411008_Report_BaselineAssessment_NRCS_final

Ageing and Health Project

Suryabinayak Municipality Ward # 2, Balkot, Bhaktapur

Baseline Study Report

December 2021

Acknowledgement

It is obviously a good moment for me that I became a part of this ageing and health baseline study. I

hope the findings received through this study will help Nepal Red Cross Society (NRCS), which is a

largest humanitarian organisation in Nepal, to plan and implement ageing and health interventions in

coming days. As the NRCS has already included ageing and health as a key component in its five year

development plan 2021-2025 considering older people as one of the vulnerable groups and prioritised

ageing population as priority beneficiaries.

I am extremely grateful to the NRCS district chapter Bhaktapur and Balkot Sub-chapter volunteers and

staffs for their valuable time during the baseline data collection. We wish to give special thanks to

representatives of the Swiss Red Cross headquarters and Nepal country office, for providing excellent

technical suggestions in the draft report.

I express my sincere thanks to officials of the Suryabinayak Municipality Ward Number -2 for their

guidance and facilitation in the baseline study process.

Finally, I would like to acknowledge and appreciate the guidance, coordination and input of Mr.

Bal Krishna Sedai, Deputy Director and entire team of NRCS Health Service Department for their

support throughout the study period.

Mahesh Sharma

Consultant

Nepal Red Cross Society Ageing & Health Project Baseline Study Report

Contents

Abbreviations ..................................................................................................................... iii

Executive summary ............................................................................................................ iv

Major findings

iv

General health condition and access to health services

v

Community and policy makers perception towards older people

v

Major recommendations

vi

1. Introduction and background ............................................................................................... 1

2. Objectives of the study ........................................................................................................ 2

3. Methodology ........................................................................................................................ 2

3.1 Study area: .............................................................................................................................. 2

3.2 Sample size: ............................................................................................................................ 2

3.3 Sampling strategy: .................................................................................................................. 2

3.4 Data quality ............................................................................................................................. 4

3.5 Data analysis ........................................................................................................................... 4

3.6 Limitations .............................................................................................................................. 4

4. Findings ................................................................................................................................ 5

4.1 Respondents profile and general household information...................................................... 5

4.2 Findings of the study ............................................................................................................... 6

A. Engage in income earning activities ............................................................................... 6

B. Social pension and other benefits .................................................................................. 7

C. General health condition and access to health services ................................................. 9

D. Physical activities .......................................................................................................... 12

E. Care and support required ............................................................................................ 12

F. Psychosocial well being ................................................................................................. 13

G. Community/social activities ......................................................................................... 14

H. Community perception towards older people ............................................................. 16

I. Key informants views ..................................................................................................... 17

5. Conclusions and recommendations .................................................................................... 18

5.1 Conclusions ........................................................................................................................... 18

5.2 Recommendations ................................................................................................................ 19

References 21

Annexes 22

Annex 1: Data tables 22

Annex 2: Consent paper for interview 35

Annex 3: vibre communication (examples) 36

Tables

Table 1: Respondents profile .................................................................................................................. 5

Table 2: Engaged in income-earning activity .......................................................................................... 6

Table 3: Type of pension received .......................................................................................................... 7

Table 4 Reasons for not receiving social pension ................................................................................... 8

Table 5: Use of pension ........................................................................................................................... 9

Table 6: Old age benefits received in public services ............................................................................. 9

Table 7: Receiving treatment by age group .......................................................................................... 10

Table 8: Health problems under treatment .......................................................................................... 10

i


Table 9: Difficulty with work/household activities ............................................................................... 10

Table 10: Where did you go .................................................................................................................. 11

Table 11: Access to health insurance .................................................................................................... 11

Table 12: Means of covering hospital cost ........................................................................................... 12

Table 13: Days spent in physical activities in a week ............................................................................ 12

Table 14: level of care and support required for daily routine ............................................................. 13

Table 15: How often do you meet friends and spend time .................................................................. 13

Table 16: Hours spend in leisure/day ................................................................................................... 14

Table 17: Engaged in mind concentration activities ............................................................................. 14

Table 18: Engage in community/social activities .................................................................................. 15

Table 19: Feeling in and around the community towards senior citizens? .......................................... 16

Figures

Figure 1: Cluster division ......................................................................................................................... 3

Figure 2: Interviewed to .......................................................................................................................... 5

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Abbreviations

FGD

Focus Group Discussions

GIS

Global Information System

KII

Key Informants Interview

MIPAA Madrid International Plan of Action

NRCS Nepal Red Cross Society (Red Cross)

SDG

Sustainable Development Goals

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Executive summary

Nepal Red Cross Society has included ageing as one of the key programmes in its five year

development plan considering older people as one of the vulnerable groups and prioritised ageing

population as priority beneficiaries of its development interventions. In line with this, NRCS in

collaboration with Swiss Red Cross intends to initiate a pilot on Ageing and Health at Suryabinayak

Municipality, ward no 2 (Balkot).

Keeping this in view, with the purpose of preparing a baseline status of old age people of the ward no

2 of Suryabinayak municipality (Bhaktapur district), this study was conducted during November-

December 2021 applying mixed methods (quantitative and qualitative) and participatory approaches

engaging the older people. The specific objectives were to identify issues and needs of the aging

population of the area along with use of government policies and facilities by the senior citizen. It also

aimed to identify senior citizen and their family’s knowledge, behaviour, and practices in relation to

healthy ageing.

Major findings

Among the respondents, 55% (142/256) were female and 44.5% (114/256) were male. 48%

(N=123/256) were from 60-69 age bracket, and 62% were 70+ age group. 46% of the respondents

were living there for 20 years or less where as 64% were living there for longer period of over 20 years.

Clearly, this area (ward number 2) is rapidly urbanising with influx of people from all over the country.

The data suggested that Senior citizen in ward number 2 are generally happy and majority are living

in a joint family. Corollary to this, 78% expressed their overall satisfaction to the life they are living

and only less than 4% expressed their complete dissatisfaction. But this situation may change as social

and family structures are changing rapidly.

"Daughter in law (Buhari) care for me, prepares my favourite meals, but during day time there

is no one to stay with me" (82 years old female)

As for the daily routine is concerned, most had 'normal' routine fixed, like engaging in household

activities, watching TV , using social media, go out and meet friends in tea shops and so on. Only small

percentage (12%) of elderly people in this area were engaged in some sorts of income earning

activities. Data also did not suggest that the majority of the senior citizen were keen on engaging in

income generating work.

Among all those who are 70 years old and qualified for pension (N=148/256), 68% of the respondents

were receiving social pension or single women allowances (Rs 4000, USD 35/month) and 30% were on

retirement pension. Those who do not have other income source, Rs 4000 was said to be too small to

cover their basic needs.

Contrary to the near universal access to social pension, access to and use of other old age benefits

announced by the government 1 were not satisfactory as many people (62.5%) were not aware of such

facility. Service providers were also not very supportive in implementing the government policy.

Utilisation of the government health insurance too was not satisfactory either, with only 20%

1

Govt. Announced facilities includes -discount in public transport, discount in hospital charges, free treatment for

certain conditions i.e. dialysis for kidney patients, cash contribution towards treatment of major diseases like

cancer, heart problem etc)

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enrolment with 12% getting their health care cost covered. Similar dissatisfactions were also

expressed during FGD. One of the reasons for such low uptake of the service, as implicitly indicated

by the data could be physical distance of the hospital that offer services to insured people.

General health condition and access to health services

At the time of interview, 74% of the respondents were receiving one or another treatment for their

health problem. While the majority reported very good to moderate health condition, quite a few

reported bad (31%) to very bad (4%). Among those (N=190) who were receiving medication for their

health problem, large percentage of the respondents (44.74%) were under 70 years of age. The

medications was for wide varieties of health problems, but most notable health problems were

hypertension (58.95%) , diabetic (30.5%) and asthma (20%).

Nearly half of the respondents (47.6%) visited hospital/health facility within last three months for

varied problem. But interestingly, those who visited health facilities (N=122), majority had gone to

private hospital/facility and very few (only two person) went to government health post, which is very

close and in the same ward. For majority (63.93%), the cost of health was paid by the family members,

only 12% got their cost covered through government health insurance and 8.2% paid from their own

savings. But generally older people were cared by the family members.

Some FGD participants however had critical views about caring older person.

v

"it is difficult to handle old people, they often grumble on everything. They could be looked

after better if they behave little more decently" (46 years old male)

Engagement in routine physical activities were reported to be moderate by 43%, while 20% and 23%

reported low and basic movement respectively. 10% reported almost none physical activities.

Almost all FGD participants expressed the lack of community facility such as park or library where they

could spend time and meet friends.

"There is no any facility in the community for the older people" (62 years old female, 70 years

old male)

"It would have been easy to spend time, had there been a park or library in the ward

(community)" (80 years old male)

Vast majority of the respondents did require only minimal care or no care for daily life. Only 3%

required complete care and 12% required partial care.

For emotional or psycho social wellbeing, sharing the feelings and interacting with each other is

important. Majority were quite active and meeting friends very regularly, but over 20% of the

respondents reported none, which means they do not meet their friends and exchange ideas and

emotions. For mind concentration, only 37% replied affirmatively that they do yoga or meditation. But

people (75%) also reported engaging in Bhajan (prayer) and other activities.

Community and policy makers perception towards older people

Quality of life of older people is also influenced by the community perceptions and reactions towards

older people. The overall response towards community behaviour towards older people was very


affirmative. Only less than 4% of the respondents said that they do not feel respected or supportive.

Although most felt safe while walking in the morning or evening and no fear of mugging, but often felt

unsafe and frightened by fast driving motorbikes and care.

"Wish they could drive slow and care for walking persons" (78 years old male)

"It is frightening while crossing the road because of fast racing car (and bikes)" (70

years old male)

Key Informants, mainly the municipal and ward authority had positive attitude and expressed their

willingness to support senior citizen. Ward office has allocated some fund for social cause which can

also be available to activities related to senior citizen. All key informants said that

"Senior citizen are our guide, they are the torch blower, and they have rich

experiences that we should learn and use their expertise"

But when it comes to addressing specific needs (open space, meeting forum) and understanding the

specific problems (i.e. health, psychosocial) of older people most were not quite appreciative to it.

And also when it comes to reallocating the resources – they often say that rules do not allow for this.

Rhetoric on older people and their issues was common among the policy makers.

Major recommendations

A forum (self-help club) needs to be established where senior citizens can freely come, meet friends,

share their ideas and feelings and try to do some creative work for themselves and for the larger

community towards building age friendly community In other words, support organising various

activities through the established forum that empower the older people. Red Cross can initiate this in

collaboration with Ward office. With careful planning such forum is possible to make itself selfpropelling

managed by old age people themselves voluntarily with no or little support. First piloting

with one, such forum can be promoted in different locales depending on the interest of the older

people.

