Tell us briefly about you and HelpAge India.
HelpAge India is a nationwide organisation. We are present in more than 17 states directly and we have State Heads who drive the implementation of all our programs. We have four missions which are – healthcare, age care, livelihoods & emergencies, and advocacy. I came in as Chief Operating Officer in 2017with the mandate to work with both the Mission Heads and the State Heads in driving our mission and plans forward. For the last two and a half to three years, I essentially worked across India with all the Mission Heads and States Heads on program strategy, setting out goals and the targets and implementing them. That had been the main focus of my work, along with overseeing human resource and communications.
Before joining HelpAge India in October 2017, I have worked in both the corporate sector and social sector. My experience has broadly been in organisation building with interest in healthcare sector. My previous organisation was a public-private initiative for public health capacity building. I kind of naturally transitioned from corporate to a public-private initiative and then the social sector.
What area of HelpAge India’s work that struck you the most when you travel to the project sites?
Before joining HelpAge India, one saw older people and issues concerning them in a much narrower context. But when you travel across the country, especially rural areas, you see the actual economic deprivation and the destitution that is there.
Economic deprivation, is probably the primary concern and along with social exclusion. ,Like in many countries across the world, people are moving from rural areas into urban areas and when you go and visit any particular rural area, you will find that older people are the ones left behind, while younger people have moved to urban centres for better economic opportunities. The whole migrant story actually reversed during this particular pandemic crisis.
One is struck by the fact that older people are completely invisible. The media doesn’t see them. The government doesn’t see them. The administration doesn’t give enough importance to them or realise what can be done about them. That actually is a very staggering and probably one of the biggest realisations.
I went to Odisha, one of the states which was struck by Cyclone Fani. We were doing community kitchens and after 15 or 20 days of overseeing relief operations from Delhi, we said let’s stop the community kitchens now, because it maynot be needed anymore. People would have recovered, the health system would have kicked in, but when I visited about four weeks after the disaster struck, the local population said please continue, don’t stop it. Give us the rations. We’ll make the food ourselves, so we realised that something as simple as food distribution that we thought to discontinue after the initial days of immediate relief and as part of our DRR thinking that this phase is over and now the next phase is going to kick in, but it didn’t work that way. So that was something striking.
We promote active ageing and see older people as a resource, not all are vulnerable, is it applicable to older people you are encounter with? What is your view on that?
I think there was a huge shift from what we call the welfare approach which is based on the premise that there is a huge vulnerable population so let’s go and serve them, to the development and rights approach, which suggest that while recognizing that there was vulnerability at the same time, recognise them as a resource. If they are made capable, if they are empowered, then they can take care of themselves and also be better prepared for the challenges that they have. This shift already had taken place in our framework, but going forward as part of Vision 2025 as we are setting our strategy, we have emphasised that very deeply. One of the ways in which we started seeing the elderly long time ago was not just in their age but also their ability. In all our work, we classified older people in three categories; active, assisted and dependent. A 70-year-old can be in an active category, while 60 year old can be in dependent category, so it’s not age but their ability and what they can do.
Over the last few years, we have been advocating to the Ministry of Rural Development, Ministry of Social Justice about Elder-Self-Help-Groups, as an enabling and empowering platform, as a resource, as a way of living life in a sustained manner and with dignity.
In the most recent documents that the Government of India released, they have recognised what’s called an Action Groups for social reconstruction. It’s a program that the Government of India had launched for the first time saying that senior citizens, if they are brought together, they can be a force of change. They can be a force for contributing to society.
There’s a lot of conversation about younger people, the demographic dividend. Now there’s a talk about the demographic bonus, which is a complete mindset shift.
Mathew Cherian, my predecessor, talks about the second demographic dividend in his book, you know. And this is something that we have taken up.
We also do a lot of active aging programs in terms of walkathons, workshops. Those are something that we work with senior citizens and we feel that those should be increased even more.
What is the situation of COVID 19 and older people in India? What are the responses by HelpAge India?
When COVID-19 hit India and the across the world, the focus was on the older population being a high-risk segment. In March, we started looking at how we can respond. In the beginning, we started with a lot of awareness programs, but we soon realised, it was a matter of survival for the older population because the older population in India are facing what we called ‘the triple struggle’. First, health was a natural hit, because 60% of the 60 plus typically have the co-morbidities, they have non-communicable diseases and lower immunity as a risk factor combined with the social iniquities, where 50% of elderly in rural areas are living below poverty line. Ninety per cent work in the informal sector have very little social security.
We conducted a survey in June amongst 5,000 elders, to study the impact of COVID 19 on the elderly and what we found was that almost 65% faced loss in livelihoods, a direct loss in livelihoods or through the loss of income of their supporters. Seventy-eight per cent actually faced lack of access. If there’s a pension that government transferred to the bank, they could not go to the bank and take the money. If there are free rations being made available through the public distribution system, they could not go and take the food. They did not have, the medications they needed to continue their care and the lack of digital literacy only heightened their inaccessibility to even the most basic services for survival.
