Mala Kapur Shankardass
INDIA has a rich tradition of philanthropic and voluntary activities for mitigating the sufferings of disadvantaged and marginalized people. The old, particularly the poor, frail, disabled and homeless over the centuries have been beneficiaries of various initiatives, though not adequate, supported by voluntarism and/or state provisions. Indeed, the voluntary sector was the first to respond to the problems of the elderly in India.1
Beginning with the enactment of the Societies Registration Act of 1860, ‘voluntary organizations’ encompassing a wide range of agencies, viz. societies, cooperatives, trusts, and trade unions – have been given a legitimate place in the welfare mechanisms in the country. They are now more popularly referred to as non-governmental organizations (NGOs) in order to have some uniformity with regard to international terminology.
While this uniformity makes for convenience, it also creates a false picture of homogeneity, particularly to those persons who are not connected with voluntary action.2 There is a subtle difference between organized voluntary action and non governmental organization functioning, which can become critical when trying to match the opportunity structures provided by different organizations to potential workers.
In recent decades, the processes of social change – modernization, urbanization and technological change leading to urban migration, employment of women outside the home, nuclear families – have undermined the traditional patterns of care of the elderly, that is by the family. Given changing value systems and priorities, provisions for the care of older persons have increasingly to be provided by voluntary organizations/NGOs.
A directory of voluntary agencies for the welfare of the aged in India compiled in 1982 by CEWA3 listed 379 agencies; the number of new ones established each decade showing an increase especially after India attained Independence. Significantly, more than half are located in the southern states and Maharashtra. 13 states and union territories did not have any registered voluntary agency working for older persons. About 86% of the listed agencies are institutions providing services like day care, recreation, counselling, geriatric care (medical and psychiatric care) and financial as assistance. Information in the CEWA directory indicates that the number of NGOs per million persons aged 60 plus for the country as a whole is 6.46.
A decade later in 1992, the Handbook of Information published by the Association of Senior Citizens4 listed 665 organizations in India working in the field of welfare of the aged. The list included old age homes, day care centres, pensioners’ associations, institutions providing medical help, institutes devoted to research, and associations of senior citizens.
Most registered voluntary agencies provide institutional care in the form of old age homes, either as free facilities or on a ‘pay and stay’ basis. Many of these are set up under religious auspices. Old age homes in India are used by the ‘needy’ elderly to pass their last days either as a last resort when for various reasons the family support system breaks down, or for seeking solace while disengaging from family and social concerns. The quality of care in these homes varies, ranging from the bare minimum of lodging and boarding facilities to provisions for medical services, though at only primary level, recreational pursuits, and social activity.5
Acomprehensive analysis of old age homes in the country is not available though the first old age home in India was set up as far back as the early 18th century. A general understanding of the institutional care facilities available to older persons in the country is provided in a monograph titled, ‘Care for Elderly’.6 The monograph lists 329 institutions involved in care of the elderly, out of which only 4 were under the auspices of the government. 189 of the elderly care centres listed were run by Christians, 12 by Hindus, 2 by Muslims, and 117 were under secular auspices, with 5 put under the category of ‘others’. Of the listed institutions 88% functioned as old age homes while 6% were engaged in providing health care and self-employment opportunities. 6% of voluntary organizations also provided day care facilities.
As of 1989, based on information in the monograph, 15,471 elderly were accommodated in old age homes available in the country. A Directory of Old Age Homes in India7 published in 1995 referred to 354 institutions. Based on a nationwide survey and responses from 256 old age homes, the Directory indicated that 12,702 elderly persons resided in these establishments, not all of which were registered with the government. Another survey carried out on old age homes in the country by the Centre for Development Studies, Trivandrum8 to which only 186 homes responded indicated that most of the funds for these institutions came through religious organizations, private sources and other types of trusts and caste organizations.
The role of voluntary agencies/NGOs in the care of older persons has become important because central and state government activities and funding for the welfare of the elderly are limited. In fact, the government solicits active participation of the voluntary sector to meet the needs of older persons. The role of the voluntary sector in ensuring welfare to various segments of the population, including the elderly, has been emphasized in the 8th and 9th plan documents. The National Policy on Older Persons announced in January 1999 by the government talks of promoting and assisting voluntary organizations for providing non-institutional services, construction and maintenance of old age homes, organizing services such as day care, multi-service citizen’s centres, reach out services, supply of disability related aids and appliances, short term stay services and friendly home visits by social workers.
It was in 1983-84 that the government for the first time decided to make grants to voluntary organizations for services to the aged. The grants-in-aid-provision is for (i) rendering welfare services to the aged, such as health care, income generation, subsistence training; and (ii) for constructing homes for the aged. Over the years many NGOs have been supported from the budget outlays of the respective state governments. But, with most state governments giving low priority to the welfare of the elderly, and the low social encouragement given to the concept of ‘voluntary’ care vis-a-vis family care, the provision for grants has not been optimally used by the voluntary sector.