Engage young people and family members along with older people in ageing and health programme.

Ultimately it is the family members who should take the full responsibility of old people. Engaging

young people would not only bring new dimension to the ageing programme, it will also be more

sustainable. Moreover, this would contribute in creating an environment that respects older peoples'

dignity and human rights, free from gender and age based discrimination.

Though the government health insurance is a good programme, the low enrolment in it is a big

challenge that Red Cross can intervene and encourage people to join and use the facility. Moreover,

since the cost of treatment was mostly paid by the family members, it must of an interest of the family

members too to get enrolled in the health insurance plan.

Red Cross might play a role by advocating with municipality mayor and local ward authority to

approach Ministry of Health to address the health insurance concern. Senior citizen would be happy

to join hand with Red Cross in this.

Red Cross can also facilitate routine health check-up (monitoring blood pressure, blood sugar, routine

urine test etc.) and conduct health education sessions either coordinating with local health post or

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mobilising semi volunteers (i.e. older people, young volunteers, community nurse). Old age persons

forum can be a good entry point for such interventions.

Despite the positive attitude among the policy makers towards the Senior citizen, rhetoric was

prevalent. More practical thinking is necessary to address the specific needs of the older people and

making an age friendly community. A regular interactions of old age people with policy makers at

different levels along with lobbying and advocacy for better policy and for resources allocation needs

to organised.

Regular interaction of old age people with Health Post and Ward authority would improve confidence

of old age people to access the services it provides and also encourages health post to be more age

friendly with quality services.

Many older people were not physically active or do any physical exercise and meet friends reclining

and talking. Engaging in mind concentration activities (meditation, Yoga) was also limited. This is

another area that Red Cross can play a crucial role by creating a regular forum where older people can

be engaged in physical or mental or other activities.

Building age friendly community should be the mainstay of the programme intervention. As such,

engaging in social/community activity and developing a sense of belonging is crucial for psychosocial

health which reduces stress and the feeling of loneliness. The findings indicated that a mechanism is

needed to allow the senior citizen to engage in some social/community activities. Some of the

possibilities includes exploring and working with local club/NGOs in order to create an environment

for engaging senior citizen in some meaningful activities voluntarily depending on the interest and

skills of the old age people.

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1. Introduction and background

The Senior Citizens Acts 2063, Nepal defines the senior citizens (older people population) as "a citizen

of Nepal having completed the age of Sixty years". About 9% of the total population accounts for 60+

population and the number is projected to be around 20% by 2050. The increase in the population of

older people has given rise to challenges in both developmental and humanitarian areas in terms of

promoting their well-being by meeting their social, emotional, health, financial and developmental

needs. Various observations show that the proportion of older people population is high in Mountain

and Hilly regions in comparison to Terai. Similarly, it is noted that the female older people population

is higher than the male older people population among three ecological regions 2 .

The Constitution of Nepal (2015) recognises the right to health and the social security as fundamental

rights. As such number of policies and programmes are being implemented, such as social security

allowance (old age allowance); free or subsidised health package for senior citizen, geriatric beds in

hospitals, gender friendly infrastructure (as a part of National Health Policy 2019 which aims to devise

different strategies to effectively implement Universal Health Coverage); concession in travel fare etc.

The 2030 Agenda for Sustainable Development sets out a universal plan of action to achieve

sustainable development in a uniform manner and aspires to realize the human rights of all people. It

calls for ensuring that the Sustainable Development Goals (SDGs) are met for every component of the

society, at all ages, with a discreet focus on the most vulnerable population group, which includes the

older people. Moreover, much earlier in 2002, a global agreement was reached at Madrid, called

Madrid International Plan of Action on Ageing (MIPPA) which offers a comprehensive action plan for

governments and civil society, amongst other groups, for building a society for all ages 3 . Similarly, UN

has declared the decade of 2021 – 2030 as UN Decade of Healthy Ageing that brings together

governments, civil society, international agencies, professionals, academia, the media, and the private

sector to improve the lives of older people, their families, and the communities in which they live 4 .

Likewise, government of Nepal developed a Plan of Action for Ageing in 2005 and revised in 2013 in

line with international commitments and declarations 5 .

Keeping this in view and in recognition of challenging in ageing population, Nepal Red Cross Society

has included ageing as one of the key programme in its five year development plan and prioritised

ageing group as priority beneficiaries of its development interventions. Besides, NRCS with

collaboration with Swiss Red Cross intends to initiate a pilot on Ageing and Health at Suryabinayak

Municipality, ward no 2 (Balkot) with ultimate aim of expanding its understanding on ageing and

health issues so that NRCS can work strategically for the benefit of the older people.

2

Bhandari, K (2020), Trends in Age Structure and Ageing Population in Nepal, Journal of Population and

Development, June 2020

3

https://www.helpage.org/what-we-do/rights/the-madrid-plan-mipaa/

4

United Nations Decade of Healthy Ageing (2021–2030), https://documents-ddsny.un.org/doc/UNDOC/GEN/N20/363/87/PDF/N2036387.pdf?OpenElement

5

GoN, Ministry of Social Welfare, Children and Women. National Plan of Action for Senior Citizens 2062 (2005)

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2. Objectives of the study

The purpose of the current study was to prepare a baseline status of the ward no. 2 of Suryabinayak

municipality (Bhaktapur district) and identify major issues and needs of the ageing population of the

area and suggest appropriate implementation strategies/interventions at an operational level to

address the gaps/needs which can be incorporated in the project design.

It also aimed to identify senior citizen and their family’s knowledge, behaviour, and practice in relation

to healthy ageing. Social protection, gender dimensions of ageing, and inclusion related information

were also aimed to collect mainly to identify the barriers and enablers in knowledge, behaviour,

practice and access to resources and participation in matters that affect the health and well-being of

the older people.

3. Methodology

A mix method of qualitative and quantitative was applied along with participatory approaches

engaging older people and NRCS volunteers. The methodology and tools were adapted from WHO

(SAGE manual) and Age friendly cities project methodology 6,7

3.1 Study area:

NRCS decided to initiate a pilot project on ageing and health in Suryabinayak Municipality, ward no. 2

(Balkot). Therefore the data collection and other subsequent process was conducted in this area.

3.2 Sample size:

Based on of 60+ age group population (projected from 2011 CBS data), a total of 252 (including proxy

respondents as applicable) senior citizen was calculated be covered for quantitative data collection

(calculated using web based calculator) 8 . The sample size was adjusted with design effects 2 and 10

percent no response rate.

Following formula was used to calculate sample size

n = N*X / (X + N – 1),

where,

X = Z α/2

2

*p*(1-p) / MOE 2 ,

and Z α/2 is the critical value of the Normal distribution at α/2 (e.g. for a confidence level of 95%, α is

0.05 and the critical value is 1.96), MOE is the margin of error, p is the sample proportion, and N is the

population size. Note that a Finite Population Correction has been applied to the sample size formula.

3.3 Sampling strategy:

Quantitative: A multi-stage sampling approach was used

6

WHO (2006). WHO SAGE Survey Manual: The WHO Study on Global Ageing and Adult Health (SAGE).

Geneva, World Health Organization

7

WHO (2007). WHO Age Friendly Cities Project Methodology, Vancouver Protocol, World Health Organisation, Geneva

8

https://select-statistics.co.uk/calculators/sample-size-calculator-population-proportion/

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Step 1: The ward was divided into four sector/cluster arbitrarily using ward map as follows. Along this

line, a more practical clustering for the ease of data collection was done in consultation of

local people and NRCS sub branch Balkot in ward no. 2

Step 2: In each sector, at the time of interview starting from one end, every alternate household was

contacted and checked if there was a eligible member of 60+ age group to be interviewed. In

a situation where there were more than one member of 60+ person, the oldest one was

interviewed irrespective of sex.

Step 3: After eight consecutive interviews, sex ratio of interviewee was checked to see if equal or near

equal number of male and female were interviewed. Interview preference were adjusted in

next set of interview to create a balance of the sex ratio. During the interview, some

adjustment in the household selection had to be made to include respondents from Dalit

community.

Figure 1: Cluster division

Qualitative: Focus group discussion in each cluster

In total eleven focus group discussions were conducted for under 60 years age group and for 60 above

age groups equally from each cluster. Efforts for conducting FGD of only women or only men did not

work as the tendency for aged couple was to walk together or have someone to assist with same age

group. All FGD were recorded as well as notes were taken simultaneously by a note taker. All the

notes were expanded, rechecked for any inconsistency and unclear statement and verified with

recorded note as required.

Four Key Informant interviews were also carried out with the municipality mayor, ward chair and

health staff of the ward number 2. Additionally KII was also carried out with other senior citizens of

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the ward. Some valuable information were also obtained from consultation with Mayer of the

Suryabinayak municipality and district public health officer of the Bhaktapur district. Consultations

were also conducted with some executive committee members of Balkot Red Cross sub branch.

3.4 Data quality

Following approaches and steps were applied to ensure the data quality.

1. A field research team of twelve was recruited by the Balkot Red Cross sub branch, among from

the Red Cross volunteers who in the past had participated in Red Cross activities. A two and

half day training was organised at Balkot Red Cross building. During the training the major

topics covered were; An overview and introduction on ageing population; qualitative and

quantitative research concept, method and tools; data collection and conducting focus group

discussion; research ethics; KOBK tool set up and its use; understanding on questionnaire and

detail practice on questionnaire directly on KOBO tool using smart phone of field researchers;

and communicating with older people. Each research team was assigned to take charge of one

sector/cluster.

2. A pre-test was organised after the training directly using KOBO tools. After the pre-test some

adjustment in questionnaire and KOBO was made. Every interviews were uploaded in KOBO

platform immediately (if internet access is available) with GIS marking or at least by the same

evening if internet access is not available during interview time. Red Cross team and

consultant reviewed that data in the KOBO platform in the same evening to check if the data

collection is happening as desired.

3. A vibre group was created with all the field researchers, Red Cross team and consultant for

quick and uniform communication related to field work and data quality. This was found to be

a very effective mechanism to quickly communicate and give feedback to field researchers

(some screen shorts communication in vibre group are presented in Annex as an example)

3.5 Data analysis

Quantitative data uploaded in KOBO platform were first exported to excel for data cleaning. Once the

data was cleaned in excel, further analysis was done using excel and SPSS depending on type of

analysis required. Simple statistical tools such as frequency distributions, mean, and percentages have

been used to organize or summarize the quantitative data.

All the qualitative data from FGD, KII and consultations were reviewed carefully and were analysed by

searching for patterns and ideas. In other words a both the 'inductive' and the 'deductive' process

were followed. Similar patterns and ideas were grouped together into a 'sub theme'. Likewise,

subtheme were grouped into a theme. Further analysis and interpretation were done by the theme/s.

3.6 Limitations

The study was conducted in ward no. 2 (Balkot) of Suryabinayak areas, therefore the findings of this

study cannot be generalised and applied in other context.

