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Towards an Effective Care Economy for the Middle East and North Africa (MENA) Region

2022 witnessed the fourth MIPPA review. The review was accompanied by several positive developments addressing the ageing transition in the Middle East and North Africa (MENA) region. The latter consisted of conferences and workshops focusing on the ageing transition, the need for sustainable pension systems, and reviews of social protection laws. Notably, the UN-ESCWA conference and the Population Development Report focused on older adults and the need for new markets to develop a Long Term Care (LTC) economy. The latter is the focus of this blog post.

An LTC economy for the MENA region would create new job opportunities, such as for care workers, nurses, social workers, occupational therapists, and ancillary staff, such as cleaners, drivers, managers, IT specialists, and administrative personnel. These jobs require different qualifications, skill sets, and training levels, and have a range of wage structures. Although many of these jobs could benefit from innovation, they are difficult to fully automate through advanced robotics or autonomous systems. The likelihood, therefore, is that these jobs will continue to require human capital. LTC markets are a great source of job creation. For example, the size of the adult social care workforce in England is approximately 1.8 million jobs spanning approximately 39 thousand organisations. In addition, at least 56 thousand individuals receive direct payment from the state. LTC markets are also female-dominated sectors. The International Labour Organisation (ILO) estimates the global care workforce consists of 249 million women and 132 million men, which constitutes around 11.5% of worldwide employment. These figures represent a significant proportion of the global employment market, with up to 19.3% of female jobs and 6.6% of male employment. The ILO estimates that by 2030, increasing investments in the care economy will create an additional 117 million new jobs. The exact number of these jobs across countries and workforce structures will vary depending on particular cultural contexts, demand, government spending, and regulation.

Care markets are needed in the MENA region. The rapid transition towards an ageing population is accompanied by changes brought about by internal migration, social structure, and other factors that have resulted in reductions in informal care. Additionally, informal caregiving negatively impacts caregivers’ (who are primarily female) health, and employment prospects. These circumstances make the current situation unsustainable. Furthermore, although home-based care is the preferred approach for providing support to older adults, there are other complex cases that would benefit from residential arrangements and/or nursing homes.

For most countries in the region, these care service markets currently do not exist or are fragmented. If LTC markets are to be effective and sustainable, they should be designed for older adults’ needs and preferences while remaining cognisant of ways to reduce the significant burden experienced by their families. Such a market design requires collecting different types of data. Although the region acknowledges the need for data collection, a shift to full-scale care markets will require additional data for service planning and delivery. Additionally, administrative data will be needed for running and monitoring these services.

It should be noted that reviewing and introducing social protection laws and policies will also play a role in deciding which data is required. However, there is no need to wait for the complete development of these policies and regulations, nor is there a requirement for the full design of data to be available before data collection can begin. An incremental approach would be advantageous, starting with the essential information needed to create a minimum data set. Subsequently, this data set can expand its coverage when necessary. Exemplary in this regard is the Adult Social Care Workforce Data Set (ASC-WDS) in England (formerly the National Minimum Data Set (NMDS)). Here key administrative data was collected and its coverage was subsequently expanded. The creation of administrative data can be time-consuming and costly, however. Perhaps the MENA region can accelerate this process by learning from the UK. For example, examining the ASC-WDS design may aid an understanding of what data collection methods are needed to monitor adult care providers. The ASC-WDS is publicly available, and its collections range from small, to local authority, providers of the adult social care market in England.

The MENA region countries may also benefit from unifying their efforts to establish adult care markets. However, due to differences in some of the region’s countries, generalisations will be difficult. For example, countries range from high-income nations with significant investment in healthcare systems, to those without functional governments due to conflict. There have been previous attempts at classification, separating the region's countries into three groups based on health expenditure per capita and life expectancy. The 6 Gulf Cooperative Council (GCC) countries and Lebanon have the highest healthcare expenditure and average life expectancy (although the latter was an outlier regarding health expenditure). The second group, with lower health expenditure and life expectancy, consists of Algeria, Egypt, Jordan, Iraq, Libya, Morocco, the Occupied Palestinian Territory, Syria, and Tunisia. The third group, with considerably less life expectancy and lower health expenditure, consists of Djibouti, Mauritania, Somalia, Sudan, and Yemen. Although the classification is only based on two indicators, it could be a useful starting point for planning and developing LTC markets in the region.

Most of the region’s countries need to design and implement new LTC markets from scratch. Governments are expected to define, regulate and, at least in part, participate in financially supporting and initiating such markets. However, for countries with limited governance, there will be a need for protocols and/or guidelines to standardise service provision. International organisations such as the United Nations (UN), the World Health Organisation (WHO) and the World Bank (WB) could support development of these protocols in consultation with stakeholders, including older adults and their families. Such protocols could also help relevant Non-Governmental Organisations (NGOs) address broader requirements efficiently. Protocols may also help NGOs identify hidden populations, such as those living with dementia. While these protocols would be designed for MENA regional contexts, they may be transferable to other areas of the world, either in part or in whole.

About the author: Mohamed Ismail is an Affiliate Research Fellow at the Oxford Institute of Population Ageing. His research focuses on the ageing dynamics and estimating the cost of care, particularly in the Middle East and North Africa (MENA) region.  


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