SEVAI HEALTH AND SANITATION MEASURES
Dream Comes True
SEVAI implements providing Community based Drinking Water Supply with the components of (I) demand-driven and community participation approach, (ii) panchayats / communities to plan, implement, operate, maintain and manage all drinking water schemes, (iii) partial capital cost sharing by the communities upfront in cash, (iv) full ownership of drinking water assets with Gram Panchayats and (v) full Operation and Maintenance by the users/ Panchayats.
Individual Health and hygiene is largely dependent on adequate availability of drinking water and proper sanitation. There is, therefore, a direct relationship between water, sanitation and health. Consumption of unsafe drinking water, improper disposal of human excreta, improper environmental sanitation and lack of personal and food hygiene have been major causes of many diseases in developing countries. India is no exception to this. Prevailing High Infant Mortality Rate is also largely attributed to poor sanitation.
It was in this context that the Central Rural Sanitation Programme (CRSP) was launched in 1986 primarily with the objective of improving the quality of life of the rural people and also to provide privacy and dignity to women.
The concept of sanitation was earlier limited to disposal of human excreta by cess pools, open ditches, pit latrines, bucket system etc. Today it connotes a comprehensive concept, which includes liquid and solid waste disposal, food hygiene, and personal, /SEVAI health workers /domestic as well as environmental hygiene. Proper sanitation is important not only from the general health point of view but it has a vital role to play in our individual and social life too.
Sanitation is one of the basic determinants of quality of life and human development index. Good sanitary practices prevent contamination of water and soil and thereby prevent diseases. The concept of sanitation was, therefore, expanded to include personal hygiene, home sanitation, safe water, garbage disposal, excreta disposal and waste water disposal.
Sanitation moves towards a “demand driven” approach. The approach in the Programme titled “Total Sanitation Campaign (TSC)” emphasizes more on Information, Education and Communication (IEC), Human Resource Development, Capacity Development activities to increase awareness among the rural people and generation of demand for sanitary facilities. This will also enhance people’s capacity to choose appropriate options through alternate delivery mechanisms as per their economic condition.
The Programme is being implemented with focus on community-led and people centred initiatives. Children play an effective role in absorbing and popularizing ideas and concepts. This Programme, therefore, intends to tap their potential as the most persuasive advocates of good sanitation practices in their own house-holds and in schools. The aim is also to provide separate urinals/toilets for boys and girls in all the schools/ Anganwadis in rural areas in the country.
The main outcome of this project in target villages:- Bring about an improvement in the general quality of life in the rural areas.- Accelerate sanitation coverage in rural areas.- Generate felt demand for sanitation facilities through awareness creation and health education. . /Dental Health Check up/
- Encourage cost effective and
appropriate technologies in sanitation.
- Eliminate open defecation to minimize risk of contamination of drinking water sources and food.
The strategy is to make the Programme 'community led' and 'people centered'. A "demand driven approach" is adopted with increased emphasis on awareness creation and demand generation for sanitary facilities in houses, schools and for cleaner environment. Alternate delivery mechanisms had been adopted to meet the community needs. Subsidy for individual household latrine units has been replaced by incentive to the poorest of the poor households. Sanitation is a major component and an entry point for wider acceptance of sanitation by the rural people. Technology improvisations to meet the customer preferences and location specific intensive IEC Campaign involving Panchayati Raj Institutions, Women Groups, Self Help Groups, etc. are also important components of the Strategy. The strategy addresses all sections of rural population to bring about the relevant behavioural changes for improved sanitation and hygiene practices and meet their sanitary hardware requirements in an affordable and accessible manner by offering a wide range of technological choicesThe physical implementation gets oriented towards satisfying the felt-needs, wherein individual households choose from a menu of options for their household latrines. The built-in flexibility in the menu of options gives the poor and the disadvantaged families’ opportunity for subsequent upgradation depending upon their requirements and financial position. In the “campaign approach”, intensive IEC and advocacy, with participation of SHGs/Panchayati Raj Institutions/resource organizations, take place to bring about the desired behavioural changes for relevant sanitation practices, provision of alternate delivery system; proper technical specifications, designs and quality of installations are also provided to effectively. /Bed side nursing by SEVAI worker/
SEVAI enlighten the target communities that Drinking water, like every other substance, contains small amounts of bacteria. Most of these bacteria are common ones and they are generally not harmful. Chlorine is usually added to drinking water to prevent bacterial growth while the water streams through pipelines. This is why drinking water also contains minimal amounts of chlorine. Water mostly consists of minerals and other inorganic compounds, such as calcium. /Patient care/Sanitation project implemented is an improvement in the general quality of life in the rural areas and to accelerate sanitation coverage in rural areas to access to toilets to all by motivating communities and Panchayati Raj Institutions in promoting sustainable sanitation facilities through awareness creation and health education. Individual Household Latrines, School Toilets, Anganwaadi Toilets, Sanitary Complexes and Rural Sanitary Marts are taken up under the scheme.
