Policy Brief

UTILIZATION OF PUBLIC HEALTH SERVICES BY

ELDERLY WOMEN IN PUNJAB, PAKISTAN

A collaborative initiative of

HELPAGE INTERNATIONAL PAKISTAN

&
HEALTH SERVICES ACADEMY
Ministry of National Health Services
Regulation & Coordination
Islamabad.

With the Financial Support of United Nations Population Fund

This policy brief highlights the findings of the exploratory study focusing on utilization proportions, trends and probable
causes of health problems in elderly, especially the women in Punjab province. The source of Data was DHIS.

Introduction
The number and proportion of elderly is increasing in both the developed and less developed
countries as a result of improved health facilities. Pakistans demographic trends show that
between 1990 till 2010, the elderly population has increased by 75 % this percentage is expected to
raise substantially in next two decades.

Salient Points
Average monthly turnover of elderly at primary and secondary care facilities is approximately
0.78 million and 0.44 million respectively.
One fourth i.e. (20-25%) of the entire Outpatient Department in the primary and secondary
healthcare facility being utilized by the elderly.
At secondary level facilities most of elderly people are coming to hospital for treatment of eye
problems followed closely by orthopedic problems.
At both primary and secondary level facilities No major dierence exists in male to female ratio
of service utilization.
Pelvic Inammatory disease is the most common cause of admission by elderly women at
tertiary facilities.

Key Recommendations
Community based research needs to be done for these special groups to identify the burden of
health problems and health seeking behavior among elderly.
Community health projects targeting awareness of people regarding relationship of healthy
eating and health needs to be focused specically for elderly.
Interventions to increase awareness regarding good control of chronic diseases among elderly
are desired.

The Context
Ageing is a natural
progression in the life cycle.
The changing demographic
structure in many of the
developing countries has
resulted in a rapid increase in
the proportion of the elderly
population. By the end of year
2020 there will be one billion
elderly, and 71 percent of
them would be living in the
less developed countries.1
1

Good health, economic and

social security and adequate
housing are essential
requirements of aging with
dignity. Many elderly women
face neglect as they are
considered no longer
economically or
reproductively useful, and are
seen as burdens on their
families.
Pakistan is sixth most

populous country in the world

and is among one of those
fteen countries in the world
where people over 60

Uncertainly Rules Over Lives: The Situation of Elderly People in Bangladesh. London: Help Age International.)

are more than 10 million2. It is estimated

that6.5% of the total population of Pakistan
is over 60 years old and this percentage is
expected to rise to 16% by 20503. HelpAge
International and UNFPA have recently
ranked Pakistan 89 out of 91 countries in
the Global Age Watch Index. This index
ranks countries based on four key domains
that enable old peoples well-being, i.e.,
their income security, health status,
education and employment, and the
presence of enabling societies and
environments4. Punjab is the most
populated province of Pakistan; home to
approximately 56% of the countrys
population5. This policy brief provides the
estimates of utilization of government
health services by elderly. The secondary
data analysis of the data collected through
District Health Information System (DHIS)
and various tertiary care hospitals of
Punjab province was done.

Methodology & Key Findings

Data for the Public health care facilities of
Punjab was extracted for the last one year
i.e. from August 2012 to July 2013. Three
representative months were selected and
only data for the month of August, January
and May were utilized during this study.
Following sections outline key ndings
from the research study:

Total Burden Of Elderly

On an average 3.8 million people per month
come to utilize primary and 1.7 million at
secondary level public health care facilities
across 36 districts of Punjab province6.
Burden of elderly at the primary healthcare
level is 20% whereas at secondary level
facilities it further increases to 25% i.e. one
fourth of the total OPD patients are 50
years and above.

Primary Healthcare utilization

The average elderly utilizing these facilities
every month is 0.788 million.The percentage
distribution of male: female is almost similar
i.e. 10.27%:10.29 % respectively7.

cases ) 50 +

Secondary Healthcare utilization

On an average 14,500 elderly are seen in the
OPD on a daily basis. The maximum elderly
patients are requiring treatment for various eye
problems followed closely by orthopedic
problems.

First ever index to measure the wellbeing of elderly people | Global AgeWatch Index http://www.helpage.org/global-agewatch/
Country ageing data |Data | Global AgeWatch Index
http://www.helpage.org/global-agewatch/population-ageing-data/country-ageing-data/?country=Pakistan
4
First ever index to measure the wellbeing of elderly people | Global AgeWatch Index http://www.helpage.org/global-agewatch/
5
Population situation of Punjab http://pwd.punjab.gov.pk/sites/pwd.punjab.gov.pk/les/Population%20situation%20of%20Punjab.pdf
6
http://health.punjab.gov.pk/?q=system/les/1st_Quarter_2012.pdf
7
The percentage of elderly male/female utilization =Total elderly males /female x 100
Total male and female seen all ages
2
3

of the problems among elderly.As studies

shows clearly that majority of the elderly
are having eye problems. In many cases
Vitamin deciency is associated with
visual imparity hence community health
projects targeting awareness of people
regarding relationship of healthy eating
and health needs to be focused specically
for elderly.

Tertiary Healthcare utilization

Pelvic inammatory disease is the most
prevalent disease among the elderly
admitted patients in Gyne Department of
tertiary care hospitals. And on the second
place comes the Fibroid and then
Utero-Vaginal prolapse.

Also interventions should focus on

implementation of nutritional guideless for
elderly age group including the minimum
nutritional requirement for them. Apart
from that interventions to reduce disease
risks should be looked in.
Most of the elderly have vision problems as
a result of end organ damage from chronic
illnesses e.g. poorly controlled diabetes and
hypertension and other risk factors like
smoking and excessive sunlight exposure.
At all levels of facilities special focus
should be given to the patient counseling
on importance of good diabetic and
hypertensive controls and also avoiding of
This

research

has

identied

very

important issues in context to elderly

utilization trends at the public healthcare
facilities. Lessons learnt from this study

Way forward based on research

So far less evidence is available
regarding elderly, which needs further
studies and research focusing on
disease prevalence and health seeking
behaviors to identify the real magnitude

present an important opportunity for the

Department of Health, Punjab to improve
overall quality of care provided to elderly
at primary secondary and tertiary level
facilities.

HEALTH SERVICES ACADEMY

Ministry of National Health Services Regulation & Coordination Islamabad.