This was a mixed method study including both qualitative and quantitative interview, which was carried out during January and February 2015. It was done in the service area of Urban Health Centre of a tertiary level teaching hospital in urban Puducherry, which caters a population of 9791 belonging to Kuruchikuppam, Vazhakulam, Vaithikuppam and Chinnayapuram. Fishing and working daily base is the major occupation of these people.

Elderly beneficiaries belonging to service areas of JIUHC and received pension at least once in the last six months were included as study participants for the first phase of the study.

Based on satisfaction rates of 46% among beneficiaries [3] and absolute precision of 7%, sample size was estimated to be 195. Calculations were done using Openepi software, based on 95% confidence levels. Allowing for 5% non-response, final sample size was estimated to be 205. The list of beneficiaries of old age pension was collected from the Department of Women and Child Development, Puducherry, India. Proportionate stratified sampling method was adopted to know the number of samples to be taken from each ward. Simple random sampling based on system generated random numbers of 205 elderly from all four areas was done proportionate to the population of elderly beneficiaries in each ward. The number of subjects selected from each ward (Total population) is as follows: Kuruchikuppam (354)-53, Vazhakulam (628)-93, Vaithikuppam (46)-7 and Chinnayapuram (350)-52. The houses of the participants were located from the address list and in case of any difficulty the corresponding anganwadi worker was contacted.

The proposal was approved by the scientific committee and Institute Ethics Committee. A structured questionnaire was developed to study the beneficiary satisfaction and utilization pattern of the monetary benefit received under the scheme. The variables included were socio-demographic details, details of pension received (duration, amount), beneficiary satisfaction (regularity, timeliness, mechanism, amount, autonomy) and utilization of pension amount. The questionnaire was translated into the local language and back translated to English. A pilot study was conducted among 10 elderly subjects in a different area and the questionnaire was pretested. After obtaining written informed consent the questionnaire was administered to the subjects.

In depth, interviews were conducted as part of the qualitative component to explore the perception of the stakeholders regarding delivery of the old age pension. Purposive sampling was adopted to choose the respondents and the key informants for the individual interviews. Informed consent was obtained from the participants and confidentiality of the data was assured. Interview was conducted based on the guide and responses were noted by the note taker. Appropriate probing was used wherever required. The duration of interview was limited to one hour. A total of 12 in depth interviews were conducted [among beneficiaries (4), family members (4) and Anganwadi workers (4)]. Interview guide was prepared to explore the stakeholders perception and details about pension approval, pension disbursement mechanism and benefits of the pension scheme. The interview guide was pretested in a few participants and probes were built in to enable the flow of discussion. The interviews were transcribed and translated in English. The compiled data was coded and content analysis was done. This enabled to generate themes of analysis which were further supplemented with quotes from the interviews. The analysed data was summarized into qualitative reports.

Data were expressed as proportions mean and standard deviation. Data entry was done through Epidata. Association of socio-demographic variables with satisfaction levels were done by using Chi-square or Fishers-exact test. Analysis was carried out at 95% level of significance and p-value <0.05 was considered as significant. SPSS version 20 was used for statistical analysis.

The mean age of the study participants was 71 ±7.6 years. Around 49% of the study participants were aged between 65 to 74 years. Around 70% of study subjects were females and 62% were illiterate. Around 4% of the study participants were employed, 74.6% of the subjects belonged to class IV of Prasad’s scale, and 22.4% belonged to class III and V [Table/Fig-1]. Around 64% of study participants were living with their sons or daughters while 22% live with their spouse; 14% of the participants were living alone. Around 23% of participants were suffering from diabetes and 33% had hypertension. One fourth of the study population had at least one addiction behavior like tobacco-smoking, tobacco-chewing and alcohol.

Eligible beneficiaries more than 55 years of age received an amount of Rs 1100 as old age pension. Now the amount has been revised and all beneficiary were availing Rs.1500 as their monitory benefit [6]. Almost 42% subjects were receiving pension for the past 5-10 years, while 27% received for the past five years.

Around 80% of participants availed pension from banks and the rest from Anganwadis. Around 55% received their pension during second week of every month, while 15% within the third week. The respondents felt that old people face difficulty in availing the pension from the bank, especially for those who are illiterate and living alone. Travelling to bank, which is far from their residential area, standing in a queue for a long time, filling challans, etc. were found to be the major difficulties faced by the beneficiaries.

Around 20% beneficiaries continue to receive pension from the Anganwadis. All the respondents said that the pension was regularly distributed before the second week of each month. There were no incentives or bribes involved in the process or any other difficulties in receiving the entire amount.

Majority of the people responded that Anganwadi was their preferred mode of receiving pension (80%). One-third of the subjects felt that they would approach Anganwadi workers in case of grievances (29.8%). Around 39% responded that Anganwadi workers were the source of information regarding the pension scheme, while two thirds came to know from their neighbors.

Half of the subjects (49.3%) utilized the pension money for health needs (like medicines, visiting doctor); while one-third used it for travel; around 14% used it for their daily activities and social needs like visiting relatives attending social functions and ceremonies. Half of the subjects (54.6%) felt that they possess financial autonomy in utilization of pension amount. Around 85% subjects (n=175) told that they spend the entire pension amount received on their own. However, the remaining 15% gave some economic support towards their family; among them, the money was handled by their son (13%) or daughter and spouse (1.5%).

Majority of participants (96%) were satisfied with the regularity in the distribution of pension and overall performance of the pension scheme (98%). Half of the beneficiaries (n=107, 52%) expressed dissatisfaction with the amount of pension received. Though satisfaction rates were higher in subjects aged <75 years and higher education status, this was not statistically significant [Table/Fig-2].