Remote rural areas suffer from a lack of health and sanitation measures which had a negative effect on all of the community's members. Water has impact on both health and disease. Water-related diseases include those due to micro-organisms and chemicals in water people drink; diseases like schistosomiasis which have part of their lifecycle in water; diseases like malaria with water-related vectors; drowning and some injuries; and others such as legionellosis carried by aerosols containing certain micro-organisms. Water also contributes to health, through hygiene.
SEVAI has both rural and urban projects to help increase access to water and sanitation. As sanitation coverage is very low, projects focus on promoting sanitation among the rural poor by creating a demand for latrines. When members of the community learn that poor hygiene fuels disease and work out for themselves the costs in medicine and lost productivity, their raised awareness will inspire them to develop their own solutions.
A series of well received training manuals and materials developed by SEVAI have also given hygiene promotion a boost. These materials have been used by Self Help groups and user groups.SEVAI projects are aimed at stopping open defecation in the intervention areas which include rural and urban slums in Cities.
WaterAid first Director, Mr.David SEVAI enabled the panchayat to declare Allur village as open defecation free village. Based on the community led total sanitation approach, SEVAI so far helped the local communities 256 villages as open defecation free. By demonstrating cost effective, practical examples using appropriate technologies that involve communities through self help groups, SEVAI has been into incorporate low cost latrines.
Mr. David Collect, Water Aid visited SEVAI and had interaction with village head.
SEVAI is focusing on making people friendly toilets so that even the poorest can benefit. SEVAI encourages its self help groups to take the lead in all its work and they in turn ensure that all members of the community, including the poorest and most marginalized, are involved in the projects. Community toilet by SEVAI.In rural projects, SEVAI and its SHGS help people to gain access to water and sanitation from the Government.
SEVAI trains villagers to maintain the new infrastructure and set up village water and sanitation committees to manage the projects in a way that involves all the community and promotes good hygiene. SEVAI also helps the rural poor to put forward their views in village governing bodies such as the Gram Sabha (a village level forum for decision making) and Panchayats (local government) so that their concerns over water and sanitation are raised. Health committees had been formed by SEVAI in the target 362 village communities in an effort to improve sanitation measures, and also to improve access to health services. SEVAI experienced that the Schools situated in target villages also have a role in promoting health and sanitation within their communities; they are agents of change by introducing health and sanitation measures that they learn at school to their families. SEVAI launched hand washing program at schools, SEVAI launched a deworming program in target areas schools very inexpensively, launch a gardening program, and with the investment of a relatively small amount they could launch a latrine program at schools.
SEVAI has achieved remarkable success in providing safe Drinking water to rural population of district Trichy, Karur and Nagapatinam Districts through different water
supply programme i.e. sinking of tube wells and Orani improvement and Tara pump water schemes.
Developing hygiene awareness, helping people to become conscious of their relationship between safe water, sanitation, health and development and bringing about a change in the attitude and behavior appeared to be some of the difficult task, but it has been carried out through collaborating with “Total Sanitation Campaign”.
Commissioner Rural Development discussed about eco-sanitation with SEVAI.
To promote sustainability of safe drinking water systems, the assets and the responsibility for operation and maintenance need to be transferred to the local Water and Sanitation committees for effective repair and maintenance of the rural water supply systems.
Improving sanitation represents one of our best options to really accelerate health, social and even economic development.
SEVAI’s work has shown that sanitation does improve health - simple achievable interventions reduce for example diarrhoeal disease.
SEVAI is proud that it has recognized the importance of sanitation since its inception sanitation as a priority, and to this day we continue to recognize its importance.
SEVAI continues to ensure that objective, balanced information is available to support decision-taking, advocate investment in sanitation as a cost-effective health intervention.
