Hrev_master [page 12] [Healthcare in Low-resource Settings 2017; 5:5932] Building resilient and responsive health systems for geriatric care in India Sandul Yasobant,1 Kranti Vora,2 Deepak Saxena2 1Center for Development Research (ZEF), University of Bonn, Germany; 2Indian Instititue of Public Health, Gandhinagar, India Dear Editor, Currently, more than 12% of the world’s elderly population lives in India. The demo- graphic trends suggest that between the years 2000-2050, the Indian population in their 60s and above will increase by 326%, while those in the age group of 80+ will increase by 700% – the fastest growing group.1 With this demographic transition, very soon India might become a grey nation. As a consequence, the proportion of disease burden contributed by cancers, car- diovascular conditions, diabetes, muscu- loskeletal disorders and neurological disor- ders such as dementia, hearing and vision loss, is expected to increase.2 Therefore, we aimed to do a situational analysis and iden- tify opportunities to build resilient health system for better geriatric care in India. Overview of the Indian health system Indian health system is presently strug- gling with rapidly changing demographics and disease burden. Underfinancing, short- age of skilled human resource for health are one of the greatest challenges to respond to changing priorities.3 Currently, we are pass- ing through a stage of epidemiological mosaic with an unfinished agenda of infec- tious diseases and maternal, child health problems with an added burden of Non- communicable diseases due to aging popu- lation. Indian health system has responded to these changes, but in addition to limited public health infrastructure there are also issues such as geographical vastness, socio- cultural diversity and rural-urban differ- ences throughout the nation.4 In addition to infrastructure issues dog- ging public sector there is a vast private sec- tor in India that caters to more than two thirds of health services. A mixed health care market of public and private providers is a reality as India is an under-resourced country with respect to human resources for health.5 Because of limited access in public sector, formal and informal private providers remain the main source for pri- mary health care services in India.6 Current geriatric care system in India Geriatrics health care in India is in its nascent stage. Indian Government has focused on rural healthcare since independ- ence and developed a three tier healthcare delivery system to improve access in remote areas by providing primary care at the village level, secondary care at the sub- district and district levels, and tertiary care at the regional level. Medical colleges are developed as apex institutes with special- ties. Neither infrastructure wise nor by skilled training of human resources, these three tier system healthcare services are geared for geriatrics care except in few apex institutes. To improve public sector capacity for health services targeted for elderly, the Govt. of India has implemented a national level health program called National Programme for the Health Care for the Elderly (NPHCE) in 2011.7 NPHCE pro- gram focused on development of Regional Geriatric Centers (RGC), specific geriatric ward, training of health personnel in geri- atric healthcare and conducting research including Postgraduate degree in geriatric medicine in the RGCs.8 Opportunities to build a resilient geriatric care system in India Currently, Indian health system has a mixed market and there are ample opportu- nities if private providers are included into the current strategies of planning for univer- sal health care. Unfortunately, for the geri- atrics care in reference to NPHCE, there is no concept of public-private mix. We pro- pose that public-private mix could be a potential strategy to improve access to geri- atric care with available resources and it could lead to building a responsive health system. We use relevant resilient health sys- tem criteria9 to propose strategies to build the same for geriatric care in India. First, systems awareness: developing an up-to-date map of resources available including private sector and not limiting to RGCs. Mapping would help identify resource gaps in human, physical, and infor- mation and help in efficient planning and monitoring. Second, system diversity: geriatric care services should address a broad range of health services needs starting from curative to preventive services in a comprehensive package for each tier. Third, systems integration: geriatric care should be integrated with allied sectors like old-age homes, education department etc. As geriatric care requires multidisciplinary team, integration with other sectors is vital for holistic and culturally appropriate care. Fourth, system adaptation: as the cur- rent system does not have geriatric care as a focus area, once that has been achieved, system should be able to adapt to any shocks. Health system resilience has been well understood only after the Ebola out-break,10 similarly it is important to build such sys- tem for geriatric care in India. Improved system would be able to withstand any upcoming challenges. In the current health system scenario of India and given the mag- nitude of the service provision in this coun- try of billions, it is important to take baby steps towards building responsive and resilient system for the elderly. It seems a daunting task but Indian health system has adapted in the past and can continue to do so in its endeavor to provide universal health care. References 1. Verma R, Khanna P. National program of health-care for the elderly in India: a hope for healthy ageing. Int J Prev Med 2013;4:1103–7. 2. Thakur R, Banerjee A, Nikumb V. Health problems among the elderly: a cross-sectional study. Ann Med Health Sci Res 2013;3:19–25. 3. Kumar JR. Role of public health sys- tems in the present health scenario: key challenges. Indian J Publ Health 2013;57:133–7. Healthcare in Low-resource Settings 2017; volume 5:5932 Correspondence: Sandul Yasobant, Center for Development Research (ZEF), Walter Flex Str.3, 53113 Bonn, Germany. Tel: +49-162-161-0570. Email: dryasobant@gmail.com Key words: Resilient health systems; Responsive health systems; Geriatric care; India. Contributions: SY, KV, DS equally con- tributed to the manuscript. Conflict of interest: the authors declare no potential conflict of interest. Received for publication: 13 April 2016. Revision received: 28 February 2017. Accepted for publication: 17 March 2017. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright S. Yasobant et al., 2017 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2017; 5:5932 doi:10.4081/hls.2017.5932 Non co mmerc ial us e o nly [Healthcare in Low-resource Settings 2017; 5:5932] [page 13] 4. Engelgau MM, El-Saharty S, Kudesia P, et al. Capitalizing on the demographic transition: tackling noncommunicable diseases in South Asia. Washington, DC: World Bank; 2011. 5. Srinivisan R. Health care in India- vision 2020: issues & prospects. New Delhi, India: Government of India, Planning Commission of India; 2010. 6. Alok M. Public-private partnership in the health sector in India. Public-Private Partnerships. 2000. Available from: uhrc.in/uhgateway/documents/1073.pdf 7. Indian Ministry of Health and Family Welfare. National Programme for the Health Care of the Elderly (NPHCE): An approach towards active and healthy ageing. New Dehli: Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India; 2011. 8. Indian Ministry of Health and Family Welfare. National Programme for the Health Care of the Elderly. Operational Guidelines. New Dehli: Ministry of Health and Family Welfare, Governement India; 2011. 9. Maresso A, Wismar M, Greer S, Palm W. What makes healthsystems resilient & innovative? Voices from Europe. Eurohealth Obs 2013;19:3–6. 10. Kruk ME, Myers M, Varpilah ST, Dahn BT. What is a resilient health system? Lessons from Ebola. Lancet 2015;385:1910–2. Letter to the Editor Non co mmerc ial us e o nly