Evaluating the National Programme for Health Care of the Elderly in Kerala's Rapidly Ageing Context Uncovering the Geriatric Care Paradox

Introduction 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. Methods 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. Results The quantitative findings show that NPHCE has expanded from five pilot districts to all fourteen, establishing geriatric wards, outpatient clinics, and elderly-friendly infrastructure. However, implementation remains uneven, with disparities in staffing, infrastructure quality, and service utilisation across districts, indicating inconsistencies in accessibility and care delivery. Qualitative findings reveal 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 were emphasised to enhance programme effectiveness. Conclusion Kerala’s decentralised healthcare model provides a strong foundation for elderly care. However, addressing political, financial, and operational challenges remains critical to improving the quality of life for the state’s ageing population.