Rain water harvesting for drinking.
A lack of access to safe, clean water may not be the most obvious problem for those living along India's extensive and beautiful coastline. Yet it is becoming increasingly apparent that coastal areas are facing serious difficulties when it comes to providing an adequate domestic water supply to the rural and urban population.
Promotion of Kitchen gardening by tribal
The roots of the crisis are linked to development. Sustainable development has proved challenging for many coastal villages, as they struggle to balance their delicate ecology against heavy economic demands and the desire for growth. While coastal ecosystems can promote biodiversity and protect against saline winds, cyclones and tsunamis, they also provide many raw materials for manufacturing activities. Boats building, oil refineries, agriculture, tourism and fisheries are all likely to put great pressure on coastal ecosystems - and lead to salinity in the groundwater, depletion and degradation of natural resources, pollution - and a lack of safe potable water.
In Thirunagari, Tamil Nadu, a cyclone caused many villages to flood and seawater to contaminate the water supply. Intensive prawn cultivation in the area has also negatively impacted the groundwater; salt water pumped into ponds for rearing prawns devastates the land which then cannot be reclaimed for agriculture by local people when the prawn farmers move on.
SEVAI explored the feasibility of technological alternatives to the problem of salinity in the groundwater - for example, rainwater harvesting, desalination and dew harvesting - and looked towards establishing an area-specific strategy for ensuring access to a domestic water supply in coastal regions.
SEVAI continues to work in coastal Nagapatinam regions to promote low-cost, sustainable approaches to accessing safe domestic and drinking water, enabling the country's poorest people to gain access to the most important resource of all.
Shallow water tables: In rural areas, water supplies are generally provided by hand pump tube wells which tap water from underground. But in many places, water supplying with hand pump tube wells are facing severe problems due to various reasons. The major reasons are:
Lowering of Water Table.
Water Quality Problem.
Absence of Suitable Water Bearing Formation.
Arsenic Contamination Problem
SEVAI is therefore, has been conducting Research and Development activities to improve existing technologies, develop cost effective alternatives and develop alternative technological option to provide water in the problematic areas.
Considering the problem encountered in rural water supply a technical committee comprising experts from different organizations started their work on Research and Development activities. Because of water table depletion, hand pump was very essential to be introduced in Shallow water level areas such as Cauvery belt and coastal belt in SEVAI target belt and coast belt. After a series of discussions, workshop and field verification,
Implication of Declining Water Table: Since 1986, SEVAI has been monitoring the fluctuations of groundwater table using a measuring network having one tub well in each union of the country. Measurements are taken once annually during peak dry season. The data indicates the area where the water table has fallen beyond the suction limit has increased from 12% in 1986 to 20% in 1990. As a result a large number of tube wells fitted with no 6 suction pump become non-functioning during dry season. During 1992-95 an in depth study had been carried out to predict the area of the country where the water table would be beyond the suction limit in the year 2010. Findings on water table monitoring show that water table has fallen beyond suction limit about 27% in 2004. However, declination of water table has been analyzed for deep and shallow aquifer has been undertaken.
Conversion of DSP into TARA: The conventional deep-set pumps were becoming obsolete due to difficulties & expensive maintenance. These wells could easily be converted into TARA, provided the upper well casing remains within water level.
Water Quality Problem:
Coastal Belt Mapping Updating: In coastal belt areas the major problem encountered in tube well was salinity of excess concentration. Besides this, in some places no suitable aquifer was available. In 1990-91 a detailed map of the coastal belt was prepared showing different problem areas on it. After that, extensive work to find out suitable water bearing layer was done. By this time some areas were found successful, some areas found unsuccessful for normal hand pump well, where alternate technologies were being applied and some new areas with different problem were identified. All these changes were incorporated in the maps and the coastal belt mapping were updated. The exercise was started in 1993.
Health Education Street plays.
R & D division has designed and piloted community based Rain Water Harvesting System (RWHS) to serve 3 to 5 families ie about 25 to 30 users for drinking and cooking purpose. The storage tank volume is 2500litre. The construction cost is about Tk 11000/. The user contribution in construction is 20 % of the estimated cost. The models designed to ensure 7 months water security. It has been monitored for about 7 months for technical, socioeconomic, management and O & M aspects. The findings are satisfactory to be replicated. Piloting on point of use water treatment technologies has been undertaken. Baseline survey has been completed. Other works like distribution of disinfectant, motivation of the community, testing of water quality is going on.
