Hari Maya Budathoki 81-year-old lives in Dolakha, Nepal with her husband. She states: “I know my bones are weak and brittle – referring to ‘osteoporosis’. I cannot go to hospital as I have to walk 4 hours to reach there. No transportations are available in our village. I am helpless.”
Health care services are very expensive. I am old and cannot earn. The old age pension doesn’t even fulfill our basic needs, how can we spend it in health services? – said, Budathoki’s husband.
Like Hari Maya Budathoki, there are many other older person out there whose health needs are unmet. WHO estimates that 130 million people in South-East Asia Region lack access to essential health services. And over 50 million people are pushed into poverty every year because of health care costs.
UHC has 13 targets under the third goal of Sustainable Development Goals (SDGs). According to UHC, “Every person — no matter who they are, where they live, or how much money they have —should be able to access quality health services without suffering financial hardship”. Each 12 December is commemorated as the unanimous United Nations resolution summoning for all the nations to provide accessible, affordable and quality health care for their citizens.
In the context of rapid population ageing, where 2.1 billion People will be older (60+), representing 21% of the world’s population by 2050 – World Population Prospects: the 2017. Age-related inequalities take on greater urgency, and generally older persons are left behind. Developed countries have already started to take steps toward the inclusion of older person in UHC through policy making. As well as researches are being conducted on the health status and quality life of older person. While low and middle-income countries like Nepal are still lagging behind.
There is a great difference in health care between older persons and other age groups. A major concern shown to only child bearing woman for Reproductive health despite knowing that older women bear the most of its consequences is the major evidence of it. This kind of evidences can be easily found in rural and urban areas of Nepal where, people are still unaware about geriatric health. But along with that, there are also disparities among older person themselves, such as by gender, income level and education. These inequalities have created a huge impact on assessing health services.
Budathoki states: “Even though I reach hospital by walking alone, I get lost there. It is very hard for us to search the right room for checkup. Those hospitals with big charts and board with information in it doesn’t fit for illiterate older person like us. I don’t know if government could ever help people like us. However, we hear nowadays, older persons are getting their rights; but only in the capital city. We older person from rural areas are left behind in many things and our voices are still unheard.”
Increasing age is associated with expanding health-care utilization and routine health expenditure. But that cost due to the complex health conditions or their need for long term care results “financial catastrophe” which can be prevented by the health package under UHC. But due to illiteracy many older people are unaware about their own health benefit packages. Education plays an important role in being aware about it in developing country like Nepal. High illiteracy rate among older person hinders them from being fully informed about the benefits of health programs which are offered to them.
Nepal has started to enshrine the right to healthy living and access to health services as a fundamental human right. It has also oriented its health system toward Universal Health Coverage. Nepal Government has included UHC as one of the policy strategies in National Health Policy 2014 and Health Insurance Policy 2013. And also they are now focusing on free health-care policy and several other schemes. The Social health insurance scheme which was implemented in 2016 has reached population coverage of 5% in the implemented districts in just within a year of implementation as per research. It has played a vital role in health care systems in a very short period and has been able to enroll an encouraging number of members. This will be a great help to reduce the huge expenditure on health care services and increasing access of poor people.
But still these efforts are not sufficient in achieving UHC especially for ageing population. To achieve UHC, disease –specific programmes should be shifted to health system strengthening at local and national levels. The local health care delivery should be stronger to provide integrated health system easily. Social protection programme should include integrated health services and should be expanded more towards older person as well.
Additionally, more focus is needed towards older person’s health care. Paying out of pocket for health services can be impoverishing as many older persons avoid treatments in order to save the expenses for their basic needs. To prevent this, there should be availability of affordable, quality and accessible health services. Those should include long-term care, palliative care and hospice care. And also increase of education and training in geriatric health is needed for promoting healthy ageing. Therefore health benefit package should be designed age-friendly. UHC can only be achieved when there are sufficient health care providers, sound health policies and health financing strategies without marginalizing any age group.
The Day for Older Persons (IDOP), a day designated by the UN in 14th of December 1990 was celebrated globally on 1 Oct. 2018. It was observed for the first time on 1st October, 1991 to make people aware about the issues affecting elders as well as to appreciate and value their significant contribution towards the society. This day is celebrated every year throughout the world including Nepal where issues affecting senior citizens are raised, public awareness is built by all the organizations working for ageing population in order to create and sustain suitable environment for elderly.
Each year different theme is chosen for the celebration so that people can realize the magnitude and priority placed for older persons. For 2018 International Day for Older People (IDOP) campaign goes under a theme “Celebrating Older Human Rights Champions” with the following aims:
1) Promote the rights enshrined in the Declaration from the second World Conference on Ageing and what it means in the daily lives of older persons;
2) Raise the visibility of senior citizen as participating members of society committed to improving the enjoyment of human rights in many areas of life and not just those that affect them immediately;
3) Reflect on progress and challenges in ensuring full and equal enjoyment of human rights and fundamental freedoms by older persons; and
4) Engage broad audience across the world and mobilize people for human rights at all stages of life.
