclusion, health and well being among older persons