Livelihoods, survival, hunger was their primary concern. Health and access came after that.
Our first response post lockdown was a nationwide response where we gave relief in terms of food and ration, and family survival kits. We reached out to about 200,000 with cooked meals to. Survival kits, which is a combination of basic rice, flour, oil and so on was distributed to about 60,000 families, reaching about 3,00,000 people.
The second response was healthcare and we ran 150 Mobile Healthcare Units across the country. We use these units as a way to provide primary care, but also to do a lot of awareness building and distributing what we call as hygiene kits, sanitisers or soaps. These were very basic requirements, but you can imagine poor people in a village where they don’t have any access to soap or even basic hygiene materials.
The third response was the livelihood support from a recovery perspective. We did direct benefit cash transfer to about 30,000 elderly across 5000 Elder Self Help Groups. It brings me back to the fact that we saw evidence of the usefulness of these Elder-Self-Help-Groups in action. You’ll be surprised that elders from these groups who were poor and had very little cash with them, came forward and supported those even the more poor & destitute amongst them. They came together and knitted masks for themselves and the community around them, cooked meals and provides basic ration. These were examples which told us that the resilience of the poor or those are unsupported, was remarkable and it inspired us to go back and do even more for them.
The fourth important part of our response was our Elder Helplines. We have a national toll free helpline operating across 24 locations in the country. We made them respond to the pulse of the elderly and we also actively reached out to elders in need. Usually, we wait for calls, in this instance, we actually started calling all the elderly in our databases to inquire how they are and see if they need anything.
And we partnered with the voluntary and local organisations so that they could bring the relevant supplies to the door steps of these elderly. We were not there in every district, & town, but there are other organisations that are, so we partnered with them and supported them. Along with that we also started our next push, which is policy and advocacy because we realise that there are many gaps in the system and we are now going at each state level to put our demands to the government, to the policymakers, to the district administrations on what specifically can and needs to be done. We have a large implementation program with UNFPA for the first time. They are supporting us for a community-based health services programme.
We are continuing to respond, but there are shifts. We’re moving to the recovery and resilience stage.
How do you envision the future of HelpAge India under your leadership?
HelpAge India has the advantage and the privilege of an organisation with 42 years of strong base and I think it’s well recognised in India and we feel very proud of it. It has been torch bearers for elder care. Even when nobody was talking about it, HelpAge India had been raising the flag consistently over the years. So I think all one needs is a strong base and a focused vision I think we are well geared for future. We also have huge and very dedicated teams across the country. That’s again an excellent base to look at our journey going forward. And the third is we are fortunate to have a very engaged board.
What is more important for us when you’re looking at the next 30 years of journey, we see that India is at the inflection point. One in five of the Indian population are young now, but rapidly ageing, it will soon be aged and you will have a country which is relatively young but not recognising that it is ageing rapidly. So we are well-positioned to drive change, but it is critical for us to do accelerated change going forward.
I think the urgency of action is something that is missing completely in the current policy and development agenda. One of the things we want to do is raise the level of urgency for planning an action and therefore mainstreaming ageing into the development agenda.
Programmatically we would continue to do what we have done, which is focused on the disadvantage elderly, bring the programs in terms of healthcare, agecare and other relief to them, but also add two things. One is the aspect around capacity building, from just delivering programs move to working with the systems, work with the health system, care system, family system, community system, bring the training and development agenda as an important part of what we do. And the second aspect, which we want is to focus on, is policy and advocacy, because we realised that we are very strong in implementation. We’re doing great work on the ground, we are connected to communities, we know the problems, we know the aspects that need to be focused on, but how do we also become a knowledge and evidence-driven organisation so that we can leverage on the implementation experience, add the capacity building agenda to it, and drive policy and advocacy in a much more aggressive and more coordinated manner.
We said three things are important for us. The number one is partnerships, because if we try to do it ourselves, we will only reach that far. So how do we partner with the government, with the civil society, with the private sector. We are very open and we want to actually take up the whole partnership in collaborations, in a very strong way going forward.
Number two, we want to focus on what we call the digital adoption. We felt that technology is probably going to be the biggest multiplier or the amplifier. As an organisation, we need to focus and invest more on programmatic technology that can help the cause of the elderly.
The third one is working with the 90%, which are schoolchildren to working adults, going on to be next elderly over time. The generations are changing very rapidly, so the next wave of resource givers, the next wave of change-makers, will be the Millennials and Gen Z’s of the world. If we are not engaging with the Generation Z, Gen X and Gen Y then we’re missing out on something as a going-forward approach and we felt that along with partnerships, technology, the intergenerational approach, is a very important part.
Partnerships, technology and intergenerational, these as the tenets of our vision and strategic plans.
This will be important for building a caring society that values elders but also preparing India for ageing.