10:45 - 12:15
Care for older persons in resource poor settings – global perspectives on challenges and opportunities
Moderation: T. Kafczyk, Bielefeld; K. Hämel, Bielefeld; J. Focke, Osnabrück
Care and support for older people in resource poor settings is a topic of increasing importance in Gerontology. The accelerating demographic change in low- and middle-income countries poses new challenges to which health and social care system have so far been slow to respond. In Europe and other high-income regions, an increasing number of older people particularly in socio-economically disadvantaged communities are at high risk to be excluded by care systems struggling to provide needs-based access for older people. This is especially true in the current Corona pandemic situation. The question arises, how health and social care systems – in resource poor settings – should and can be shaped to enable comprehensive and needs-based care for older people.
In this symposium, we analyse and discuss challenges in different resource poor settings and emerging opportunities for the design of health and social care systems. In doing so, our intention is to explore global perspectives on ageing – beyond national borders – and to discuss where similarities and differences are evident. The symposium is based on a cooperation between the civil society organisation HelpAge Germany and the board of the section IV Social Gerontology and Working with Older People of the German Society of Gerontology and Geriatrics (DGGG).
Social exclusion can be understood simply as the disjunction of (older) individuals and groups from the resources and processes of mainstream societies. As a multidimensional concept, it grasps inequalities in different areas of life, and how they typically develop alongside disadvantages over a lifetime. An EU-financed network (ROSEnet CA15122 COST ACTION, 2016-2020) has collected and reflected empirical data as well as conceptual and theoretical frameworks to understand the phenomena of exclusion in old age. Five key areas were identified and elaborated: economic exclusion, exclusion from social relations, exclusion from services, community and spatial exclusion, civic exclusion. Mechanisms and processes were described to interact and to enhance each other within and between these areas.
For the frame of this workshop, exclusion from services will be in the focus of this presentation. Interacting mechanisms with other areas of exclusion will be highlighted.
Social protection has experienced a dramatic surge in low- and middle-income countries with social pensions often being one of the first measures put in place. The question remains however whether the increase in coverage is sufficient and keeps pace with the upscaling of other social protection programmes, whether the elderly stand to adequately benefit from current social protection measures and whether the design of schemes is sufficiently elderly-friendly. This contribution will discuss these critical questions and map out policy implications in social protection for the elderly.
Like in most East African countries, the burden of disease in Tanzania is shifting towards non-communicable diseases (NCDs) largely due to population ageing. In 2018, already over three million people in Tanzania were 60 and older, most of them live in rural areas, and the number is growing rapidly. Older people are the most affected age group of NCDs, over 60% of deaths in this age group in Tanzania can be attributed to NCDs.
However, the health system has been struggling to cope with the rising NCD care needs among older persons - in urban but especially in rural areas - what has several reasons that are discussed. The Tanzanian government started to recognize the need for improvements in health care services for older people. Together with civil society actors – particularly the non-governmental organisation HelpAge – health sector reforms were initiated to improve NCD care for older people. HelpAge has supported the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) in developing a National Strategy for the Provision of Quality Health Services for Older People that is in its final development stage.
This contribution discusses theoretical policy developments and their practical implications for NCD care in Tanzania emphasizing older people, reflects on the role of HelpAge in the policy making process, and ultimately analyses achievements and gaps in the public and private health care system to address the increasing NCD burden in older persons.
Mental healthcare for older persons is increasingly discussed in low- and middle-income countries (LMICs); especially the importance of primary mental healthcare is highlighted in these discourses. Where this becomes particular evident is India, that has one of the largest and fastest growing numbers of older persons globally. In recent years, the Indian national government has increased its efforts to frame and develop the primary mental healthcare system in India, in legislations, strategies and programmes. In this contribution, we are taking a closer at look at these developments and explore public policy strategies for and approaches to the mental health of older persons, focusing on the primary healthcare (PHC) level and the role of the family. Unique to our approach is, that we understand primary mental healthcare for older persons as a cross-cutting issue spanning old age, general health, and mental healthcare policies. A document analysis of 39 key public national policy documents (2007-2019) was conducted. We are showing that comprehensive community-based primary mental healthcare – focusing on vulnerable population groups including older persons – has been strengthened significantly since 2007 in India. The promulgated approaches and strategies build on traditional community-based approaches to mental healthcare in India. They focus on (a) integrating community health workers into primary mental healthcare, (b) empowering the community to participate in healthcare planning, implementation, and monitoring, (c) supporting the family through a family-led approach to mental healthcare, and (d) integrating traditional Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy (AYUSH) services into primary mental healthcare. While all policy fields address mental PHC, they do so in different ways, and approaches and strategies that promote an integrated perspective across policy fields are lacking. We are discussing further research and practice directions in light of social developments such as eroding family norms and the poor state of the public health system in India, with the benefits older people would experience taking center stage.
Diskutant D. Köster, Wetter (Ruhr)