According to the protocol of deep tube well, sealing is to be done to prevent the leaching of arsenic in deep aquifer through drilling hole. Accordingly clay sealing is being done in deep tube well. But the procedure of clay sealing raised some confusion regarding its effectiveness. In this context as a part of R&D activities, initiatives has been undertaken to find out the best possible procedure of clay sealing and to examine its effectiveness.
SEVAI works in the areas of Health with focus:
Reduction in Grade 3 & 4 malnutrition in 0-6 age group.Special focus on health, nutrition and immunization aspects in 0-3 age group
Reduction in Grade 1 & 2 malnutrition in 0-6 age group
Newborn care initiatives
Antenatal, prenatal and postnatal care for mothers
Focus on pre-teen/adolescent girls: nutrition
Child rearing by grandfather with food hygiene.
Transfer of the management function to the community
Issues for thought
Still too much focus on food, too little on improving child-care behaviour, family nutrition patterns
Children in 0-3 age group and from disadvantaged groups not served adequately by existing ICDS
Lack of clear policy focus on areas with greatest levels of malnutrition
A need to put emphasis on
Human change, relationships & partnerships (personal/interpersonal/systemic)
Shared understanding of malnutrition in a holistic framework
Interaction between actors concerned with malnutrition, especially the communities to be served
Passion, commitment, orientation to action
Wood stove carbonreducton process.
SEVAI promotes Feeding is an important aspect of caring for infants and young children. Appropriate feeding practices stimulate bonding with the caregiver and psycho-social development. They lead to improved nutrition and physical growth, reduced susceptibility to common childhood infections and better resistance to cope with them. Improved health outcomes in young children have long-lasting health effects throughout the life-span, including increased performance and productivity, and reduced risk of certain non-communicable diseases. Malnourished children are, in turn, more vulnerable to disease and the vicious circle is established. Improved feeding practices to prevent or treat malnutrition could save 800,000 lives per year.
Counselling for mothers and caretakers
Management of severe malnutrition
SEVAI; Adolescent Nutrition
Adolescence represents a window of opportunity to prepare for a healthy adult life. During adolescence, nutritional problems originating earlier in life can potentially be corrected, in addition to addressing current ones. It is also a timely period to shape and consolidate healthy eating and lifestyle behaviours, thereby preventing or postponing the onset of nutrition-related chronic diseases in adulthood.
As adolescents have a low prevalence of infections such as pneumonia and gastroenteritis compared with younger children, and of chronic disease compared with ageing people, they have generally been given little health and nutrition attention, except for reproductive health concerns. However, there are nutritional issues, which are adolescent-specific, and which call for specific strategies and approaches.
The main issues in adolescent nutrition are:
Micronutrient deficiencies (iron deficiency and anaemia)
Malnutrition and stunting
Obesity and other nutrition-related chronic diseases
Adolescents eating patterns and lifestyles
Nutrition in relation
Tiruchirappalli District of Tamil Nadu is one of the viable models where the organic wastes are converted as vermi-compost. The vermi-compost produced at this compost yard is purchased by the local farmers for banana cultivation and paddy fields. The one acre compost yard is housing vermi-compost sheds, waste storage structures, dumping yard for natural decompose with a recreation centre.
The wastes are segregated and categorized by using different bins by the local residents which would be later handed over to waste retrievers who come with tri-cycles in the morning hours. At the disposal yard, the wastes are primarily segregated as organic wastes which include rotten vegetables, leaves etc., Inorganic wastes and non-biodegradable items like plastic wastes
Identified active Self Help Group (formed by women) members in the affected villages towards formation of Water, Hygiene and Sanitation Committee. This Watson committee facilitated in taking responsibility on their own for improved hygiene practices and appropriate management of sanitation components in their village. The committee facilitated with necessary guidance, education and skills in implementing the day to day practices towards creating healthy communities. For integrating the programme in a holistic manner, opinion leaders, officials were collaborated.
