India’s Ageing Population: Are we budgeting enough for our elders?
India is undergoing a demographic transition. As per the 2011 Census, 8.6% of the population was aged 60 and above. This figure is projected to rise to 10.1% by 2026, 14.9% by 2036 and 19.5% by 2050. Even more striking is the expected 340% increase in the population aged 75 and above. By 2030, older adults are projected to account for nearly 45% of India’s disease burden, with chronic conditions becoming even more prevalent. Since elderly individuals require specialised healthcare services and often face unique barriers in accessing them such as reduced mobility and limited health literacy, India needs to strengthen its existing infrastructure to address the specific needs of this growing demographic.
The Longitudinal Ageing Study of India (LASI)
To inform its policy and planning efforts the Ministry of Health and Family Welfare (MoHFW) launched the LASI in 2016. This nationally representative survey covered 73, 396 individuals aged 45 and above across all states and union territories.1 The LASI offers insights into ageing by analysing four key dimensions:
- Health: prevalence of chronic conditions, disease burden and risk factors
- Social: family, social network and social welfare programmes for the elderly
- Economic: income, employment, pension, expenditure and wealth
- Healthcare and healthcare financing
The main findings of the survey were that:
- Chronic health conditions such as cardiovascular diseases, hypertension, diabetes, stroke, asthma etc. were more prevalent among those aged above 60
- Poor self-reported health is twice as common among older adults, as compared to younger age groups
- Almost one-third of the elderly population has depressive symptoms, with 20% of the elderly suffering from mental health issues
- Households with at least one elderly member report significantly lower per capita income and consumption
- Access to healthcare is unequal with higher treatment and hospitalisation rates in urban areas and wealthier households, pointing to disparities in service delivery
Government response: The National Programme for Healthcare of the Elderly (NPHCE)
To address the healthcare needs of India’s ageing population, the Government of India introduced the NPHCE in 2010. It aims to deliver affordable, accessible and high quality primary, secondary and tertiary healthcare specifically to senior citizens.
Primary and secondary care is to be delivered under the National Health Mission (NHM)2 through the existing primary health centres, community health centres, district hospitals and health and wellness centres. This was to be done by ensuring:
- Healthcare workers make domiciliary visits to address the needs of bedridden elderly patients and provide training to family members so that they can look after the disabled elderly persons better
- Dedicated services are provided at these centres through additional provision of machinery, equipment and human resources
- Units for physiotherapy and counselling needs of the elderly population are established
- Separate dedicated wards are set up at the district hospital level
- Health personnel are provided training to manage specific diseases of the elderly and in geriatric healthcare
Tertiary care is to be provided through the establishment of separate infrastructure. Further to this, regional geriatric centres were established across 19 medical colleges in the country and two National Centres for Ageing were set up in New Delhi and Chennai.
According to the MoHFW’s Annual Report (2024-25) there has been a rise in geriatric outpatient visits and admissions at district hospitals, clinics, as well as increased use of services at geriatric centres. However, concerns remain about the adequacy and quality of services offered.
Budgeting for Elder care: Not a priority
The NPHCE is funded under the Non-Communicable Diseases (NCD) flexipool, one of the six financing components of the NHM.3 Despite the rising need, financing primary and secondary elderly healthcare remains a low priority in states. Although the NHM’s total budget saw an increase between FY 24-25 and FY 25-26, funding of the NPHCE remains marginal.
A review of budget allocations in India’s 10 most populous states reveals that less than 0.1% of their total health budgets are earmarked for elderly care. Further:
- The NPHCE allocated budget increased in 4 states between FY 23-24 and FY 24-25 but declined in the other 6. The largest increase in the allocated budget between these two years was in Rajasthan, where it increased by 113 times and Madhya Pradesh where it increased by 5 times. Karnataka and West Bengal saw a decline in the allocated budget by 86% and 48%, respectively.
- In FY 2024-25, only Rajasthan (13%) and Madhya Pradesh (4%) allocated a notable share of their NCD budget to the NPHCE, while other states allocated less than 3%
- In FY 2023-24, only Uttar Pradesh allocated close to 3% of its NCD budget towards the NPHCE, with other states allocating below 2%
Further, fund utilisation varies across states and is uneven. In FY 23-24, only 3 Indian states utilised more than 75% of their allocated budget, with Madhya Pradesh utilising triple its allocated budget and Karnataka’s utilisation being double. Bihar and Uttar Pradesh utilised the lowest, at 8% and 9% respectively. Additionally, fund utilisation does not appear to be uniform throughout the year, as is evident from utilisation trends in FY 24-25. Until November 2024, only one Indian state i.e. West Bengal utilised more than 75% of its allocated budget. Tamil Nadu and Rajasthan have utilised a negligible amount of their allocated budget.
Hence, while the NPHCE is a step in the right direction, limited funding and low prioritisation in states risks leaving older adults without the care they need. Prioritising elderly health is the need of the hour.
For a more detailed analysis of the MoHFW’s budget trends, see our detailed budget insights.