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4. Findings

4.1 Respondents profile and general household information

Almost all the respondents were direct respondents who took part in the survey interview. Only 4.3%

old people took part in the interview through an escort (proxy).

Figure 2: Interviewed to

There were more women respondents (5% more than

men). In age grouping also there were more women

respondents in the two age brackets (80 – 89 and 90 – 100).

More males have formal education than females. Majority

(60%) were currently married while 37% were widowed (M

9.8%, F 27%). Majority were living in this are for over 40

years, but percentage of old age people living for last 20

years or less was also quite substantial (46%). Majority

were born in this district and were livening in their own house where as 20% were living in a rented

house.

Table 1: Respondents profile

1. Male 2. Female Total

Particular Number % Number % Number %

Age of respondent

60-69 58 22.7% 65 25.4% 123 48.0%

70-79 41 16.0% 57 22.3% 98 38.3%

80-89 14 5.5% 18 7.0% 32 12.5%

90-100 1 0.4% 2 0.8% 3 1.2%

Education

1. Illiterate 27 10.5% 119 46.5% 146 57.0%

2. Basic education (up to class 8) 51 19.9% 18 7.0% 69 27.0%

3. School completed (class 12) 19 7.4% 4 1.6% 23 9.0%

4. Bachelors 8 3.1% 1 0.4% 9 3.5%

5. Above bachelors 9 3.5% 0.0% 9 3.5%

Religion

2. Hindu 111 43.4% 139 54.3% 250 97.7%

3. Buddhist 2 0.8% 3 1.2% 5 2.0%

6. Kirat/Prakriti Pujak 1 0.4% 0.0% 1 0.4%

Current marital status

1. Never married 1 0.4% 1 0.4% 2 0.8%

2. Currently married 85 33.2% 70 27.3% 155 60.5%

3. Cohabiting/Living together 3 1.2% 0.0% 3 1.2%

4. Separated/divorced 0.0% 1 0.4% 1 0.4%

5. Widowed 25 9.8% 70 27.3% 95 37.1%

Number of years living in this locale

1-20 49 19.1% 69 27.0% 118 46.1%

21-40 9 3.5% 11 4.3% 20 7.8%

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41-60 1 0.4% 35 13.7% 36 14.1%

61-80 48 18.8% 24 9.4% 72 28.1%

81-100 7 2.7% 3 1.2% 10 3.9%

Staying house

1. Own 88 34.4% 115 44.9% 203 79.3%

2. Rented 25 9.8% 27 10.5% 52 20.3%

3. Relative's house 1 0.4% 0.0% 1 0.4%

Family structure

1. Nuclear 29 11.3% 21 8.2% 50 19.5%

2. Joint 85 33.2% 121 47.3% 206 80.5%

Ethnicity

1.Brahmin 39 15.2% 47 18.4% 86 33.6%

2.Chhetri/Thakuri 49 19.1% 64 25.0% 113 44.1%

3.Adivasi/Janajatis 24 9.4% 31 12.1% 55 21.5%

4.Dalit 2 0.8% 0.0% 2 0.8%

Place of birth

Bhaktapur District (current district) 90 35.2% 95 37.1% 185 72.3%

Other districts 24 9.4% 47 18.4% 71 27.7%

Grand Total 114 44.5% 142 55.5% 256 100%

4.2 Findings of the study

Findings from quantitative and qualitative data are summarised below. All the frequency tables for

each survey questions are presented in the annex, only major frequency tables are presented here in

the main body.

A. Engage in income earning activities

It is important to understand how older people spend their time routinely and whether they have any

regular source of income. In this context, when asked if they were currently engaged in any income

earning activities, only 12% (M 23; F 9) were currently engaged in some sorts of income earning

activities.

Table 2: Engaged in income-earning activity


Yes/No Explanation Nos. % Nos. % Nos. %

1. Yes 1. Working in my own farm 2 0.8% 5 7 2.7%

2. Working as agricultural labourer 1 0.4% 0.0% 1 0.4%

3. Working as non–agricultural labourer 2 0.8% 0.0% 2 0.8%

4. Doing my own business (except farming) 11 4.3% 2 0.8% 13 5.1%

5. Doing my own traditional occupation 2 0.8% 0.0% 2 0.8%

97. Others (Health volunteer) 0.0% 1 0.4% 1 0.4%

97. Others (Pandit) 2 0.8% 0.0% 2 0.8%

97. Others (Priest) 1 0.4% 0.0% 1 0.4%

97. Others (Shop keeper) 2 0.8% 1 0.4% 3 1.2%

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Yes/No Explanation Nos. % Nos. % Nos. %

Total (Yes) 23 9.0% 9 3.5% 32 12.5%

2. No 1. Busy in household activity 11 4.3% 22 8.6% 33 12.9%

2. Cannot find a job 5 2.0% 3 1.2% 8 3.1%

3. Health problem/disability 12 4.7% 12 4.7% 24 9.4%

4. Take care of family 5 2.0% 5 2.0% 10 3.9%

5. Too old to work 51 19.9% 90 35.2% 141 55.1%

6. Seasonal work 0.0% 1 0.4% 1 0.4%

97. Other (Retired) 7 2.7% 0.0% 7 2.7%

Total (No) 91 35.5% 133 52.0% 224 87.5%

Grand Total 114 44.5% 142 55.5% 256 100.0%

FGD data also indicated that engaging older people in income generating activities or paid work

appeared very limited, except one or two older people who had their own shops or vegetable

gardening – there was no other opportunity or engagement reported by the FGD participants. Women

appeared to be more excluded from such opportunity than men. Some older people were not

interested to engage in any income generating activities because of their age or extra income was not

required.

"(we have) no agriculture work, stay home, prepare food and clean dishes. Do not

burden the daughter in law only (in household chores)" (71 years old female)

Couple of participants appeared to be in a difficult situation. Either their children are away or not

taking care of the older people. Some had no regular additional source of income other than old age

allowance.

" I have no one living for me. Neither son nor daughter care for me, do not know if I

exists for them. I say to everyone that my son has died. Son has died for me and I have

also dead for him. No one give me work as I am old. No one believe me that I have

hard times – they accuse me of pretending" (65 years old female)

B. Social pension and other benefits

Majority (58%: M 62; F 82) were receiving one or other types pension (social pension, retirement

pension or other). Almost 80% of those who were receiving the pension collected their pension by

themselves, nearly 15% had their pension collected by their son/daughter in which majority were

female. In other words men tends to be collecting their pension by themselves compared to women

respondents. The types of pension received and the reasons for not receiving any pension were as

follows

Table 3: Type of pension received

Type of pension 1. Male 2. Female Total (N=148)

Number % Number % Number %

1. Old age allowance 33 22% 52 35% 85 57%

2. Single women allowances 0% 17 11% 17 11%

4. Govt. pension 28 19% 17 11% 45 30%

97. Other (Upadan/gratuity) 1 1% 0% 1 1%

Grand Total 62 42% 86 58% 148 100%

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Table 4 Reasons for not receiving social pension

Age Sex Reasons for not receiving pension? Nos %

60-69 Male 1. I am under age (70) 40 37.04%

3. I have not registered myself yet 2 1.85%

4. I do not want to receive it (I have other financial sources to

support me) 1 0.93%

Female 1. I am under age (70) 40 37.04%


70-79 Male 3. I have not registered myself yet 6 5.56%

4. I do not want to receive it (I have other financial sources to

support me) 2 1.85%

Female 1. I am under age (70) 1 0.93%


80-89 Male 3. I have not registered myself yet 1 0.93%

Female 3. I have not registered myself yet 1 0.93%

90-100 Female 2. I am receiving government pension 1 0.93%

Total 108 100%

There were many reasons for not receiving the pension, but the 21% (M 9; F 14) of the respondents

who had not registered themselves as yet at the ward office to receive social pension and quite a few

of whom were already over 80 years of age should be of a concern. Ward office need to initiate a

campaign with support from Red Cross to enrol all those who are eligible in the social pension

scheme.

Use of pension

Majority (77%) used their pension for paying for their own health related expenses and for personal

use. Over 35% used their pension to support their family and household expenses. Some (2.7%) of the

respondents also contributed to social/charity work (Table 5).

Almost all participants in FGD opined that the social pension is not adequate to meet the need of older

people and such pension should be available to those who are over 60 years of age. Majority expressed

their dissatisfaction on social health insurance – which is no longer available from hospital close to

them (Korean hospital). Now it is available only in Bhaktapur hospital which is not easily accessible to

many due to physical distance.

"Government has announce the facility, but do not deliver, we had health insurance

and used to go to Korean hospital, now they do not provide (this facility)" (80 years

old male).

Use of other old age benefits

Majority (73%) have not received other old age benefits like discount in transportation, discount in

hospitals, priority seat in public transport and so on. But those who have received other benefits

includes discount in transportation (61%), discount in hospital (20%), priority seat in public transport

(64%) and so on (Table 6). Old age people should be made aware about the available public befits

and encourage to use such facility.

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Table 5: Use of pension


% of Total

cases

Responses (multiple) No. % No. % No. % n=148

1 Support family/household expenses 29 24.37 25 15.15 54 19.01 36.49

2. Pay school fee for children 0 0.00 1 0.61 1 0.35 0.68

3. Religious activities 1 0.84 1 0.61 2 0.70 1.35

4. Pay for own health care/medicine 42 35.29 70 42.42 112 39.44 75.68

5. Personal use 45 37.82 66 40.00 111 39.08 75.00

6. Donation for social work/charity 2 1.68 2 1.21 4 1.41 2.70

Total 119 100.00 165 100.00 284 100.00 191.89

Table 6: Old age benefits received in public services

1. Male 2. Female Total % of Total cases


1. Discount in transport/bus 26 42.62 16 35.56 42 39.62 61.76

2. Discount in hospital 9 14.75 5 11.11 14 13.21 20.59

3. Priority (no queuing) in govt. offices 3 4.92 0 0.00 3 2.83 4.41

4. Priority in private offices (i.e. Banks) 2 3.28 1 2.22 3 2.83 4.41

5. Priority seat in public transport 21 34.43 23 51.11 44 41.51 64.71

Total 61 100 45 100 106 100 155.88

About the discount in public transports, there was mixed views from FGD participants regarding the

availability of discount in public transport. Almost all expressed that pubic transports tend to ignore

the discount to senior citizen. Priority seat are also not given to senior citizen. Almost all expressed

their dissatisfaction to the sheer lack of 'waiting place' in the bus stand, where they could sit and wait

for the public transport.

"it (the discount in the public bus) is for those who can argue (with the bus conductor),

they ask for ID card even though they know the person is 80 years old" (72 years old

male)

"some give it (to older person), and some just ignore and do not give up (the priority

seat)" (65 years old female)

An interesting observation

"Girls tend give up (the priority seat to older people) compared to boys" (72 years old

male)

C. General health condition and access to health services

At the time of interview, 74% of the respondents were receiving one or another medicine/treatment

for their health problem. While the majority reported very good to moderate general health condition,

quite a few reported bad (31%) to very bad (4%).

