October 27, 2022

What a helpline for India’s elderly can teach nonprofits about scale

Successfully developing and expanding a programme in India can be challenging. Here's what the scaling up of an elderly assistance helpline can teach nonprofits about the same.

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Elder Line is a national helpline that was launched in October 2021 by the government of India to offer assistance to the elderly experiencing legal, financial, health, or social issues. The helpline, which is a toll-free number (14567), was piloted in Hyderabad by the Telangana state government and Tata Trusts between March 2019 and September 2020, and was subsequently scaled up to cover all states and union territories.

One important measure of success in the social impact space is when a pilot designed, conceptualised, and executed by a civil society organisation is adopted by the government and taken to scale. There have been examples in the past of such pilots—the 108 Emergency Response Service, self-help groups, and ASHA workers. The Elder Line service is the most recent example of this ‘adoption and scale up by government’ model. And though the obstacles to any endeavour to scale may differ based on the programme being scaled and the team in charge of it, we believe there are learnings from this initiative that might be valuable to the sector.

1. Make the case

Convincing the government of the need for collaboration can often be the primary hurdle for organisations looking to scale their programme. We had to field questions regarding the need for the service and how it was different from any other call centre. Additionally, we had to establish the larger purpose, beyond providing assistance to callers, that the helpline would serve. Highlighting how we had a field team in place to respond to issues on the ground and work with the communities across the state helped convince government officials about the robustness of the model.

Additionally, the calls themselves can be viewed as microcosms of the larger issues that most commonly plague the elderly. They help us identify the areas in need of intervention, and these areas can be worked upon with the help of the government, development sector partners, or the community. For example, during the Ratha Yatra in the month of July 2022, the Odisha state government popularised the Elder Line number and its services. The Odisha Connect Centre, Elder Line’s call centre in the state, saw a surge in call volumes pertaining to the social security pension issued by the state government of Odisha. As per the state government’s policy, an eligible senior citizen should get their social security pension within a fixed duration of submitting an online application. However, those who called in mentioned that they had applied for the pension—some as long as three years ago—but the portal showed that their application was still being processed. The team then began to investigate where these applications were getting stuck, and realised that the first-level approval for the pension comes from the panchayat executive officer, who often did not open the portal to conduct the required verification as it was not one of their core responsibilities. The team identified a range of issues and presented some recommendations to the pension-disbursing authority. The suggested changes included a monitoring mechanism to make the stakeholders accountable and increased transparency to make the process more suitable to senior citizens in the state.

The expansion of the project was also aided substantially by the COVID-19 pandemic. In our initial meetings with the Ministry of Social Justice in 2019, we were told that it was too soon for them to decide to come on board to scale it up. However, the onset of the pandemic and the simultaneous successful piloting of Elder Line in Telangana enabled the government to understand how critical such a service could be for senior citizens all over the country. Soon after, we were working with the ministry to create the infrastructure for the service across all states and union territories.

2. Use public sector infrastructure

Managing to convince the government of the importance of the helpline and getting them on board to facilitate its scaling resulted in the emergence of new challenges. We were instructed to utilise existing government infrastructure to execute our vision. This included utilising the cloud server of the National Informatics Centre (NIC) rather than any private entity, as we would be dealing with sensitive data pertaining to the senior citizens of the country. They also mandated that we use BSNL for all of Elder Line’s telephone/internet requirements. These mandates resulted in some delays in the nationwide launch of the helpline, as institutions such as the NIC and BSNL had several other priorities. Additionally, specific protocols had to be followed to use the cloud of the NIC since the security of the server was of prime importance.

To elaborate on the same, let’s consider the role of private cloud service providers. They typically appoint an account manager, who ensures that the requirements of clients are met and performs troubleshooting tasks if necessary. However, at the NIC, different people are responsible for different aspects of the cloud service due to security reasons. Therefore, reaching out to the NIC officials and receiving approvals was a time-consuming process for us as an external entity.

Another instance of delay was when we were trying to ensure uninterrupted service. The helpline is connected with backups for all the critical services such as electricity, telephone, and internet connections. The primary telephone connection is from BSNL, but there is also a secondary connection from another service provider in place, and calls are automatically routed through it in case the primary connection is down. It took us a while to find out whether it would be possible for us to establish such a system and whom we could approach to enable it. Once we did, the same had to be repeated to every state/union territory, and explaining the process to the staff at each centre took a great amount of time and effort. 

Although we faced challenges and delays initially, using public sector infrastructure worked out in our favour in the long run as union territories such as Dadra and Nagar Haveli, Daman and Diu, and Ladakh have no service providers for internet and telephone connectivity other than BSNL. Additionally, the strict protocols that were followed to ensure the security of the server have protected it against any breaches.

Other nonprofits seeking to scale their programmes through the government must therefore factor in the mechanics of working with existing public sector infrastructure. Even though this can be time-consuming, it is beneficial in the long run.