Observing mentioned themes; one can realize that all persons should have their rightful position at old age without any discrimination in the society as well as their roles and contributions made during young days shouldn’t be ignored. Older people’s rights matters more these days because the demographic revolution is underway all over the world. In 2017 almost 962 million people were 60 above and it is projected to reach nearly 1.4 billion by 2030 and expected to double again by 2050. For the first time in human history, the number of people over 60 will exceed the number of children. Moreover, the increase rate of older people is the highest and most rapid in the developing countries, and Asia has the largest share. According to census of 2001, Nepal had 6.5% of elderly population (60+) that reached up to 8.31% in 2011 and it is escalating at the rate of 3.5%.
Women, children and people with disabilities are all protected through special international conventions but no such convention exists for senior citizen despite their high vulnerability. In our country Nepal there is a huge gap that needs to be bridged to support older people within existing human rights standards. There are no senior citizens specific human rights to address the multiple forms of discrimination -elder abuse, neglect, palliative care and so on. These concerns are not adequately addressed in existing human right standard.
In recent years, elder abuse is in rise and most of them are experienced in their own homes and in nursing homes/day care centers. Many elders who face abuse are not even allowed to make any decision about their personal life such as money matters, property, use of old age allowance, health care, food , clothing, to name a few.
There are only few countries that collect the data on violation of the rights of older people where Nepal is far behind in these matters. This kind of violation continues as there is lack of information regarding the prevalence of these abuses. This may be because older people are seen as a charity-recipient rather than holders of their own human rights. For that reason, older people’s rights are exceptionally neglected in the current human rights framework. Thus, to bridge the huge gap all organizations working for welfare of senior citizens comes together every year on October 1st and organize various programmes that supports, protect and promote older rights through demonstration of promotional material at schools, institution, offices and public notice boards so that people will be encouraged about their roles and responsibility towards their lives.
It can be concluded that senior citizens play an important role in contributing for betterment of the society through their experiences and wisdom. Strong and protected older rights will enable the nation and the world to become strong as a whole. Hence, human rights-based approach must be adopted in order to change people’s perception from a charity-recipient to a rights holder.
Considering the global problems “Poverty, Inequality and Climate Change”, 193 Member States of the United Nations adopted Agenda 2030 for Sustainable Development-a set of 17 goals aiming to transform the world over the next 15 years,on 25th September 2015.
Nepal, being the least developed country with the population of about 30 million is an active member of the global initiative for sustainable development. Its development plans and programmes are geared towards the implementation of Sustainable Development Agenda whereas its target to achieve the SDGs has fortified the country’s drive to the path of prosperity.
SDGs and Old Age
According to data from World Population Prospects: the 2017 Revision, the number of Older person (60 years or over) is expected to more than double by 2050 and to more than triple by 2100, rising from 962 million globally in 2017 to 2.1 billion in 2050.
SDGs do not stand alone. Its achievement of one goal has implication on others. Therefore, if older person are left behind, SDGs cannot achieved with its major theme of “Leaving No one Behind”. These goals are comprehensive and challenging which demand huge resources, efforts across countries and inclusion of people of all ages.
Issues & Challenges
Even though SDGs has been focusing on the pledge ‘Leaving no one behind’, Nepal lacks targets focusing particularly on older person. Most of the older people compel to suffer from poverty, poor health care and undernourishment. Although government has set target to address the nutritional needs of adolescent girls, pregnant, lactating women and children, there are no specific interventions mentioned or planned particularly for older persons.
Furthermore, SDG 3 lacks the target and indicators for the healthy life of older person. People are still unaware about geriatric health. A concern to Reproductive health has always concentrated on child bearing women although its consequences are seen mostly in older age.
Many studies have revealed that globally one in six elder face abuse. In Nepal, a majority of the elders even do not realize that they are being abused. It is estimated that each year about 4000 older people suffer from elder abuse in Nepal. Similarly, when catastrophic earthquake hit Nepal in 2015, there were no emergency preparedness services for older people. Older persons are extremely vulnerable in such emergency situation but still their concerns are being ignored.
Nepal has been addressing the issues of gender inequality since decades. But because of the long history of gender inequality that prevailed in Nepali society, most of the women are now illiterate in their older age. The present day society is prohibitive to illiterates especially older people alienating them from mainstream of society. To address this issue, Ageing Nepal – a NGO – piloted Basic Literacy Class for Older Persons in 2016 with support from UN Committee of Ageing. Despite the success achieved and replications made, literacy for older person is not yet included in any educational programme of the government. This leads to conclude that older persons are left behind as far as SDG 4 is concerned.
SDGs have provided an important platform for Nepal to address many developmental issues including concerns of older persons. It has given opportunity to identify elder issues through research and implement evidence based policies and programmes. Therefore, it is high time for our Government to achieve sustainable development goals ensuring betterment of older person.