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Among those (N=190) who were receiving medication for their health problem, majority of

respondents (44.74%) were under 70 years of age (Table 7).

Table 7: Receiving treatment by age group


Age Number % Number % Number %

60-69 32 16.84% 53 27.89% 85 44.74%

70-79 29 15.26% 47 24.74% 76 40.00%

80-89 10 5.26% 16 8.42% 26 13.68%

90-100 1 0.53% 2 1.05% 3 1.58%

Grand Total 72 37.89% 118 62.11% 190 100.00%

Those who had been receiving medication was for wide varieties of health problems, most notable

were hypertension, diabetic and asthma (Table 8).

Table 8: Health problems under treatment


Responses (multiple) No. % No. % No. % N= 190

1. Blood pressure 40 37.74% 72 32.73% 112 34.36% 58.95

2. Diabetes 24 22.64% 34 15.45% 58 17.79% 30.53

3. Gout/Arthritis/joint problems 4 3.77% 24 10.91% 28 8.59% 14.74

4. Heart problem 12 11.32% 18 8.18% 30 9.20% 15.79

5. Lung problem (TB etc.) 0 0.00% 3 1.36% 3 0.92% 1.58

6. Asthma 10 9.43% 28 12.73% 38 11.66% 20.00

7. Liver problem 1 0.94% 1 0.45% 2 0.61% 1.05

8. Kidney problem 0 0.00% 6 2.73% 6 1.84% 3.16

9. Urine/prostrate 6 5.66% 1 0.45% 7 2.15% 3.68

10. Thyroid 3 2.83% 9 4.09% 12 3.68% 6.32

11. Alzheimer 0 0.00% 1 0.45% 1 0.31% 0.53

12. Depression 0 0.00% 1 0.45% 1 0.31% 0.53

13. Cataract (मोितिबु) 0 0.00% 2 0.91% 2 0.61% 1.05

14. Cancer 1 0.94% 1 0.45% 2 0.61% 1.05

15. Mental problem 0 0.00% 1 0.45% 1 0.31% 0.53

97. Other (specify) 5 4.72% 18 8.18% 23 7.06% 12.11

Total 106 100% 220 100% 326 100% 171.58

Other wide range of unspecific problems were also reported such as gastric, headache, body ache, skin and so

on (Multiple response)

While only 74% of the respondents were receiving treatment, but majority have had some difficulties

to carry out their household activities (Table 9), only 21% of the respondents reported with no

problem in carrying out their household activities.

Table 9: Difficulty with work/household activities

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1. None 39 15.23% 16 6.25% 55 21.48%

2. Mild 39 15.23% 34 13.28% 73 28.52%

3. Moderate 22 8.59% 49 19.14% 71 27.73%

4. Severe 12 4.69% 30 11.72% 42 16.41%

5. Extreme/cannot do 2 0.78% 13 5.08% 15 5.86%

Grand Total 114 44.53% 142 55.47% 256 100.00%

Nearly half of the respondents (47.6%) visited hospital/health facility within last three months for the

main health problems like hypertension (40.9%), diabetes (32.7%), heart problem (17%), asthma

(15%) and so on (Please refer annex tables for detail).

But interestingly, among those who visited hospital or health facilities (N=122), majority had gone to

private hospital and very few (only two person) went to close-by health post in the same ward (Table

10). This clearly calls for improving the services from the health post and build confidence of senior

citizen in utilising the facility. Moreover, it is important to make the health facility old age friendly.

Table 10: Where did you go


Health facility visited Number % Number % Number %

1. Government hospital 12 9.84% 19 15.57% 31 25.41%

2. Health Post 2 1.64% 0.00% 2 1.64%

3. Private hospital 14 11.48% 31 25.41% 45 36.89%

4. Ayurvedic hospital 0.00% 1 0.82% 1 0.82%

5. Private clinic (Doctor) 10 8.20% 18 14.75% 28 22.95%

6. Medical store/Pharmacy 3 2.46% 12 9.84% 15 12.30%

Grand Total 41 33.61% 81 66.39% 122 100.00%

Cost of health services

Cost of health services can be exorbitantly high beyond the reach for many as it is not fully free even

in the government hospitals. Those who are depending on social pension for their health care, hospital

or medical cost could be prohibitive to access the health services when required. Health insurance

therefore plays a very vital role to many. But only 20% of the respondents had government health

insurance (Table 11). Red Cross in collaboration with Ward office can encourage old age people and

their family to get enrolled in the government health insurance scheme and make people aware

about the facilities available in hospitals.

Table 11: Access to health insurance



1. Yes (Government Insurance) 26 10.16% 27 10.55% 53 20.70%

2. Yes (Other Insurance) 13 5.08% 12 4.69% 25 9.77%

3. No 73 28.52% 90 35.16% 163 63.67%

4. Don't Know 1 0.39% 13 5.08% 14 5.47%

Missing value 1 0.39% 0.00% 1 0.39%

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Grand Total 114 44.53% 142 55.47% 256 100.00%

For those who visited hospital/health facility (N=122) had wide varieties of means to support the cost

of treatment. Government also provide 50% discount to senior citizen in the government hospital as

well as grant support to some health problems like treatment of cancer, dialysis for kidney patients

and so on. But majority (62.5%) were not aware about government facilities available for the

treatment (refer detail data in annex).

Table 12: Means of covering hospital cost


No % No % No %

1. Govt. health insurance 7 5.74% 8 6.56% 15 12.30%

2. Other Health Insurance 1 0.82% 1 0.82% 2 1.64%

3. Paid by my family members 15 12.30% 63 51.64% 78 63.93%

4. Paid by my relatives 1 0.82% 1 0.82% 2 1.64%

5. I paid myself from pension/old age allowance 7 5.74% 3 2.46% 10 8.20%

6. I paid from my other savings 7 5.74% 3 2.46% 10 8.20%

7. I paid with borrowed money 3 2.46% 1 0.82% 4 3.28%

97. Other (Free treatment) 0.00% 1 0.82% 1 0.82%

Grand Total 41 33.61% 81 66.39% 122 100%

D. Physical activities

Engagement in routine physical activities were reported to be moderate by 43%, while 20% and 23%

reported low and basic movement respectively. 10% reported almost none physical activities (refer to

Annex data table 38) . Corollary to this, when asked if they spend any time in sports or fitness related

activities almost all reported engaging in some sorts of physical activities in a week (Table 13).

Table 13: Days spent in physical activities in a week


Physical activities/week Number % Number % Number %

0-1 Days 25 9.77% 60 23.44% 85 33.20%

2-3 Days 26 10.16% 24 9.38% 50 19.53%

4-5 Days 10 3.91% 15 5.86% 25 9.77%

6-7 Days 53 20.70% 43 16.80% 96 37.50%

Grand Total 114 44.53% 142 55.47% 256 100.00%

Despite the existing health problems or being under medication regularly, on the whole, almost 70%

of the respondents expressed that they were satisfied with their overall health condition, whereas

around 9% were dissatisfied or very dissatisfied. Corollary to this 78% expressed their overall

satisfaction to the life they are living and only less than 4% expressed their complete dissatisfaction

(detail data in annex table).

E. Care and support required

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Ageing people require number of assistance to carry out their daily routine depending on their age,

health condition and general physical ability. When asked about their care requirement for their daily

life, only 3% required complete care and 12% required partial care. Vast majority of the respondents

did require minimal care or no care (Table 14). Whoever were receiving care, whatsoever the level of

care was, almost all care was provided by the family members (refer to Annex Data table 48).

This situation may change over the time as people age, therefore it is necessary to track their care

requirements regularly. This can be best achieve through a senior citizen forum or meeting place

where they meet regularly and share their care requirements and changes.

Table 14: level of care and support required for daily routine


Around community N % N % N %

1. Complete care (incl. toilet, feeding etc) 3 1.17% 5 1.95% 8 3.13%

2. Partial care 8 3.13% 24 9.38% 32 12.50%

3. Minimal care 23 8.98% 48 18.75% 71 27.73%

4. None (I am capable to taking care myself) 80 31.25% 65 25.39% 145 56.64%

Grand Total 114 44.53% 142 55.47% 256 100.00%

Almost all participants over 60 years old during FGD expressed that they received support and care

from family members and was great to be with grandchildren. But during day time, many expressed

that there would be no one to talk (as family members go for work and children go to school).

"Daughter in law (Buhari) care for me, prepares my favourite meals, but during day

time there is no one to stay with me" (82 years old female)

"Son lives in America, I and my wife are staying here" (61 years old male)

"They care us – at least to show to the society" (66 years old male)

F. Psychosocial well being

For emotional or psycho social wellbeing, sharing the feelings and interacting with each other is

important. Majority are quite active and meeting friends very regularly, but over 20% of the

respondents reported none, which means they do not meet their friends and exchange ideas and

emotions (Table 15). But interestingly, data indicated that those who were staying in joint family tend

to be less active in meeting friends outside.

A meeting forum with specific place needs to be established where senior citizens can freely come,

meet friends, share their ideas and feelings and try to do some creative work. Red Cross can initiate

this in collaboration with Ward office. With careful planning such forum is possible to make itself

self-propelling managed by old age people themselves voluntarily.

Table 15: How often do you meet friends and spend time



1.Every day 65 25.39% 50 19.53% 115 44.92%

2. 1-3 times a week 16 6.25% 22 8.59% 38 14.84%

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3. Every months 1 0.39% 2 0.78% 3 1.17%

4. Occasionally 18 7.03% 29 11.33% 47 18.36%

5. None 14 5.47% 39 15.23% 53 20.70%

Grand Total 114 44.53% 142 55.47% 256 100.00%

Related to this, it is also important to understand how often older people spend their time reclining

or in leisure recalling old memories, achievements and contribution to family/society.

Table 16: Hours spend in leisure/day



1-2 hours 36 14.06% 30 11.72% 66 25.78%

3-4 hours 42 16.41% 54 21.09% 96 37.50%

5-6 hours 33 12.89% 54 21.09% 87 33.98%

7-9 hours 3 1.17% 4 1.56% 7 2.73%

Grand Total 114 44.53% 142 55.47% 256 100.00%

All the respondents did spent some time in a day reclining or in leisure. It will be useful to explore

further in this to see how and what exactly they do when in leisure. As part of programme

intervention, older people can be encouraged to share their feeling and emotions in small group. It

is also beneficial to encourage old age persons to practice some mind concentration activities.

When asked if they do any mind concentration activities like yoga, meditation, only 37% replied

affirmatively that they do yoga or meditation. But people also reported engaging in Bhajan (prayer)

and other activities (Table 17).

