By Helen Mudora, Africa Platform for Social Protection Toward LTC systems approaches : Existing national-level efforts in SSA to coordinate LTC 2nd IAGG Conference Nairobi, 5-8 December 2016 By Helen Mudora, Africa Platform for Social Protection

Background Relatively scant knowledge is available on the situations of older persons in sub-Saharan Africa. Reliable and accessible demographic and health statistics are needed to inform policy making for the older population. According to ILO, more than half of the global population aged 65 and above, representing 300 million people, is excluded from urgently needed long-term care (LTC)

According to ILO Global shortfall of 13.6 million formally employed LTC workers In Africa, to 1.5 million LTC workers are needed ( ILO 2015). The informal LTC workers – often unpaid female family members

Source: ILO estimates 2015, World Bank, 2015 (population data in 2013).

Definition of social protection How social protection is defined in a country has an impact in the design of programmes. A set of public policies, programmes and systems that help poor and vulnerable individuals and households to; Reduce their economic and social vulnerabilities, Improve their ability to cope with risks and shocks and; Enhance their human rights and social status. .

SP definitions and focus Major vulnerabilities in Africa - food security, HIV and AIDs and conflict Focus – livelihood and welfare In the African context social protection includes safety nets aimed at responding to natural disasters, risks and vulnerabilities Social insurance, social security, health insurance, Emergency relief, Labour market interventions Not necessarily to respond to social rights

Social protection Preventive – should provide safeguards Protective: should address negative coping strategies which may otherwise increase risk Promotional : should support Transformative: should empower people and their communities

Social security Social pensions are an increasingly popular instrument for delivering social protection to older persons and other vulnerable groups in African countries. Limitation - limited coverage. Formally employed workers in the public and private sectors, mostly living in urban centres, are covered, but this rarely extends beyond 10% of the population. Pays about 5 – 20 US$ per month to every participating worker after they retire, which is widely perceived as inadequate to meet pensioners’ basic needs, let alone LTC needs.

Social security The majority of citizens – rural smallholder farmers, informal sector workers, the self-employed – are not covered at all. **** How do we extend social security to these ‘uncovered’ groups, who typically comprise the poorest and most vulnerable sections of the population. How do we encourage part of these contributions to be set aside for LTC?

Health insurance Health risk are among the major life risks tackled by social protection. Focuses on removing financial barriers that prevent access to health . Protects people from the impoverishing effects of medical expenditures However it is limited in scope – cover those in formal employment **** is there a way of influencing to have LTC part of this package

Cash transfers Social insurance - regular, unconditional cash transfers to citizens, whose eligibility is determined mainly by age and vulnerability but sometimes also by individually assessed poverty status (in the case of means tested schemes) Most countries in sub-Saharan Africa currently provide social pensions to their older citizens, however the aim is not to meet LTC needs. ****Influence policy - How to increase the package to include LTC For example Kenya is introducing a Cash+ programme for beneficiaries, discussions on the Cash plus package should include LTC

SP and LTC Social protection for LTC aims to ensure that people with special long term care needs (i.e. due to frailty, ill health or disability) can get the goods and services they need for a life of dignity, and will not fall into poverty. Do people dependent on LTC get the help they need – institutional care, tailor made support, independent living, support to families ? Is this achieved without impoverishing the person needing help or their family?

Experiences in SSA Available data and reports indicate that it is only in South Africa where there is some level of intervention on SP and LTC Most countries spend 0 per cent of GDP on LTC – only in South Africa public expenditure of 0.2 per cent of GDP is observed. Such interventions are means tested – meaning that only a certain level of people in need of LTC can

SSA Only persons in a certain income and wealth thresholds enjoy legal coverage for LTC. Older persons with income or wealth above the thresholds have to first use up their savings and assets, before being entitled to services. This means that they must first become “poor” before they become eligible for LTC Majority of the population is deprived of their right to LTC as they do not fall under these conditions

Challenges Lack of data in most of Africa on older persons and on the need for LTC Absence of such information - policy makers cannot identify LTC as a priority area for interventions In view of competing interests – food, HIV & AIDS, conflicts, access to health care, , education, LTC is not seen as a priority No visible coalition pushing for LTC policy and programmes

Opportunities Provision of LTC services is a universal right anchored in national legislations. Promoting Social protection floors – nationally defined basic guarantees and security. Role of government in financing basic guarantees , and services. Addressing risks and vulnerabilities is cross cutting and so is LTC – different players Advocacy for financing and budgetary allocation – Investment/business option

SP agenda in Africa Social protection agenda in Africa is shaped by three sets of factors (Devereux and White 2008): technocratic (‘what works’): building the evidence base about social protection impacts; political (‘what’s popular’): the political impacts (vote-winning potential) of social protection; ideological (‘what’s right’): realising universal rights (to food, health, etc.) for the poor LTC must be packaged to fit into one or all the three factors.