Regarding mechanism of delivery of old age pension, 93% beneficiaries availing pension from Anganwadi were satisfied compared to 58% availing from banks and this association was statistically significant (Chi-square 18.14, df=1, p<0.001) [Table/Fig-3].

Majority of the subjects (88%) opined that they feel independent to take decisions of their daily living and there is improvement in their social status. Close to three-fourth felt that pension scheme has provided them economic empowerment. Nearly three-fifth (60%) of the subjects felt that old age pension has given them a feeling of self-esteem and more than half (55%) of them felt a renewed confidence [Table/Fig-4].

[Table/Fig-4]:

Perception regarding social and psychological benefits of receiving old age pension among the study participants (n=205).

* Figures are expressed in %

One family member mentioned “Pension gives economic support for the elderly to buy medicine or food.” One elderly male beneficiary told “I feel respectable about myself and feel that the Government cares for old people like me. The money gives me financial and moral support and helps me to be independent.”

This study was done in an urban area of Pondicherry to get an insight into the beneficiary satisfaction, utilization pattern and perception of stakeholders regarding IGNOAPS. In our study, the mean age of the study participants was 71 years. The socio-demographic details were comparable to the general statistics in the region and also with an earlier study done in Puducherry [4]. Around 64% subjects were residing with their sons or daughters showing a high dependency of elderly on other family members. The high prevalence of chronic health conditions like diabetes and hypertension show the burden of diseases among elderly and the need for health care and social support.

In this study, 27.3% participants were receiving pension for the past 1-5 years. It was observed in the qualitative interviews that compared to earlier days, the process for pension application had been made more rigorous. Simplification of the pension application and approval process with further facilitation at the Tehsildar office would help the beneficiaries to avail the pension benefits with more ease. The number of documents being asked for verification and proof can also be reduced. The time period for the pension application and approval seems to be a long and tedious process. However, once approved there is no major delay in the sanction of pension or in the regularity of pension disbursement as stated by the respondents.

Majority of the beneficiaries (80%) were availing pension from the bank while remaining was receiving from the Anganwadi. Regarding time of receiving pension 57.1% responded that they received their pension in the second week. Earlier studies done in Puducherry shows that people availed pension money at home (money order) or Anganwadis. After the money order payment was stopped the disbursement of pension took place in Anganwadi and in bank [4].

In this study, 98% of beneficiaries were satisfied with the overall performance of the pension scheme. This is comparable with earlier studies which showed a positive impact on their livelihood [4]. Similar findings were observed in studies and evaluation reports on old age pension from other states [3,7,8].

Among the study subjects, 65% were satisfied regarding the mechanism of delivery of old age pension. The association between source of receiving pension (Anganwadis) and satisfaction level regarding mechanism of delivery (p<0.001) was statistically significant. With the introduction of bank-based delivery of pension, respondents felt the process to be more cumbersome to travel to the bank and to wait in a queue. This transition to banking system may be initially difficult for elderly as this may be their first opportunity at banks, but in the long run this may be helpful, as perceived by a few beneficiaries. Pension disbursement through banks and branches closer to their homes will help the elderly in reducing their burden of travelling long distance to avail their pension. Additional facilities like use of smart card or ATM card based money withdrawal can be explored so that these services are brought closer to their homes. However, the logistics regarding this measure needs to be piloted and tested for feasibility.

Majority of the people responded that Anganwadi was their preferred mode of receiving pension, and as mentioned in the In-depth interviews, few beneficiaries found it to be more convenient and less cumbersome. Pension delivery mechanism through banks has reduced the burden on the Anganwadi workers who are primarily involved in the functioning of Integrated Child Development Services (ICDS). However, facilitation of OAP and other Government schemes by the Anganwadi worker is a huge support for the community, and may be continued in future.

Half of the respondents (52%) were not satisfied with the amount received. However, Puducherry is one of the regions which provides high pension rate, with a state share of Rs 900 compared to other states with a state share of Rs 200 to Rs 500.

In this study, it was observed that majority of the study participants spent the entire pension amount received for their own use (health needs, travel, daily activities and social needs) while the remaining gave some economic support to their family. Half of them felt that they possess financial autonomy in planning their expenditure. Majority felt that receiving pension had given them economic empowerment, a sense of self-esteem and renewed confidence in life. These findings were corroborated through the qualitative component of the study. Further research can be done on utilization and satisfaction among rural elderly and its impact on the quality of life.

This was a community based mixed methods study where the qualitative interviews enable in-depth understanding of the topic in hand. Involvement of other stakeholders like family members and anganwadi workers gives additional perspectives regarding the pension scheme. Stratified random sampling of respondents and coverage of sample size enables representativeness in the community.

However, there are few limitations. As this study evaluates beneficiaries from urban areas, implications of old age pension in rural areas could not be captured. Utilization pattern of the pension amount could not be captured distinctly as there was considerable overlap in the money spent. Interviews with the Programme officers of Department of Women and Child Development could not be carried out as proposed and so their perspectives could not be studied.

Financial assistance to the elderly empowers them and improves their social status, independence, self-esteem and overall quality of life. The satisfaction of close to half of the elderly population in this study with the pension amount questions the need to raise the pension amount. Further research is required to understand the implications in other domains like health needs. With increasing proportion of elderly in Indian population, it is important to study the effectiveness of such schemes so that corrective measures can be taken to facilitate its access to the disadvantaged section of the society.