Table 17: Engaged in mind concentration activities


Responses (multiple) N % N % N % n=96

1. Meditation 5 11.36% 10 14.08% 15 13.04% 15.63%

2. Yoga 13 29.55% 14 19.72% 27 23.48% 28.13%

3. Bhajan/Prayer 26 59.09% 46 64.79% 72 62.61% 75.00%

97. Other therapy 0 0.00% 1 1.41% 1 0.87% 1.04%

Total 44 100% 71 100% 115 100% 119.79%

G. Community/social activities

Engaging in social/community activity and developing a sense of belonging is crucial for psychosocial

health which reduces the feeling of loneliness. Among the respondents only 25% (N=65) reported

being engaged in some sort of social/community activities either being a member of political party or

other local institutions (Table 18).

The findings indicates that a mechanism is needed to allow the older people to engage in some

social/community activities. Some of the possibilities includes exploring and working with local

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club/NGOs to create an environment for engaging senior citizen in some meaningful activities

voluntarily depending on the interest of the older people.

Table 18: Engage in community/social activities


Responses (multiple) N % N % N % n=65

1. Local club/group (CBO) 6 13.33% 5 17.86% 11 15.07% 16.92%

2. Tole Sudhar Samittee (committee) 7 15.56% 0 0.00% 7 9.59% 10.77%

3. NGO Committee 3 6.67% 1 3.57% 4 5.48% 6.15%

4. Village/Guthi/Temple committee 25 55.56% 22 78.57% 47 64.38% 72.31%

5. School committee 0 0.00% 0 0.00% 0 0.00% 0.00%

6. Political party 4 8.89% 0 0.00% 4 5.48% 6.15%

Total 45 100% 28 100% 73 100% 112.31%

FGD participants expressed varied experiences regarding social inclusion and community

participation. While majority were engaged in social/family events (wedding, religious functions), very

few expressed not much interested to attend such functions. Some felt that 'younger generations' do

not engage older people in social functions. Almost all expressed lack of community facility such as

park or library where they could spend time and meet friends.

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"There is no any facility in the community for the old age people" (62 years old female,

70 years old male)

"It would have been easy to spend time, had there been park or library in the ward

(community)" (80 years old male)

Most participants expressed that they were not involved in community meetings, ward meetings,

clubs or similar events. Some kind of group seems to have existed where some women used to

participant in the past, but currently it is not clear if such group exists. A day centre for old age people

is functional (near temple) where older people spend their time together, listen teachings of Shree

Bhagvat Gita, and also get tea/snacks). But his is in one corner of ward no 2 which is not easily

accessible to all. Most however said that they often engaged in religious events.

"No one informs us about the programme, this is the first time I have attended a

meeting. Red Cross has big building, but nothing from it (for older people)" (61 years

old male).

"… we were a member of Didi Bahini Samuha, a group started informally by a group

of women at their community. They organized yearly picnic from that group, women

in the group listened to her (to each other) carefully and expressed their thoughts

with an open heart" (69 and 77 years old females)

While majority the younger participant during the FGD for under 60 years of age echoed similar views,

few had critical observations regarding inclusion particularly in decision making.

“If the suggestions have nothing bad in it, we follow them. They are rarely wrong in

terms of decision making” (55 years old male)


"All decision of older people cannot be accepted, there decision taking ability is

deteriorated (42 years old male)

H. Community perception towards older people

Quality of life of older people is also influenced by the community perceptions, reactions and how

friendly they were towards older people. When asked how they feel in and around the community

towards old age people, the overall response was very affirmative. Only less than 4% of the

respondents said that they did not feel respected or supportive (Table 19).

It is necessary to keep this positive attitude and response of the community towards the senior

citizen. Red Cross can play a role in this by integrating old age related activities in its other

programmes as well as organising regular interaction with community people. Building age friendly

community is crucial for quality of life of older people.

Table 19: Feeling in and around the community towards senior citizens?


N % N % N %

1. Respected 73 28.52% 88 34.38% 161 62.89%

2. Speaking politely 32 12.50% 38 14.84% 70 27.34%

3. Responsiveness to the need of senior citizen 7 2.73% 8 3.13% 15 5.86%

4. Do not feel respected 2 0.78% 5 1.95% 7 2.73%

5. Do not feel supportive 0.00% 3 1.17% 3 1.17%

Grand Total 114 44.53% 142 55.47% 256 100.00%

FGD participants of under 60 years old also expressed their generally positive attitude and views

towards older people. Most participants acknowledged and appreciated the knowledge and wisdom

of older people which could be good resource to the community.

"We enjoy talking with elderly people" (38 years old male)

Almost all elderly of Balkotkot area who participated in FGD felt that they are respected and listened

to by everyone.

"We speak with respect, they (other people) also speak with respect. They are very

polite, I have not experience any disrespect so far in my life (80 years and 78 years old

male). They greet and show respect" (82 years old female)

Some participants had critical views,

“I don’t like when old people who do not want to stay active even when they are

physically able" (43 years old male).

"it is difficult to handle old people, they often grumble on everything. They could be

looked after better if they behave little more decently" (46 years old male)

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Although almost all the participants appeared familiar with the changes that happens with aging but

true appreciation for such changes was lacking or limited. Besides, community at times did not appear

appreciative to old age persons and their need in public places. There were mixed responses about

surrounding community from older people in FGD. Although most felt safe while walking in the

morning or evening and no fear of mugging, but often felt unsafe and frightened by fast driving

motorbikes and cars.

"Wish they could drive slow and care for walking persons" (78 years old male)

"It is frightening while crossing the road because of fast racing car (and bikes)" (70

years old male)

Clearly, unless the younger people are engaged in older people issues and programmes, full benefits

of any intervention aimed to improve the quality of senior citizen's life would not be fully achieved.

Engaging young people would not only bring new dimension to the older people issue, will also be

more sustainable.

I. Key informants views

Key Informants, mainly the municipal and ward authorities met had positive attitude and expressed

their willingness to support senior citizen. Ward office has allocated some fund for social cause which

can also be available to activities related to senior citizen. All key informants said that

"Senior citizen are our guide, they are the torch blower, and they have rich

experiences that we should learn and use their expertise"

But when it comes to addressing specific needs and understanding the specific problems of older

people that needs to be addressed they were not very clearer about it. And also when it comes to

reallocating some of the resources – they often say that rules do not allow for this. Rhetoric on older

people and their issues is common among the policy makers.

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5. Conclusions and recommendations

5.1 Conclusions

The data suggested that older people in ward number 2 were generally happy and there was no

surprising data or unusual pattern of any particular health or other problems or occurrence of any

specific health conditions. Data also suggested that majority were living in joint family which means

despite some usual dissatisfaction/annoyance while staying in a joint family, they were happy and

have someone who provide basic care (if required) and some company. Those who have grandchildren

have someone with whom they can spend time. But this situation may change as social and family

structures are changing more rapidly than before. It was interesting to note that more people under

70 years of age were receiving one or other medication for their health problems.

This area (ward number 2) is rapidly urbanising with influx of people from different parts of the

country, therefore the community are diverse with different economic status. But some part of the

ward still retain its semi-rural characteristics with majority born and lived here for generations. Which

means 'community' feeling appeared to be still prevalent with cooperating to each other and engaging

in social and family functions.

As for the daily routine is concerned, most have 'normal' routine fixed like engaging in household

activities, watching TV , using social media, go out and meet friends in tea shops and so on. Only small

percentage of older people in this area were engaged in some sorts of income earning activities. But

data really did not suggest that the majority of senior citizen are keen on engaging in income

generating work. Qualitative data however suggested that some require additional income for their

livelihood. All those who qualify for social pension (70 years of age) were receiving it and using it for

all sorts of payments like household expenses, personal expenses and so on. 30% on retirement

pension is good indicator. People however preferred an easy way of accessing the social pension i.e.

delivered to their door steps. Those who do not have other income source social pension of Rs 4000

per months (US$ 35 approx.) appeared too small to cover their needs therefore strongly demanded

to increase it.

Contrary to the near universal access to social pension, access to and use of other old age benefits

announced by the government are not very satisfactory. Some of the announced benefits are discount

in public transport, discount in hospital charge, free treatment for certain conditions (i.e. dialysis for

kidney patients), cash contribution towards treatment to major disease like cancer, heart problem etc.

But many people (62%) were not aware about this facility. Many people were also enrolled in social

health insurance but once the designated hospital is changed from Korean hospital to Bhaktapur

hospital many are not accessing it because of physical distance. Nevertheless, social health insurance

is a good programme that Red Cross should encourage people to join and use the facility. Moreover,

the cost of treatment is mostly paid by the family members, it must of an interest of the family

members too to get enrolled in the health insurance plan.

Another area of general concerns was need to visit health facility (mostly private) even for routine

check-up like blood sugar test, blood pressure check, routine urine test etc. Ideally such test should

be available in the government health post. Nearly half of the respondents (47.6%) visited

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hospital/health facility within last three months for varied problem. But interestingly, those who

visited health facilities (N=122), majority had gone to private hospital/facility and very few (only two

person) went to government health post, which is very close and in the same ward. For majority

(63.93%), the cost of health was paid by the family members, only 12% got their cost covered through

government health insurance and 8.2% paid from their own savings.

The current data indicated that a small percentage of older people require assistance and complete

care while majority did not require full assistance. But the scenario may change rapidly, therefore

ageing and health programme in this area needs to plan and prepare the community to be more

resilient in responding to such change.

These are the area where Red Cross might play a role by advocating with municipality mayor and local

ward authority to approach Ministry of Health to redress this health insurance concern. Senior citizen

would be happy to join hand with Red Cross in this. Along with encouraging the people to get

registered in health insurance, Red Cross can also facilitate routine health check-up (monitoring blood

pressure, blood sugar, routine urine test etc) and conduct health education sessions either

coordinating with local health post or mobilising semi volunteers (i.e. community nurse) to do such

test. Such volunteers ideally selected among from the community can also be mobilised for many

other health activities (health education, healthy living, encouraging for physical activities, monitor

the need to complete care and assistance and so on). Senior citizens forum or club could be a good

entry point.

Data pattern of limited physical activity, limited time spent in leisure and lack of meeting forum, (day

centre, park or open space) where people could meet friends and walk together should be of a concern

to policy makers. Many older people were not physically active or do any physical exercise and meet

friends reclining and talking. Engaging in mind concentration activities (meditation, Yoga) was limited

among the older people in this area. To maintain physical and psychosocial health such activities are

important.

While the community attitude and behaviour towards the old age people in this area was generally

felt to be good by the those who participated in this study, but their actual involvement in community

activities (i.e. member in clubs or tole sudhan samittee, NGOs or political party etc) is low. Engaging

in social/community activity and developing a sense of belonging is crucial for psychosocial health

which reduces the feeling of loneliness.

Despite the positive attitude among the policy makers towards the older people, rhetoric is prevalent.