3. Allow for localisation

While the uniformity offered by scale is alluring, the challenges to the implementation of an intervention and those experienced by the group it targets can often differ across geographies. Hence, Elder Line took the conscious decision of having a decentralised approach, where each state has its own implementing partner, instead of a single, centralised implementing agency. So while the helpline number, broad guidelines for processes, and ethos are common across states, each state ensures that local differences are taken into account while serving the elderly. Today, our challenges concern how we can standardise the service across the country while maintaining our connection with state assets. Elder Line is still fine-tuning its processes based on the issues that emerge from state to state.

When a programme achieves scale, it may encounter challenges that were never envisaged. Once Elder Line was implemented in Hyderabad, we rescued almost 200 unhoused elderly and reunited 70 of them with family members within the state itself. However, upon scaling up, we encountered many cases where the elderly persons were rescued in one state but belonged to another state. After handling a few such cases, we established a comprehensive process for handling the interstate rescue and reunion of the unhoused elderly.  

Similarly, any organisation looking to scale their programme must account for the fact that the same approach may not work for all regions. However, strengthening processes while simultaneously empowering state partners to apply a localised approach can be beneficial.

Two elderly people walking on the beach
Programme implementers should spend time learning about the preferences of their target groups. | Picture courtesy: Nagesh Jayaraman / CC BY

4. Adopt a hands-on approach

It is essential for core personnel to be involved in both the design and execution of the interventions. You have to be ready to spend time working on operations at a day-to-day level. Keep in mind that doing so will help when you decide to scale, as you will be able to communicate better with your programme managers or field teams. A hands-on approach also enables the team to understand what the barriers to implementation could be, and offer structured guidance to those who will take the work forward once the programme is scaled.

5. Understand your target

While designing Elder Line, we comprehensively studied existing helplines in the country, especially the 108 Emergency Response Service and 1098 Childline—a helpline for children in distress. Based on our learnings from examining these helplines, we worked towards ensuring that the helpline was designed with due consideration for the preferences of the elderly. Programme implementers should spend time learning about the preferences of their target groups, since this is key to adoption, regular usage, and growth of the service.

First, the helpline’s number is 14567 across the country. The number is a short code that does not require the addition of an STD code and is easy for a senior citizen to remember. All the calls originating from a particular state/union territory are directed to the connect centre within the same state/union territory, and this is determined based on the cell tower from which the call originates. Further, calling the helpline connects the caller directly to their local connect centre officer rather than an interactive voice response (IVR) system. This was done with the understanding that the elderly might find an IVR system to be overly tedious and confusing to navigate. Lastly, the connect centre staff are trained to be compassionate and patient with the callers and build the conversation with them in the local language(s). Unlike a regular call centre, there is no fixed upper time limit to close a call.

6. Design for scale

The successful transition of Elder Line to the government and its subsequent expansion can be attributed to the fact that it was conceptualised and constructed with the intention to scale. While other helplines for the elderly may rely on a very small team with one person often handling both the calls and the on-ground resolution of issues, Elder Line has a separate connect centre and field teams, who are trained to carry out their respective functions effectively.

Both sets of teams underwent seven days of domain-related training, which helped them understand why the helpline is required, what the issues of the elderly are, the various schemes and policies that cater to the elderly, the possible questions they may ask, and how they can empathise with the elderly when speaking to them.

Additionally, we used a uniform central software that the teams from all states connected to. The software contains separate ‘rooms’ for each state, which ensures that a particular state’s team can only access the data related to that state. The aim was to set up the model in a manner that allows it to be scalable and repeatable across the country, thereby making it easy for the government to take over and run it as is.  

7. Work with government machinery right from the start

In addition to ensuring that the programme was designed for scale, we approached the government early into the programme’s conceptualisation in order to collaborate with them. Receiving the backing of the government early on helped us implement our plan in a more effective manner than if we were to go at it alone. Our operations in the field are proceeding smoothly in various states because we have the support of relevant state departments. This support makes local authorities such as the police more responsive to the requests of our team and those we seek to aid. The team was also able to draw on the help of institutions such as government hospitals/dispensaries, district legal service authorities and legal aid clinics, old-age homes, and shelter homes, as well as day-care centres operated by the government and civil society organisations. 

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Know more

  • Learn more about government policies and plans for senior citizens in India.
  • Read this article on strategies for nonprofits looking to work with the government.
  • Learn about elder abuse and how we might be doing the same with the elderly around us.

Do more

  • Report cases of elder abuse or unhoused elderly on Elder Line’s toll-free number (14567).
  • If you know any senior citizen who is feeling lonely, talk to them or connect them to Elder Line’s toll-free number (14567).

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ABOUT THE AUTHORS
2055
Tapan Das-Image
Tapan Das

Tapan Das is a development professional with 24 years of experience across various sectors. He has worked on large-scale programmes from scratch—scaling them to the national level and managing large teams while working with diverse organisations as well as the government. In his recent work with Tata Trusts (and now NISD), he led Elder Line in scaling from one city to 31 states/union territories, benefitting over 1,50,000 senior citizens in less than two years.

2056
Saraswathi Padmanabhan-Image
Saraswathi Padmanabhan

Saraswathi Padmanabhan is a professional with more than 25 years of experience across corporate, government, and development sectors.

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