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Long-term care systems for sub-Saharan Africa*

The international debate on the challenges of integrated long-term care (LTC) provision for older persons is not only an agenda point for the ageing developed populations of the world but also an acute issue in the developing world with sub-Saharan Africa (SSA) as the youngest world region not an exception. Rates of functional impairment in SSA’s older populations are on a par with, or even exceed those in other parts of the globe, suggesting an already significant need for LTC in the region (WHO, 2015).  With the rise in non-communicable diseases in SSA this need is expected to escalate in coming decades. Especially since the absolute numbers of older adults (60 years and above) is expected to increase more than three-fold from 46.5 million today to an estimated 161 million by 2050. This implies 70 million more than in Northern and Western Europe combined, and 40 million more than in North America (UNPD, 2015).

It is against this background that the lack of comprehensive formal care mechanisms in SSA is glaring. At present, and in line with customary African values, responsibility for LTC provision in SSA rests overwhelmingly with families.  However, the limited body of evidence available from SSA suggests that the extant LTC arrangements are characterized by major deficits, and by detrimental impacts on those receiving and providing care, and on societies, broadly:

  • Considerable gaps in the availability of family care in both rural and urban settings and exacerbated within contexts of HIV/AIDS
  • Severely compromised quality of family care, particularly within contexts of poverty, impacting the well-being, dignity and autonomy of older care-recipients
  • Emotional and physical stress and lost opportunities for education or economic engagement among the mostly female family caregivers
  • Unregulated, ‘organic’ expansion of formal LTC services along two tiers: (1) competitive private-for-profit home-based nursing care responding to demand among affluent groups; and (2) typically under-resourced, charitable institutions addressing care needs among the poor. 
  • Entrenched inequities in access to quality care

The present situation demands of SSA clear principles and directions that can guide the development of appropriate LTC policies and practices to meet the growing demand for such care within its societies. To this end the 2nd Africa Region Conference of Gerontology and Geriatrics under the theme ‘Long term care systems for sub-Saharan Africa: setting agendas. A regional research-policy-practice dialogue’ on 6-8 December 2016 in Nairobi, Kenya will provide a platform to offer Africa appropriate perspectives on questions like:

  • What should be the purpose and goals of long term care systems in SSA – and what rights and equity considerations should they embrace? 
  • What would ‘quality’ LTC look like in SSA – what ‘minimum standards’ should be met and what services across health and social sectors would this entail?
  • What modes of, and interfaces between, ‘formal’ and ‘family’ LTC provision currently operate in SSA, and in what contexts?
  • How are families constituted and how do they function in contemporary SSA contexts?  What can and should be their relative role in meeting rising LTC needs in the region – and how can families be supported in providing such care?
  • What should be the relative role of formal LTC provision and what modes of formal care are appropriate for SSA?
  • What are likely broader development impacts of (not) expanding formal LTC – specifically for labour markets, productivity and the social contract within SSA’s societies?
  • How could an explicit expansion of formal care be reconciled with customary African values of family solidarity and obligation?
  • What emerging formal LTC practice exists – in SSA or other relevant low and middle-income contexts, that may serve as a model for the region?
  • Which role players ought to be responsible for, and steer the development of desired LTC systems in SSA?
  • What further evidence is needed as a priority to guide the process of developing SSA’s LTC systems?

Join us to think towards the generation of LTC systems in SSA to facilitate a good but affordable old age.

*This post draws on a concept note prepared for the 2nd Africa Region Conference of Gerontology and Geriatrics.

About the Author

Dr. Jaco Hoffman is a Senior Research Fellow at the Oxford Institute of Population Ageing and co-ordinates the African Research Network on Ageing (AFRAN) and the Society and Environment Research Cluster.

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