More practical thinking is necessary to build age friendly community and address the specific needs

of the older people. A regular interaction of older people with policy makers at different levels,

lobbying and advocacy for better policy and for resources allocation needs to organised.

5.2 Recommendations

Building age friendly community should be the mainstay of the programme intervention. A forum or

self-help club needs to be established where senior citizens can freely come, meet friends, share their

ideas and feelings and try to do some creative work for themselves and for the larger community. In

other words, support organising various activities by the older people for the older people (and

beyond) through the established forum that empower the older people. Red Cross can initiate this in

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collaboration with Ward office. With careful planning such forum is possible to make itself selfpropelling

managed by old age people themselves voluntarily with no or little outside support. First

piloting with one, such forum can be promoted in different locales depending on the interest of the

older people.

Engage young people and family members along with older people in ageing and health programme.

Ultimately it is the family members who should take the full responsibility of older people. Engaging

young people would not only bring new dimensions to the older people issue, will also be more

sustainable. Moreover, this would contribute in creating an environment that respects older peoples'

dignity and human rights, free from gender and age based discrimination.

Health insurance is another specific area where Red Cross might play a role by advocating with

municipality mayor and local ward authority to approach the Ministry of Health to redress this health

insurance concern. Senior citizen would be happy to join hand with Red Cross in this. Along with

encouraging the older people to get registered in health insurance, Red Cross can also facilitate

routine health check-up (monitoring blood pressure, blood sugar, routine urine test etc) either

coordinating with local health post or mobilising semi volunteers (i.e. community nurse) to do such

test. Such volunteers ideally selected among from the community can also be mobilised for many

other health activities (health education, healthy living, encouraging for physical activities, monitor

the need to complete care and assistance and so on).

In collaboration with interested and capable older people advocate with local authority (i.e.

municipality) for age friendly community. Setting up a meeting forum (self-help club) so that older

people can come freely, spend time and talk with friends; and organise activities towards building age

friendly community. This arrangement should be free (or with minimal subscription) where senior

citizens can freely come, meet friends, share their ideas and feelings and try to do some creative work.

Red Cross can initiate this in collaboration with Ward office. With careful planning such forum is

possible to make itself a self-propelling managed by old age people themselves voluntarily. Data

indicated that though small number, older people were contributing part of their pension in charity

work. Potentially, older people can contribute limited subscription to manage such forum – this needs

to be further explored as a part of programme interventions.

The findings indicates that a mechanism is needed to allow the older people to engage in some

social/community activities. Some of the possibilities includes exploring and working with local

club/NGOs to create an environment for engaging senior citizen in some meaningful activities

voluntarily depending on the interest of the older people.

Regular interaction with Health Post and ward authority by the older people would improve

confidence of older people to access the services it provides and also encourages health post to be

more age friendly with quality services.

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References

Bhandari, K (2020), Trends in Age Structure and Ageing Population in Nepal, Journal of Population

and Development, June 2020,

GoN (2005), National Plan of Action for Senior Citizens 2062 (2005), Ministry of Social Welfare,

Children and Women

GoN (2006), Senior Citizens Act, 2063 (2006), Government of Nepal, www.lawcommission.gov.np

GoN (2008), Senior Citizens Rules, 2065 (2008), Government of Nepal, www.lawcommission.gov.np

IFRC (2016), Healthy ageing toolkit for facilitators, volunteers and community, International

Federation of Red Cross and Red Crescent Societies, Geneva, 2016

MoHP (2010), Status Report on Elderly People (60+) in Nepal on Health, Nutrition and Social Status

Focusing on Research Needs, Prepared by Geriatric Centre Nepal

MoHP (2077), Geriatric (senior citizen) health services guidelines (in Nepali language 2020)

MoHP (2078), Guidelines to set and manage Social Support Unit (in Nepali language 2021)

United Nations (2021), United Nations Decade of Healthy Ageing (2021–2030), https://documentsdds-ny.un.org/doc/UNDOC/GEN/N20/363/87/PDF/N2036387.pdf?OpenElement

WHO (2006). WHO SAGE Survey Manual: The WHO Study on Global Ageing and Adult Health (SAGE).

Geneva, World Health Organization

WHO (2007). WHO Age Friendly Cities Project Methodology, Vancouver Protocol, World Health

Organisation, Geneva

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Annexes

Annex 1: Data tables

Respondents profile



Interviewed to

1. Respondent direct 111 43.4% 134 52.3% 245 95.7%

2. Proxy respondent 3 1.2% 8 3.1% 11 4.3%

Age of respondent

60-69 58 22.7% 65 25.4% 123 48.0%

70-79 41 16.0% 57 22.3% 98 38.3%

80-89 14 5.5% 18 7.0% 32 12.5%

90-100 1 0.4% 2 0.8% 3 1.2%

Education

1. Illiterate 27 10.5% 119 46.5% 146 57.0%

2. Basic education (up to class 8) 51 19.9% 18 7.0% 69 27.0%

3. School completed (class 12) 19 7.4% 4 1.6% 23 9.0%

4. Bachelors 8 3.1% 1 0.4% 9 3.5%

5. Above bachelors 9 3.5% 0.0% 9 3.5%

Religion

2. Hindu 111 43.4% 139 54.3% 250 97.7%

3. Buddhist 2 0.8% 3 1.2% 5 2.0%

6. Kirat/Prakriti Pujak 1 0.4% 0.0% 1 0.4%

Current marital status

1. Never married 1 0.4% 1 0.4% 2 0.8%

2. Currently married 85 33.2% 70 27.3% 155 60.5%

3. Cohabiting/Living together 3 1.2% 0.0% 3 1.2%

4. Separated/divorced 0.0% 1 0.4% 1 0.4%

5. Widowed 25 9.8% 70 27.3% 95 37.1%

Number of years living in this locale

1-20 49 19.1% 69 27.0% 118 46.1%

21-40 9 3.5% 11 4.3% 20 7.8%

41-60 1 0.4% 35 13.7% 36 14.1%

61-80 48 18.8% 24 9.4% 72 28.1%

81-100 7 2.7% 3 1.2% 10 3.9%

Staying house

1. Own 88 34.4% 115 44.9% 203 79.3%

2. Rented 25 9.8% 27 10.5% 52 20.3%

3. Relative's house 1 0.4% 0.0% 1 0.4%

Family structure

1. Nuclear 29 11.3% 21 8.2% 50 19.5%

2. Joint 85 33.2% 121 47.3% 206 80.5%

Ethnicity

1.Brahmin 39 15.2% 47 18.4% 86 33.6%

2.Chhetri/Thakuri 49 19.1% 64 25.0% 113 44.1%

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3.Adivasi/Janajatis 24 9.4% 31 12.1% 55 21.5%

4.Dalit 2 0.8% 0.0% 2 0.8%

Place of birth

Bhaktapur District (current district) 90 35.2% 95 37.1% 185 72.3%

Other districts 24 9.4% 47 18.4% 71 27.7%

Grand Total 114 44.5% 142 55.5% 256 100%

Q 16. Number of family members


Number of family members Number % Number % Number %

1-4 43 16.80% 37 14.45% 80 31%

5-8 62 24.22% 95 37.11% 157 61%

9-12 6 2.34% 10 3.91% 16 6%

13-16 3 1.17% 0.00% 3 1%

Grand Total 114 44.53% 142 55.47% 256 100%

Q 17. Are you doing any income-earning activity at the moment also for your

secured life?


Income generating activity Number % Number % Number %

1. Yes 23 8.98% 9 3.52% 32 12.50%

2. No 91 35.55% 133 51.95% 224 87.50%

Grand Total 114 44.53% 142 55.47% 256 100%


Yes/No Explanation Number % Number % Number %

1. Yes 1. Working in my own farm 2 0.8% 5 2.0% 7 2.7%

2. Working as agricultural

laborer 1 0.4% 0.0% 1 0.4%

3. Working as non–

agricultural laborer 2 0.8% 0.0% 2 0.8%

4. Doing my own business

(except farming) 11 4.3% 2 0.8% 13 5.1%

5. Doing my own traditional

occupation 2 0.8% 0.0% 2 0.8%

97. Others (Health volunteer) 0.0% 1 0.4% 1 0.4%

97. Others (Pandidt) 2 0.8% 0.0% 2 0.8%

97. Others (Priest) 1 0.4% 0.0% 1 0.4%

97. Others (Shop keeper) 2 0.8% 1 0.4% 3 1.2%

1. Yes

Total 23 9.0% 9 3.5% 32 12.5%

2. No 1. Busy in household activity 11 4.3% 22 8.6% 33 12.9%

2. Can not find a job 5 2.0% 3 1.2% 8 3.1%

3. Health problem/disability 12 4.7% 12 4.7% 24 9.4%

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Yes/No Explanation Number % Number % Number %

4. Take care of family 5 2.0% 5 2.0% 10 3.9%

5. Too old to work 51 19.9% 90 35.2% 141 55.1%

6. Seasonal work 0.0% 1 0.4% 1 0.4%

97. Other (Retired) 7 2.7% 0.0% 7 2.7%

2. No

Total 91 35.5% 133 52.0% 224 87.5%

Grand

Total 114 44.5% 142 55.5% 256 100.0%

Q 18. Are you receiving any type of pension (including social

pension, etc.)?


Response No. % No % No %

1. Yes 62 24% 86 34% 148 58%

2. No 52 20% 56 22% 108 42%

Grand Total 114 45% 142 55% 256 100%

18.a What type of pension

you are receiving?

1. Male

2.

Female

Total

Response No. % No. % No. %

1. Old age allowance 33 22% 52 35% 85 57%

2. Single women allowance 0% 17 11% 17 11%

4. Govt. pension 28 19% 17 11% 45 30%

97. Other (Upadan) 1 1% 0% 1 1%

Grand Total 62 42% 86 58% 148 100%

18.b How are you using your pension?

(Multiple response)


% of Total

cases

Response No. % No. % No. % n=148

1 Support family/household expenses 29 24.37 25 15.15 54 19.01 36.49

2. Pay school fee for children 0 0.00 1 0.61 1 0.35 0.68

3. Religious activities 1 0.84 1 0.61 2 0.70 1.35

4. Pay for own health care/medicine 42 35.29 70 42.42 112 39.44 75.68

5. Personal use 45 37.82 66 40.00 111 39.08 75.00

6. Donation for social work/charity 2 1.68 2 1.21 4 1.41 2.70

97. Others (specify) 0 0.00 0 0.00 0 0.00 0.00

Total 119 100.00 165 100.00 284 100.00 191.89

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18.c Why you are not receiving

pension?