Safe disposal of Human Excreta
Disposal of Waste Water
Transmission of diarrheal diseases and prevention
Solid Waste and Garbage Disposal
Home Sanitation and Food Hygiene
Promoted Children also as “Health Ambassadors” as child-to-child approach recognizes the potential of children to care for one another and learn from each other. The children are promoted as “Health Ambassadors” in each of the target village. They were encouraged to learn through experience and to apply what they learn in a practical way to improve the hygiene conditions within their own family and community. It is contacted the teachers, parents and village leaders for collaboration in health promotion activity
It is widely known that street theatre occupies an important place in the day to day life of the general mass. SEVAI has experienced strongly that through traditional media the hygiene messages could be reached appropriately in an effective manner.
Establishing Dispensary and Health Promotion Resource Centre
IEC – Hygiene, Sanitation Campaign .
The trained Nurse and the associated staff conduct puppet and street plays with the active mobilization of the affected population shall conduct street plays in all the target villages for disseminating the Hygiene messages.
The Nurses create awareness among the community concerning spread of water borne diseases, need to intake safe drinking water, safe disposal of excreta, personal hygiene, adolescent health issues, care for diarrheal diseases, preparation of ORS, environmental sanitation, safe disposal of animal wastes and domestic wastes, developing community garbage pits.A continuous effort is made to enhance sanitation in the villages. “A committee comprising people from various sections is formed in each target village to monitor the sanitary conditions and spread awareness among people on the importance of sanitation,”
The Nature of Villages Identified and Served:
Identification as tsunami affected villages.
In terms of vulnerability like heavy losses, damages
In terms of vulnerable groups including dalits, single women headed family [adolescent girls / widows]
Discussion with opinion leaders and Government officials
Detailed Village assessment analysis and survey
Exploring with Government health department officials
The Gowen’s Dispensary Programme Focussing Mobile Health Care of the tsunami affected population in Nagapatinam – Kadampadi Cluster
First aid and Medical care for tsunami affected 25215 population.
Mother and child health care for 6182 families in nine locations.
Safe water supply advocacy with the Government and organised basic sanitation for nine locations.
Prevention and control of water borne diseases and other local ailments for nine locations covering 6182 families.
Updating baseline survey on Health conditions.
HIV/AIDS/personal hygiene/Health education.
Training of health guides, health workers on dispensary project works.
Basic laboratory investigations.
Extension works based on emergency health needs in the new settlements through Mobile Health Care covering 6182 families.
Pulse Polio Immunisation Camp
The Gowen Dispensary is the basic functional unit of the public health services in tsunami affected Nagapatinam of Tamilnadu. Gowen Dispensary was established to provide accessible, affordable and available first aid and basic medical and Health Care to people of the tsunami affected nine locations of Nagapattinam covering 6182 families.
To increase the understanding and practices of women, men and children of affected communities about public health related issues and enable them to change situations in their villages.
Preventive, Educative aspects and Curative aspects.
Gowen Dispensary- health care provider:
Gowen Dispensary is a term used for the activity of a health care provider who acts as a first point of consultation for all patients frequenting Gowens Dispensary. Alternative names for the Gowen Dispensary staff including medical practicer, Nurses are the persons involved in "general practice" and "family medicine", although the terms are not synonymous.
First aid care provided in Gowen’s Dispensary to as limited care for an illness or injury, which is provided, usually by a lay person, to a sick or injured patient until definitive medical treatment is accessed, or until the illness or injury is dealt with (as not all illnesses or injuries will require a higher level of treatment). It generally consists of series of simple, sometimes life saving, medical techniques, that an individual, either with or without formal medical training, are trained to perform with minimal equipment.
The 3 main provisions of first aid followed by Gowen’s Dispensary team, commonly referred to as the “3 Ps” are: Preserve life, Prevent further injury, Promote recovery. Much of first aid is the basic health need and the target populations are almost certain to learn some elements as they go through their life (such as knowing to apply an adhesive bandage to a small cut on a finger). It's important to have an emergency first aid kit on hand in the event of minor cuts, scrapes, burns or other injuries.
The Nurses carry the Mobile First Aid Health Care Kit during their field visits in the evenings, tsunami affected locations like Cooksnagar, Cooks Road, Sellore, Thonithurai, Nambiar Nagar, Ariyanattutheru, Thethi, Palpattinacherry, Usimadakoil shelters with the following items. Two pairs of sterile latex gloves (or gloves made of other material if there are known latex allergies).
Sterile dressings, gauze pads or adhesive bandages.
Antibacterial soap or towelettes, and antibiotic ointment.
Eye wash solution.