During the 8th five year plan, welfare measures for the elderly were made more specific and comprehensive. Consequently in November 1992, the Ministry of Welfare initiated a scheme called ‘Welfare of the Aged’ to encourage voluntary organizations through grant-in-aid assistance to provide old age homes, day care centres, mobile medicare and non institutional services for older persons above the age of 60. The scheme marks the entry of the ageing population as a target group in national planning and recognises the voluntary sector as constituting an important institutional mechanism in providing services complementing the endeavours of the state.
By 1995, 212 old age homes, 31 mobile medicare units, and a number of day care centres set up by the voluntary sector received assistance from government funds marked for the purpose. However, since the scheme did not specify the services to be provided, no proper monitoring/evaluation was carried out. Consequently we have no worthwhile assessment of the functioning of the scheme.
Though the government has voiced official support for a larger role for NGOs and a number of voluntary organizations are active in the field of ageing in different cities and regions, at the national level the inputs remain limited. Moreover, vast differences exist among NGO approaches, roles and capabilities. Some are part of the government service delivery system, some are small independent service organizations, and others are trying out new approaches.
Afew NGOs have managed to establish a positive track record and gained support for their development work from international and national donors. Reference can be made here to five voluntary organizations functioning at the national level: Bharat Pensioners’ Samaj established in 1960, CARITAS India (1962), Indian Association of Retired Persons (1973), HelpAge India (1978), and Age-Care India (1980).
Bharat Pensioners’ Samaj is an all-India federation of pensioners associations headquartered at New Delhi. It functions as a nodal point for pensioners belonging to central and state governments and quasi-governmental organizations. It highlights the difficulties faced by aged pensioners and other senior citizens at various forums and strives to solve the grievances of its members by negotiating with appropriate authorities. It holds periodic seminars and conferences to focus on the problems of pensioners and other elderly citizens. The Samaj helps the needy pensioners through a benevolent fund created through contributions from its well-to-do pensioner members. All pensioners are eligible to become members of the organization as per the procedure laid down by the Samaj.
CARITAS India, a member of CARITAS International undertakes activities in different states and union territories of India. It is the official national level organization of the Catholic Bishops Conference of India, established for the education and animation of society at all levels. It aims to promote care for the sick, crippled, handicapped, destitute and the aged.
The Indian Association of Retired Persons is funded through membership fees, donations and grants-in-aid from the government and undertakes a variety of programmes for the welfare of retired persons. The association organizes regular talks and discussions with the authorities to project the problems faced by retired persons in society. Headquartered in Bombay, this voluntary body has opened its membership to all retired persons and those above the age of 60 years. It brings out a quarterly bulletin and in recent years has started a project for providing socio-medical and financial help to its members. It has also established a well-equipped library in Bombay.
Age-Care was established as a non-political, non-profit, secular, charitable, educational, cultural, and social welfare society for the care of the aged people. Initiated by its founder secretary, N.L. Kumar, who managed the support of a group of dedicated founder members from various walks of life and with diverse life experiences, it focuses on helping older persons to lead a healthy and dignified post-retirement life.
The membership to this voluntary body is open to all physically fit persons 21 years of age and above, irrespective of caste, creed or sex. With current membership of 1500 volunteers it enjoys patronage from the government, receiving grants for a number of its programmes and projects. It has also been recognized by the United Nations and is listed in the UN Handbook of Organizations active in the field of Ageing (1988 edition).
Age-Care India started off in 1981 organising free geriatric health check-up camps in Delhi for the urban poor and soon spread its network to provide the much needed health care services to the rural poor and elderly from low income groups around the metropolis. The camps, essentially a preventive measure, had till mid-1999 covered about 56,000 aged people above 50 years of age. The organization has over time opened branches at Jaipur for Rajasthan, Shimla for Himachal Pradesh, Dehra Dun for Uttar Pradesh, Faridabad for Haryana, Calcutta for West Bengal and Bhopal for activities in Madhya Pradesh.
Through voluntary donations from philanthropists and affluent persons in society, the organization has started a pension scheme providing Rs 100 per month to the economically weak and indigent elderly, particularly from rural areas. The scheme is intended to make a difference to the needy aged people above the age of 65 years. Similarly, a disability relief fund has been created at the Age-Care head office for rendering immediate financial assistance (upto a maximum limit of Rs 500) to the needy elderly during emergencies, accidents and sudden physical disability.