1. I am under age (70) 40 37.04% 41 37.96% 81 75%

2. I am receiving government pension

(*not retirement pension) 0.00% 1 0.93% 1 1%

3. I have not registered myself yet 9 8.33% 14 12.96% 23 21%

4. I do not want to receive it (I have

other financial sources to support

me) 3 2.78% 0.00% 3 3%

Grand Total 52 48.15% 56 51.85% 108 100%

19. Who collect your pension?

1. Male 2. Female Total Total


1. I myself 59 39.86% 59 39.86% 118 79.73%

2. My spouse 0.00% 3 2.03% 3 2.03%

3. My son/daughter 3 2.03% 19 12.84% 22 14.86%

97. Others (Cousin) 0.00% 1 0.68% 1 0.68%

97. Others (Grandson) 0.00% 2 1.35% 2 1.35%

97. Others (Neighbour) 0.00% 1 0.68% 1 0.68%

97. Others (Relative) 0.00% 1 0.68% 1 0.68%

Grand Total 62 41.89% 86 58.11% 148 100.00%

19.a If your spouse or household member collects the pension, does he/she give you immediately

after he/she arrives at home with the collected amount?



1. Yes (Gives full pension) 3 10.00% 26 86.67% 29 96.67%

2. Yes (Gives partial) 0.00% 1 3.33% 1 3.33%

Grand Total 3 10.00% 27 90.00% 30 100.00%

19.b If he/she does not give you the collected pension immediately (Either

full or partial), what is/are the reason/s?

Only one response because she can not manage it by herself

19.c If you can not manage, is your pension spent as per your

will/instruction?

Only one response and spent as per her instruction

20. Have you received other old age benefits for public services?



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1. Yes 36 14.06% 32 12.50% 68 26.56%

2. No 78 30.47% 110 42.97% 188 73.44%

Grand Total 114 44.53% 142 55.47% 256 100.00%

20.a What were the public services old age benefits you received, like….? (Multiple response)


% of Total

cases


1. Discount in transport/bus 26 42.62 16 35.56 42 39.62 61.76

2. Discount in hospital 9 14.75 5 11.11 14 13.21 20.59

3. Priority (i.e. no queuing) in govt

offices 3 4.92 0 0.00 3 2.83 4.41

4. Priority in private offices (i.e. Banks) 2 3.28 1 2.22 3 2.83 4.41

5. Priority seat in public transport 21 34.43 23 51.11 44 41.51 64.71

Total 61 100 45 100 106 100 155.88

21. In general, how would you rate your health today?



1. Very good 20 7.81% 10 3.91% 30 11.72%

2. Good 70 27.34% 72 28.13% 142 55.47%

3. Moderate 13 5.08% 36 14.06% 49 19.14%

4. Bad 11 4.30% 20 7.81% 31 12.11%

5. Very bad 4 1.56% 4 1.56%

Grand Total 114 44.53% 142 55.47% 256 100.00%

22. Are you under treatment or taking any medicine?



1. Yes 72 28.13% 118 46.09% 190 74.22%

2. No 42 16.41% 24 9.38% 66 25.78%

Grand Total 114 44.53% 142 55.47% 256 100%

22.a For which health problem (you are under treatment Q22)? (Multiple response)



1. Blood pressure 40 37.74% 72 32.73% 112 34.36% 58.95

2. Diabetes 24 22.64% 34 15.45% 58 17.79% 30.53

3. Gout/Arthritis/joint problems 4 3.77% 24 10.91% 28 8.59% 14.74

4. Heart problem 12 11.32% 18 8.18% 30 9.20% 15.79

5. Lung problem (TB etc.) 0 0.00% 3 1.36% 3 0.92% 1.58

6. Asthma 10 9.43% 28 12.73% 38 11.66% 20.00

7. Liver problem 1 0.94% 1 0.45% 2 0.61% 1.05

8. Kidney problem 0 0.00% 6 2.73% 6 1.84% 3.16

9. Urine/prostrate 6 5.66% 1 0.45% 7 2.15% 3.68

10. Thyroid 3 2.83% 9 4.09% 12 3.68% 6.32

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11. Alzheimer 0 0.00% 1 0.45% 1 0.31% 0.53

12. Depression 0 0.00% 1 0.45% 1 0.31% 0.53

13. Cataract (मोितिबु) 0 0.00% 2 0.91% 2 0.61% 1.05

14. Cancer 1 0.94% 1 0.45% 2 0.61% 1.05

15. Mental problem 0 0.00% 1 0.45% 1 0.31% 0.53

97. Other (specify) 5 4.72% 18 8.18% 23 7.06% 12.11

Total 106 100% 220 100% 326 100% 171.58

Other wide range of unspecific problems were also reported such as gastric, headache, body ache, skin and

so on

23. Overall in the last 30 days, how much difficulty did you have with work or household

activities?



1. None 39 15.23% 16 6.25% 55 21.48%

2. Mild 39 15.23% 34 13.28% 73 28.52%

3. Moderate 22 8.59% 49 19.14% 71 27.73%

4. Severe 12 4.69% 30 11.72% 42 16.41%

5. Extreme/can not do 2 0.78% 13 5.08% 15 5.86%

Grand Total 114 44.53% 142 55.47% 256 100.00%

24.a Overall in the last 30 days, how much difficulty did you have with self-care, such as

bathing/washing or dressing?

2.

1. Male

Female

Total

Difficulty in self care Number % Number % Number %

1. None 76 29.69% 56 21.88% 132 51.56%

2. Mild 20 7.81% 31 12.11% 51 19.92%

3. Moderate 12 4.69% 26 10.16% 38 14.84%

4. Severe 6 2.34% 21 8.20% 27 10.55%

5. Extreme/can not do 0.00% 8 3.13% 8 3.13%

Grand Total 114 44.53% 142 55.47% 256 100.00%

24.b Overall in the last 30 days, how much difficulty did you have in taking care of and maintaining

your general appearance (for example, grooming, looking neat and tidy)?



1. None 80 31.25% 54 21.09% 134 52.34%

2. Mild 21 8.20% 36 14.06% 57 22.27%

3. Moderate 8 3.13% 23 8.98% 31 12.11%

4. Severe 5 1.95% 21 8.20% 26 10.16%

5. Extreme/can not do 0.00% 8 3.13% 8 3.13%

Grand Total 114 44.53% 142 55.47% 256 100.00%

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25. How often do you meet friends and spend time with them?


How often do you meet

friends and spend time Number % Number % Number %

1.Every day 65 25.39% 50 19.53% 115 44.92%

2. 1-3 times a week 16 6.25% 22 8.59% 38 14.84%

3. Every months 1 0.39% 2 0.78% 3 1.17%

4. Occasionally 18 7.03% 29 11.33% 47 18.36%

5. None 14 5.47% 39 15.23% 53 20.70%

Grand Total 114 44.53% 142 55.47% 256 100.00%

26. Do you use eye glasses or contact lenses?


Use eye glasses or contact lenses Number % Number % Number %

1. Yes 78 30.47% 73 28.52% 151 58.98%

2. No 36 14.06% 69 26.95% 105 41.02%

Grand Total 114 44.53% 142 55.47% 256 100.00%

27. Do you smoke or chew tobacco?


Smoke or chew tobacco Number % Number % Number %

1. Yes 54 21.09% 26 10.16% 80 31.25%

2. No 60 23.44% 116 45.31% 176 68.75%

Grand Total 114 44.53% 142 55.47% 256 100.00%

28. Do you drink (alcohol)?


Do you drink Number % Number % Number %

1. Yes 24 9.38% 8 3.13% 32 12.50%

2. No 90 35.16% 134 52.34% 224 87.50%

Grand Total 114 44.53% 142 55.47% 256 100.00%

29. In the last six months, how often did you ever eat less than you felt you should because there

wasn’t enough food?


Eat less than you should Number % Number % Number %

1. Every month 1 0.39% 6 2.34% 7 2.73%

2. More than 3 months 1 0.39% 3 1.17% 4 1.56%

3. Less than 3 months 6 2.34% 5 1.95% 11 4.30%

4. Never 106 41.41% 128 50.00% 234 91.41%

Grand Total 114 44.53% 142 55.47% 256 100.00%

30. How often do you eat meat?

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How often eat meat Number % Number % Number %

1. I am vegetarian 17 6.64% 32 12.50% 49 19.14%

2. Daily 4 1.56% 4 1.56% 8 3.13%

3. At least once a week 60 23.44% 54 21.09% 114 44.53%

4. Occasional 23 8.98% 37 14.45% 60 23.44%

5. Not now 10 3.91% 15 5.86% 25 9.77%

Grand Total 114 44.53% 142 55.47% 256 100.00%

31. How often do you eat fruits?


How often eat meat Number % Number % Number %

1. Daily 39 15.23% 40 15.63% 79 30.86%

2. At least once a week 44 17.19% 54 21.09% 98 38.28%

3. Occasionally 29 11.33% 38 14.84% 67 26.17%

4. Not now 2 0.78% 10 3.91% 12 4.69%

Grand Total 114 44.53% 142 55.47% 256 100.00%

32. When did you last visit hospitals/clinics/doctors?


Last visit to hospital/clinic/doctor Number % Number % Number %

1. Within one month 27 10.55% 51 19.92% 78 30.47%

2. Within two months 8 3.13% 9 3.52% 17 6.64%

3. Within three months 6 2.34% 21 8.20% 27 10.55%

4. Not within last three months 73 28.52% 61 23.83% 134 52.34%

Grand Total 114 44.53% 142 55.47% 256 100%

33. What was the main reason/problem you visited the health facility (doctor)? Multiple response



1. Blood pressure 22 32.84% 28 21.37% 50 25.25% 40.98%

2. Diabetes 16 23.88% 24 18.32% 40 20.20% 32.79%

3. Gout/Arthritis/joint problems 3 4.48% 13 9.92% 16 8.08% 13.11%

4. Heart problem 9 13.43% 12 9.16% 21 10.61% 17.21%

5. Lung problem (TB etc.) 0 0.00% 3 2.29% 3 1.52% 2.46%

6. Asthma 3 4.48% 16 12.21% 19 9.60% 15.57%

7. Liver problem 0 0.00% 3 2.29% 3 1.52% 2.46%

8. Kidney problem 1 1.49% 5 3.82% 6 3.03% 4.92%

9. Urine/prostrate 1 1.49% 0 0.00% 1 0.51% 0.82%

10. Thyroid 1 1.49% 2 1.53% 3 1.52% 2.46%

11. Alzheimer 0 0.00% 0 0.00% 0 0.00% 0.00%

12. Depression 0 0.00% 0 0.00% 0 0.00% 0.00%

13. Cataract (मोितिबु) 0 0.00% 3 2.29% 3 1.52% 2.46%

14. Cancer 1 1.49% 1 0.76% 2 1.01% 1.64%

15. Mental problem 0 0.00% 1 0.76% 1 0.51% 0.82%

97. Other 10 14.93% 20 15.27% 30 15.15% 24.59%

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Total 67 100.00% 131 100.00% 198 100.00% 162.30%