A supply of regular daily prescription medications.
Prescribed medical supplies, like glucose, blood pressure monitoring equipment.
Quality Training in first aid has been promoted by SEVAI at its training Centres in Kadampadi of Nagapattinam District and Poovam of Karaikal region for 54 trainees of the target villages. This training programme has been linked with Gowen’s Dispensary for practical learning. Further, the students come for the training course belongs to the target tsunami affected villages. This enables the reach of first aid worker adequately for the needy target population. There are certain skills that have been regarded as core, regardless of where or how first aid is taught. First aiders have been taught to focus of first aid before giving additional treatment: Breathing, Bleeding, and Bones.
This project has been the outcome of the need expressed by the tsunami affected population. It is SEVAI’s principle that community is the subject for development and not object. SEVAI adopts participatory techniques towards project implementation with community participation to stimulate open and creative discussion about particular health aspects from the perspective of the affected population.
As SEVAI team enjoys a good rapport with the government officials and the affected population, this strengthens our team in utilizing the locally available resources viz., PHC officials, ICDS officials, elementary school children/teachers of the target villages to promote this health education programme in an integrated manner.
A baseline survey has been conducted in the proposed villages
To know the accessible situation
To appraise the existing practices among the people
To assess the needs of the community
To know their trend of development and their present level of awareness
To work out the possible solution to the problems
SEVAI team has undertaken a baseline survey for the target 6182 families in the target tsunami affected villages covered under this project to monitor how their life style evolve; improvements in their daily life and income towards self reliance and sustainability as a comprehensive project. This includes development at individual level, organization level and community level – meeting genuine need and justice, sharing and caring, individual skills development; accountability and responsibility, Nutrition and Income, Gender and family focus, improving the environment, improved livestock management, full participation in their villages development, training and education as a continuous process.
Active Self Help Group (formed by women) members have been identified in the affected villages towards formation of Water, Hygiene and Sanitation Committee. This Watson committee facilitates in taking responsibility on their own for improved hygiene practices and appropriate management of sanitation components in their village. The committee has also been capacitated with necessary guidance, education and skills in implementing the day to day practices towards creating healthy communities. For integrating the programme in a holistic manner, opinion leaders, officials are collaborated.
Safe Handling of Drinking Water
Safe disposal of Human Excreta
Disposal of Waste Water
Transmission of diarrheal diseases and prevention
Solid Waste and Garbage Disposal
Home Sanitation and Food Hygiene
Under this programme children have been promoted as “Health Ambassadors” as a part of promoting child-to-child approach. Adopting this approach brings out the potential of children to care for one another and learn from each other. The target children are promoted as “Health Ambassadors” in each of the target village. They are encouraged to learn through experience and to apply what they learn in a practical way to improve the hygiene conditions within their own family and community. SEVAI team has also contacted the teachers, parents and village leaders for collaboration in health promotion activity
SEVAI team has conducted sanitation exhibition depicting hygiene practice messages towards influencing the community for better social change. The exhibition has been an information place wherein the target population in the village has got necessary information in order to ensure discussions and participation during the sanitation exhibition mela. The villagers took active participation in organizing this sanitation exhibition and able to internalize the value of correct sanitation measures they need to adopt in their day to day life for better health at personal level, family level and community level. Children as health ambassadors of their village took active participation in understanding the demonstration sessions of personal hygiene practices they need to take care.
Functioning of Dispensary as Mobile Health Promotion Resource Unit
SEVAI Day care centre for old age people in Thirunagari takes care of many older people as this day care centre is safe shelter where they live their lives with dignity and interact with their peers. Old people have limited regenerative abilities and are more prone to disease, syndromes, and sickness than other adults.A rising trend is being noticed among the rural elderly also, who move out of their homes and into habitats especially catering to their needs, in order to spend their later years in comfort. SEVAI has started to address this need for age-friendly habitats, and care facilities for the elderly. It has been working towards helping transform old age homes into composite shelters which go beyond providing simply a roof and meeting the basic needs of the elderly. The term ‘Disability’ and ‘Elderly’ go hand in hand. Apart from the conditions such as heart diseases, cerebra-vascular diseases, and diabetes, which severely affect the health of an older person, factors such as visual, hearing, arthritis & memory impairment and urinary problems also results in serious disablement among elderly. As a person gets older, the frequency of the conditions causing disability likes balancing problem.