The policy architecture on long-term care in Africa: imperatives and gaps Isabella Aboderin, PhD

Outline Recent developments Global frames − imperatives Regional frames National frames

People in need of LTC are: ‘Persons with a reduced degree of functional capacity, physical or cognitive and who are consequently dependent for an extended period of time on help with basic or instrumental activities of daily living..’ (OECD, EU, WHO definitions)

LTC encompasses: ‘activities undertaken by others to ensure that those with a significant ongoing loss of physical or mental capacity can maintain a level of ability to be and to do what they have reason to value; consistent with their basic rights, fundamental freedoms and human dignity’ (WHO, 2015)

Developments

Over past decade, particularly last 2 years: − Consolidation of international and Africa-regional policy and legal architecture on LTC

Global Frames

Global Strategy and Action Plan on Ageing and Health LTC must: – be fair and just to those requiring care and those who provide it – enable care-dependent older people to continue to do what they value and to live lives of dignity – be viable over the longer term

Grounded in principles enshrined in overarching development and rights instruments

Sustainable Development Goals: – enabling all human beings to ‘fulfill their potential in dignity and equality and in a healthy environment’ – SDG 1, 3, 5, 8, 10

Rights treaties and declarations: – Right to highest attainable standard of health – Rights of persons with disabilities – Rights of women to non-discrimination and equality of opportunity

Imperatives for LTC practice Global strategy on ageing and health SDG Rights treaties

To ensuring – in family and formal care settings: Quality LTC (person-centered; optimizing mental and physical capacity; protecting dignity, self expression, autonomy) Integration of ‘social’ and medical care elements Equity of access to quality, integrated care Fair conditions, opportunities for those providing care

Regional Frames

Overarching development and rights instruments Ageing and health-focused frameworks

Development and rights instruments Agenda 2063, Charter on Human and People’s Rights, Protocol on the Rights of Women in Africa Affirm: – right to health – equity in opportunity and service access – empowerment for women – person-centered development.

Ageing and health-focused frameworks AU African Health Strategy 2016-2030, AU Protocol on the Rights of Older Persons, AU Policy Framework/Plan of Action on Older Persons

AHS 2016-2030 – no stipulations on LTC Policy framework/plan of action; Protocol: – Stipulations center on who ought to provide LTC: emphasis on primary role of families and need to support it. (Protocol recognises additional entitlement to residential care)

But: Little articulation of the four practice imperatives (Quality, integrated care, access equity, fair opportunities for carers in family and formal settings)

National Frames

Blueprints for national-level action on LTC – National ageing policies or bills In some countries – most have none

National ageing policies Stipulations center on who ought to provide LTC – emphasis on prime role of families and need to uphold and support it. Some recognise additional need for formal services (and their regulation) for those with no recourse to family care

National ageing legal frameworks Regulate operation, standards, coordination of existing formal LTC services; typically encourage community-based care provision

But… Little articulation of the four practice imperatives (Quality, integrated care, access equity, fair opportunities for carers in family and formal settings)

So what?

Gaps in regional and national-level ageing policy/legal frames on LTC Do they matter? Is there a case/need for action to extend the frames?