Other wide range of non specific health reasons for visiting health facility

34. Where did you go?


Where did you go Number % Number % Number %

1. Government hospital 12 9.84% 19 15.57% 31 25.41%

2. Health Post 2 1.64% 0.00% 2 1.64%

3. Private hospital 14 11.48% 31 25.41% 45 36.89%

4. Aayurvedic hospital 0.00% 1 0.82% 1 0.82%

5. Private clinic (Doctor) 10 8.20% 18 14.75% 28 22.95%

6. Medical store/Pharmacy 3 2.46% 12 9.84% 15 12.30%

Grand Total 41 33.61% 81 66.39% 122 100.00%

35. Do you have access to Health Insurance?


Access to health insurance Number % Number % Number %

1. Yes (Government Insurance) 26 10.16% 27 10.55% 53 20.70%

2. Yes (Other Insurance) 13 5.08% 12 4.69% 25 9.77%

3. No 73 28.52% 90 35.16% 163 63.67%

4. Don't Know 1 0.39% 13 5.08% 14 5.47%

Missing value 1 0.39% 0.00% 1 0.39%

Grand Total 114 44.53% 142 55.47% 256 100.00%

35.a Who paid the hospital cost or how was it paid? (related to Q 34)


Cost of hospital paid by Number % Number % Number %

1. Govt. health insurance 7 5.74% 8 6.56% 15 12.30%

2. Other Health Insurance 1 0.82% 1 0.82% 2 1.64%

3. Paid by my family members 15 12.30% 63 51.64% 78 63.93%

4. Paid by my relatives 1 0.82% 1 0.82% 2 1.64%

5. I paid myself from pension/old age

allowance 7 5.74% 3 2.46% 10 8.20%

6. I paid from my other savings 7 5.74% 3 2.46% 10 8.20%

7. I paid with borrowed money 3 2.46% 1 0.82% 4 3.28%

97. Other (Free treatment) 0.00% 1 0.82% 1 0.82%

Grand Total 41 33.61% 81 66.39% 122 100.00%

36. Do you know there are government support available for health care for Senior citizen?



1. Yes 60 23.44% 36 14.06% 96 37.50%

2. No 54 21.09% 106 41.41% 160 62.50%

Grand Total 114 44.53% 142 55.47% 256 100.00%

37. What are those facilities? Multiple response

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Responses (multiple) Number % Number % Number % n=96

1. Consultation 5 6.58% 2 5.13% 7 6.09% 7.29

2. Medicine 58 76.32% 34 87.18% 92 80.00% 95.83

3. Investigation 2 2.63% 0 0.00% 2 1.74% 2.08

4. Surgery 11 14.47% 2 5.13% 13 11.30% 13.54

97. Other (specify) bus

fare 0.00% 1 2.56% 1 0.87% 1.04

Total 76 100% 39 100% 115 100% 119.79

38. How do you describe your physical activities in a week?


Physical activities Number % Number % Number %

1. Vigorous 3 1.17% 1 0.39% 4 1.56%

2. Moderate 59 23.05% 52 20.31% 111 43.36%

3. Low 18 7.03% 34 13.28% 52 20.31%

4. Basic movements 26 10.16% 35 13.67% 61 23.83%

5. Almost none 8 3.13% 20 7.81% 28 10.94%

Grand Total 114 44.53% 142 55.47% 256 100.00%

39. In a typical week, how many days do you do physical activities, exercise, sports and fitness

activities?


Physical activities/wk in day Number % Number % Number %

0-1 Days 25 9.77% 60 23.44% 85 33.20%

2-3 Days 26 10.16% 24 9.38% 50 19.53%

4-5 Days 10 3.91% 15 5.86% 25 9.77%

6-7 Days 53 20.70% 43 16.80% 96 37.50%

Grand Total 114 44.53% 142 55.47% 256 100.00%

40. How much time (hours) do you usually spend in recreational (leisure) or sitting or reclining on

a typical day?


Hours spend in leisure/day Number % Number % Number %

1-2 hours 36 14.06% 30 11.72% 66 25.78%

3-4 hours 42 16.41% 54 21.09% 96 37.50%

5-6 hours 33 12.89% 54 21.09% 87 33.98%

7-9 hours 3 1.17% 4 1.56% 7 2.73%

41. Do you do or join any activity for mind concentration?



1. Yes 35 13.67% 61 23.83% 96 37.50%

2. No 79 30.86% 81 31.64% 160 62.50%

Grand Total 114 44.53% 142 55.47% 256 100.00%

41.a What do you do for mind concentration? Multiple response

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Responses(multiple) Number % Number % Number % n=96

1. Meditation 5 11.36% 10 14.08% 15 13.04% 15.63%

2. Yoga 13 29.55% 14 19.72% 27 23.48% 28.13%

3. Bhajan/Prayer 26 59.09% 46 64.79% 72 62.61% 75.00%

97. Other therapy 0 0.00% 1 1.41% 1 0.87% 1.04%

Total 44 100% 71 100% 115 100% 119.79%

42. Are you a member of any club, social organisation, committee, political party?


Member of organisation Number % Number % Number %

1. Yes 38 14.84% 27 10.55% 65 25.39%

2. No 76 29.69% 115 44.92% 191 74.61%

Grand Total 114 44.53% 142 55.47% 256 100.00%

43. Which organisation? Multiple response


Member of organisation Number % Number % Number % n=65

1. Local club/group (CBO) 6 13.33% 5 17.86% 11 15.07% 16.92%

2. Tole Sudhar Samittee 7 15.56% 0 0.00% 7 9.59% 10.77%

3. NGO Committee 3 6.67% 1 3.57% 4 5.48% 6.15%

4. Village/Guthi/Temple

committee 25 55.56% 22 78.57% 47 64.38% 72.31%

5. School committee 0 0.00% 0 0.00% 0 0.00% 0.00%

6. Political party 4 8.89% 0 0.00% 4 5.48% 6.15%

Total 45 100% 28 100% 73 100% 112.31%

44. How often do you participate in community activities/events?


Community participation Number % Number % Number %

1. Every day 0 0.00% 0 0.00% 0 0.00%

2. Once a week 1 0.39% 1 0.39% 2 0.78%

3. Once a month 3 1.17% 0.00% 3 1.17%

4. Occasionally 54 21.09% 32 12.50% 86 33.59%

5. None 56 21.88% 109 42.58% 165 64.45%

Grand Total 114 44.53% 142 55.47% 256 100.00%

45.a How satisfied are you with your health?


Satisfied with health Number % Number % Number %

1. Very satisfied 14 5.47% 7 2.73% 21 8.20%

2. Satisfied 74 28.91% 78 30.47% 152 59.38%

3. Neither satisfied nor dissatisfied 17 6.64% 42 16.41% 59 23.05%

4. Dissatisfied 6 2.34% 11 4.30% 17 6.64%

5. Very dissatisfied 3 1.17% 4 1.56% 7 2.73%

Grand Total 114 44.53% 142 55.47% 256 100.00%

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45.b How satisfied are you with your ability to perform your daily living activities?



1. Very satisfied 18 7.03% 6 2.34% 24 9.38%

2. Satisfied 71 27.73% 73 28.52% 144 56.25%


4. Dissatisfied 5 1.95% 18 7.03% 23 8.98%

5. Very dissatisfied 0.00% 4 1.56% 4 1.56%

Grand Total 114 44.53% 142 55.47% 256 100.00%

45.c How satisfied are you with your overall life?


Satisfied in overall life Number % Number % Number %

1. Very satisfied 20 7.81% 12 4.69% 32 12.50%

2. Satisfied 80 31.25% 88 34.38% 168 65.63%


4. Dissatisfied 3 1.17% 5 1.95% 8 3.13%

5. Very dissatisfied 1 0.39% 1 0.39% 2 0.78%

Grand Total 114 44.53% 142 55.47% 256 100.00%

46. How do you feel in and around the community towards senior citizens?


Around community Number % Number % Number %

1. Respected 73 28.52% 88 34.38% 161 62.89%

2. Speaking politely 32 12.50% 38 14.84% 70 27.34%

3. Responsiveness to the need of

senior citizen 7 2.73% 8 3.13% 15 5.86%

4. Do not feel respected 2 0.78% 5 1.95% 7 2.73%

5. Do not feel supportive 0.00% 3 1.17% 3 1.17%

Grand Total 114 44.53% 142 55.47% 256 100.00%

47. What kind/level of care and support you require in your daily life?


Around community Number % Number % Number %

1. Complete care (incl. toilet, feeding

etc) 3 1.17% 5 1.95% 8 3.13%

2. Partial care 8 3.13% 24 9.38% 32 12.50%

3. Minimal care 23 8.98% 48 18.75% 71 27.73%

4. None (I am capable to taking care

myself) 80 31.25% 65 25.39% 145 56.64%

Grand Total 114 44.53% 142 55.47% 256 100.00%

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48. Who is providing care/support to you?


Care provided by Number % Number % Number %

1. By family members 34 30.63% 76 68.47% 110 99.10%

4. BY paid care taker 0.00% 1 0.90% 1 0.90%

Grand Total 34 30.63% 77 69.37% 111 100.00%

49. How satisfied are you from the care/support you are receiving?


Satisfied with care received Number % Number % Number %

1. Very satisfied 13 11.71% 29 26.13% 42 37.84%

2. Satisfied 19 17.12% 42 37.84% 61 54.95%


4. Dissatisfied 0.00% 1 0.90% 1 0.90%

Grand Total 34 30.63% 77 69.37% 111 100.00%

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Annex 2: Consent paper for interview

नेपाल रेडस सोसाइिट

ता संकलनको लािग सहमित प

नमार,

म रेडसमा आव यंसेवक ँ। यस संाले जे नागिरकहको ा अवा सुधार गन उेले काम गनका

लािग भपुर िजा सुयिबनायक नगरपािलकाको वडा नं. २ को गाउँ तथा ेहमा िनवासी जे नागिरकहको

वतमान अवा थाहा पाउनु आवक भएकोले यहाँहलाई छोटो, ैिक अवाता िदन आह गिरएको छ ।

यस अवाताको लािग १५ देिख २० िमनेट समय लाेछ । यिद तपाईले हामीलाई समय िदन सुछ भने हामी

तपाईित धेरै आभारी नेछौ ँ । कु नै असहज लागेमा उर निदन पिन सुनेछ र अवाता कुनै पिन समयमा

रो सु नेछ । यस अगाताबाट ा जानकारीह रेडस भा अ योजनका लािग योग गिरने छैन र संकिलत

जानकारीह गो रािखने कु रा िवास िदलाउन चाहछौं । यस अयनको बारेमा तपाईलाई लागेका ह सो

सुनेछ । हामी तपाईको को उर िदने यास गनछौं।

1. तपाई मलाई के ही सो चाहनुछ?

क) चाहछु ख) चाह

2. तपाई अवाताका लािग तयार नुछ?

क) छु ख) छैन

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Annex 3: vibre communication (examples)

Image 1

Image 2

Image 3

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Image 4

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411008_Report_BaselineAssessment_NRCS_final

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