Policies And Challenges Around Ageing in Sub-Saharan Africa
By Kaushal Shah and Saloni Chandaria, Africa Health Business
People in Africa are living longer than ever before. The region continues to face a burden of persistent infectious diseases, while the prevalence of risk factors for chronic diseases is also on the increase. For elderly women, age and gender discrimination is a major concern that often leads to disempowerment and can result in poor health outcomes, victimisation and even death.
The sub-Saharan Africa (SSA) region is seeing a change in demographics with more people reaching old age. In 2020, the region had over 34mn people over the age of 65, women accounting for 19mn of the total. , Projections show that by 2050 the ageing population will increase twice as much suggesting that the region will have the fastest growth rate of older people compared to any other region of the world in this period.
Non- communicable diseases associated with aging such as heart disease, cancer and diabetes are on the rise, however, the focus on diseases such as HIV/AIDS means that preventive care is usually targeted at younger women. Older women are often given little information on healthy ageing and must compete for services with all other age groups. Chronic poverty is a major risk factor for the well-being of older women.
To address the issues around the ageing populations as well as ensure that this population is looked after, members of the United Nations and the African Union including several countries in SSA signed two international frameworks on ageing.
• The first framework was the Madrid International Plan of Action on Ageing (MIPAA) adopted at the United Nations second world assembly in 2002. The MIPAA plan consists of a comprehensive policymaking framework for governments, non-governmental organisations (NGOs) and other stakeholders to ensure that all their older citizens are able to age with security and dignity and continue to participate as citizens with full rights and receive appropriate care when required.
• In the same year, a second framework was also developed called the Africa Union (AU) Policy Framework and Plan of Action on Ageing. The AU plan was based on MIPAA and ensured that African member states develop and implement policies on ageing as part of their national development and poverty reduction policies.
Both frameworks emphasise three main strategies which include multidimensional health promotion to prevent disease and disability among the older generation, implementation of policies to ensure unrestricted access to adequate rehabilitation and curative care for the older people who already suffer from chronic diseases and disability and lastly, adequate training of the healthcare workforce for the care of older people.
To be able achieve the above, in 2015 the AU revised their Africa Health Strategy 2007-2015 and developed one for the period 2016-2030. In the strategy the plan of action for the ageing population was to reduce morbidity and end preventable mortality from non-communicable diseases (NCDs) and other health conditions by prioritizing programs to address risk factors and premature mortality from NCDs and other diseases. In addition, promoting social protection mechanisms and ensuring access to quality-assured and affordable essential health services including medicines, vaccines, health commodities and technologies.
A Challenging Environment
Despite having the frameworks as guidance, only a few countries in SSA have formulated or implemented policies for the ageing population whilst the other countries have draft policies in place. However, even with formulated or implementing policies in place there is still a challenge for countries and their governments to really drive and implement such policies. Taking it one step further, formulating policies that separates genders, is an even greater challenge.
A lack of resources and funding, lack of political will, lack of co-ordination between government agencies and most importantly lack of comprehensive data available for monitoring and evaluation on the elderly and their concerns – all create challenges.4 As countries try to reach the Sustainable Development Goals (SDGs) set out in 2015 and aim to reach good health and well-being for all by scaling up access to Universal Health Coverage (UHC), the majority of the countries in SSA still do not have policies in place to offer access to free healthcare for the elderly nor are they covered by health insurance. This lack of and inadequate access to health care and health insurance will thus inevitably contribute to increased deaths among the older population.
In addition, despite some countries having implemented policies in place only a few of have strategic plans in place for reducing disease burden such as NCDs by integrating them into primary healthcare. NCDs as we know are a major cause of death in the elderly and despite the plans being made by countries, they are still finding it hard to implement these plans and this again could be due to lack of resources and funding available to drive implementation. Nonetheless, credit should be given to countries for striving towards integrating NCDs into primary healthcare despite the challenges they face.
Another key area where policies and plans are lacking is around the training of health care workers and professionals with regards to geriatric care as well as providing guidance and support for those that become caregivers. With poor healthcare and social protection systems governments need to ensure that policies are in place for training healthcare professionals around geriatric care as well help those that bear the additional burden on looking after the elderly by providing socio-economic support as these caregivers are the future of a countries economic growth.
To overcome some of the challenges, member states, government policy makers, international development partners, civil society and the private sector must use a collaborative approach to ensure that policies are harmonised and that countries are implementing strategies and plans which are responsive to the countries priorities.5 Additionally, monitoring, evaluation and data collection around the ageing population must be increased in all countries in SSA as this will give policy makers an indication on how to prioritize health care needs of the elderly and how to include them in their development plans. Civil society and the private sector can also help by providing new innovations and technologies as well as financial resources that can help governments and policy makers ensure that goals are targets are met in policies regarding the older population.5 Policy makers must also ensure they take responsibility for designing polices which ensure that the most vulnerable can live their final years in dignity and with the respect of their carers.
A growing Elderly Female Population
The SSA region must strive to look after its ageing population as the elderly people are not only seen as a valuable resource but who have vast amount of knowledge and wisdom to share. If the continent cannot look after them, the question lies as to who will. Africa may be the youngest continent on earth, but its older population is growing, too, and it is growing fast.
For centuries African women have been the mainstay of families and communities, often in the face of extreme adversity. Despite the level of their social status and their large share of the burden of disease and death, they continue to be peacemakers, life-givers, entrepreneurs and providers of care for children – the builders of Africa’s future. Fortunately, because many NCDs can be prevented through changes in lifestyle, governments have various tools at their disposal to fight this epidemic. Advocacy and well thought out policy reform, backed up by effective legislation can largely contribute to positive change. However, women should be empowered through health education in their early years so that they at least have the information required to lead a healthy life.
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