In addition, the organization has set up day care centres, holds regular weekly public lectures on topics of ageing and allied interests, also seminars and conferences, creates awareness about problems of older persons among school and college students, and organises yoga and nature cure training for the elderly. An innovative new project, day centre on wheels, which provides services like medical consultations, BP check-up, spot counselling, and collates information pertaining to available facilities and services for seniors. The organization brings out a monthly publication, Age-Care News, for the general reader and celebrates Elders’ Day on 18 November every year to honour senior citizens above 80 years as part of its annual day function.
HelpAge India is the country’s largest voluntary organization with 23 regional offices. Receiving nominal grants from the central government, the organization runs on charity funds collected through motivating students and youth organizations, from private and public sectors, and through selling flags and greeting cards. Its primary focus is to provide financial support to other voluntary agencies engaged in the welfare of the aged. Through its research and development centres, it trains personnel engaged in the care of the aged. It is accredited to the United Nations and is closely associated with Help the Aged, UK. It is also a founder member of Help-Age International.
Over the years, HelpAge India has supported 1,600 projects at a cost of Rs 130 crore.9 In 1998-1999 alone, it supported 190 projects to the tune of over Rs 13 crore. One of the important initiatives taken by the organization is the mobile medicare unit (MMU) programme which enables older people to assume an active role in looking after their own health while encouraging others to do the same. 95 MMUs are at present servicing lakhs of older persons residing in slums, resettlement colonies and adjoining rural areas, providing medicines, counselling and health care free of cost. In 1998-1999 alone, HelpAge India spent over Rs 1 crore on the MMU project.
Besides these national level voluntary organizations, a number of regional and local level NGOs have set up multi-service facilities and innovative programmes. Mention can be made here of the Action for Social Help Assistance (ASHA), Family Welfare Agency, Dignity Foundation, Development, Welfare and Research Foundation (DWARF), Meals on Wheels, and so on, all operating in different parts of the country. Their activity relates to providing second careers, income generating activities, companionship, nutritional counselling, cooked meals, help-line services and promoting active ageing. As a result, in recent years age care services have become increasingly available in non-urban areas.
A new strata of old people requiring multifarious affordable facilities are the parents of non resident Indians (NRIs) or inland professionals/businessmen who though financially well-off are unable to personally attend to their parents. A large number of elderly now live alone without their children, and require care, assistance, help and services at their place of residence.
The Agewell Foundation, formally launched on 6 April 1999 at Delhi with support from the Ministry of Social Justice and Empowerment operates like a club by offering a life membership of Rs 5000 to an individual or an elderly couple. Children, especially NRIs, can sponsor their parents to the club, which is chiefly concerned with the problems of the privileged elderly otherwise lacking organized help.
The services arranged for the elderly range from legal assistance, financial advice, ambulance service, help with pension problems, property tax notice, wealth/income tax assessment orders, and so on. The Foundation levies a fixed tariff on the subscriber, to be billed every month depending on the frequency of use. It runs an employment exchange for older persons, help line, involves elders as volunteers for social work and provides a platform to interact with other fellow senior citizens. The Agewell Foundation while charging costs of professional services, acts as a bridge in helping members access the ‘right’ sources to alleviate their specific problems.
Despite the NGO/voluntary sector coming forward to meet the growing needs of older persons, further steps need to be taken to create mechanisms for the proper and adequate delivery of services. There is an urgent need to expand provisions, strengthen capacities, balance geographical distribution, critically evaluate the functioning of different programmes, involve the community in taking care of the aged, and sensitize and conscientize the populace to the issues of ageing.
Equally, there is need to set up an apex/nodal agency to coordinate and synergize the different activities and programmes, as also network the various actors. Given the increasing costs of service provision, we need to encourage resource sharing and promote voluntarism if we are to adequately respond to the diverse and multiple needs of our growing aged population.
1. Manabendra Mandal, ‘The Work of the NGOs for Older Persons’, Research and Development Journal 5(1), 1998, p. 24.
2. K.K. Mukherjee and Sutapa Mukherjee, Voluntary Organizations: Some Perspectives, Gandhi Peace Centre, Hyderabad, 1988, p. 4.
3. Care of the Elderly: Directory of Voluntary Agencies for the Welfare of the Aged in India, CEWA, Madras, 1982.
4. Handbook of Information, Association of Senior Citizens, Bombay, 1992.
5. Mala Kapur Shankardass, ‘Towards the Welfare of the Elderly in India’, Bold: Quarterly Journal of the International Institute on Ageing, 5(1), United Nations, Malta, August 1995.
6. Care for Elderly, a monograph, Madras Institute of Ageing, 1989.
7. Directory of Old Age Homes in India, Research and Development Division, Help-Age India, 1995.
8. For further details refer to S. Irudaya Rajan, U.S.Mishra and P. Sankara Sarma, India’s Elderly: Burden or Challenge? Sage Publications, New Delhi 1999.
9. HelpAge India, Annual Report 1998-1999.