Evaluating the National Programme for Health Care of the Elderly in Kerala’s rapidly ageing context uncovering the Geriatric Care Paradox

Globally, the proportion of older persons is steadily increasing. In India, 8% of the population is above 60 years of age, rising to 12.6% in Kerala, the highest among all states. To address the growing health needs of this demographic, the Ministry of Health and Family Welfare launched the National Programme for Health Care of the Elderly (NPHCE) in 2010–2011. This study evaluates the implementation and impact of NPHCE across five districts in Kerala—Kozhikode, Thrissur, Pathanamthitta, Alappuzha, and Idukki—and examines its key achievements and challenges. A cross-sectional, concurrent mixed-method design was used. Quantitative data were collected through structured questionnaires and observation checklists, while qualitative insights were obtained from key informant and in-depth interviews. Quantitative data were analysed using Microsoft Excel, applying data cleaning, descriptive statistics, and visualisation. Qualitative data were analysed using a hybrid approach, combining inductive open coding and deductive thematic analysis to identify key themes. The study included 10 healthcare facilities and 60 participants, comprising 5 policymakers, 35 healthcare providers, and 20 beneficiaries. In the five pilot districts where NPHCE was active at the time of the study, geriatric wards, outpatient clinics, and older person-friendly infrastructure were in place. However, quantitative data showed disparities in staffing, service utilisation, and infrastructure scores across districts, indicating inconsistencies in accessibility and care delivery. Qualitative findings indicated that while accessibility and comfort for older adults have improved, persistent challenges remain due to workforce shortages, limited funding, and inadequate transport facilities. Beneficiaries also reported social isolation, economic vulnerability, and barriers to essential healthcare. Strengthening human resources, interdepartmental coordination, and community participation was emphasised to enhance programme effectiveness. Kerala’s decentralised healthcare model provides a strong foundation for the care of older persons. This evaluation uncovers the implementation tension, despite notable success in expanding infrastructure, persistent gaps in staffing, funding and primary-level integration undermine equitable service delivery. However, addressing political, financial, and operational challenges remains critical to improving the quality of life for the state’s ageing population.