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Older Persons and Universal Health Coverage

Prasamsa Shrestha                                                                                                        12 December 2018

Older Persons and Universal Health Coverage

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.