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APPENDIX VI
MANUAL FOR MULTIPURPOSE HEALTH WORKERS

PART A

General Considerations

Those aged 60 and above constitute 6% of India's population and number nearly 43 millions (1981 census data). More than the percentage, it is the number of these people that is of great concern. Since 80% of India's population live in villages, it is understandable that many elderly people inhabit rural areas. Around the year 2000 A.D. their number is expected to cross sixty millions in India. Although the health care of the elderly has not yet assumed any seriousness, a beginning has to be made to cater to the needs of this sector of country's population.

The elderlies are at a great disadvantage by all accounts, especially with accelerating socio-cultural changes. They form a vulnerable group, not only from the point of view of health problems, but also from other aspects, namely economic, social, nutritional and others. Although it is true that India's philosophy and culture prescribe reverence and respect for the aged and recommend the care of the aged parents as a form of worship, these values are facing corrosion at present. This has been the result of breakup of the joint family system of living, migration of younger members to the urban areas for employment and the competitive nature of modern living. Although 20% of the aged are known to be enjoying a fairly good level of health and contentment, others present with various problems. All those above sixty do not form a homogenous population. It is usual to divide the elderlies into 'young-old' (between 60 and 70 years) and 'old-old' above 70. In India, 80% of the elderly population fall under the 'young-old'. By many, old people are considered as burdensome, notwithstanding their being accepted as respected persons in the family and society. It is said that a nation or a culture is judged by the way in which it takes care of its elderly. According to the constitution of India, elderlies are eligible to 'Old Age Pension' and other benefits. Many states in India have provided these benefits to the elderly, although the criteria governing them differ from State to State.

Although Primary Health Centres along with their sub-centres are distributed all over the country, each catering to a population of one lakh, many rural elderlies are not yet reachable. The rural elderlies differ from their urban counterparts. Illiteracy among the rural aged is of a higher magnitude. They are not able to avail all the facilities at the PHC or its sub-centres owing to lack of transport, geographical distance, or physical disabilities or for want of funds and physical help for travel. It is a wrong notion that all that occurs in the aged is due to ageing. Elderly people suffer from many diseases and disabilities, some of which can be either prevented or ameliorated or even cured. Hence to deny intervention assuming that nothing could be done to them is not proper. Old have as much right as the young for optimum health. The role of Multi Purpose Health Workers assumes significance taking into consideration the predicament of the rural aged.

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