L e a d e r s h i p , r e s o u r c i n g a n d g o v e r n a n c e (iii) Taking advantage, where appropriate, of opportunities that exist for collaboration between public and private providers, and health-financing organisations, under strong overall government stewardship It is clear that in many African countries the vulnerability of older people increases due to decline in employment opportunities; increased vulnerability due to health conditions; limited mobility; discrimination in access to credit; changes in household composition and status; parental responsibility arising from prime age deaths from HIV/AIDS; and collapse/decline of the traditional safety net provided by extended family (Oduor, 2015). Conclusion It is clear that over the past few decades, health sector reforms in many African and other low- and middle-income countries have increased inequities in access to affordable health care. A growing reliance on out-of-pocket payments and privately organised care has resulted in health care provided on the basis of ability to pay, which has disadvantaged some groups, including older persons.5 The health systems in Africa are not designed to meet the needs of older people or to address chronic diseases. There is thus a need for African governments to deliberately include in their health systems those services that target older people, including at peripheral and district health facilities. In addition, countries need to expand the reach of social protection programmes and work towards making them universal. The current prevalence of pilot and targeted programmes does not meet the needs of most older people, who usually make up the poorest in any country. Furthermore, countries need to be cognisant of the increasing susceptibility of the population to chronic non-communicable diseases that require a shift in the health service delivery frameworks. Changes in the health system, reforms in UHC and expansion of social protection programmes should be evidence based, taking into account the country contexts. Endnotes 1 See www.who.int/healthinfo/global_burden_disease/gbd/en/ Accessed 10 April 2015. 2 UNDESA, population ageing wall chart. 3 See Helpage International, ‘Older people in Africa: A forgotten generation’: www.helpage.org/silo/files/older-people-in-africaa forgotten-generation.pdf Accessed 10 April 2015. 4 See www.who.int/health_financing/documents/covwharesolution5833/ en/ Accessed 10 April 2015. 5 Health access constraints in Kenya include out-of-pocket payments still playing a significant role in health expenditure (36 per cent); less than two per cent of Kenyans being covered by private health insurance, with about a fifth having NHIF cover; about two-fifths of Kenyans having to dispose of their assets or borrow money to pay for medical bills; about 100,000 households being impoverished due to catastrophic expenditures; and a fifth of sick Kenyans refusing to seek care due to financial barriers, the majority of these being orphans, the elderly, the disabled and children (Muraguri, 2015). References Anotsi, A. and Aiyuk, S., 2012. ‘Impact of the pension on access to health and elected foodstuffs for pensioners of the Manonyane community in Roma, Lesotho as measured between 2004 and 2006’. Healthy Aging and Clinical Care in the Elderly, 4, pp. 27–31. Karamagi, H., 2015. ‘Health Insurance: Global Perspectives’. Presentation made during the First Social Protection Conference Week (27–30 January 2015), Nairobi, Kenya. McIntyre, D., 2004. ‘Health policy and older people in Africa’. In: P. Lloyd-Sherlock, ed., 2004. Living Longer: Ageing, Development and Social Protection. London: ZedBooks, pp. 160–183. Muraguri, N., 2015. ‘Universal access to health insurance: Vouchers, waivers and free services’. Presentation made during the First Social Protection Conference Week (27–30 January 2015), Nairobi, Kenya. Oduor, O., 2015. ‘Social protection during drought and emergencies’. Presentation made during the First Social Protection Conference Week (27–30 January 2015), Nairobi, Kenya. Peltzer, K., Williams, J. S., Kowal, P. et al., 2014. ‘Universal health coverage in emerging economies’. Global Health Action, 7. WHO-AFRO (World Health Organization Regional Office for Africa), 2012. Health Systems in Africa: Community Perceptions and Perspectives. Brazzaville: WHO-AFRO. 106 Commonwealth Health Partnerships 2015 MARY AMUYUNZU-NYAMONGO, ALICE SINKEET and BRENDA MAINA are, respectively, executive director and founder; senior programme officer; and programme assistant at the African Institute for Health and Development (AIHD), 7th Floor, Commodore Office Suites, Kindaruma Road, PO Box 45259-00100, Nairobi, Kenya. Dr Amuyunzu-Nyamongo can also be contacted by email at email@example.com or firstname.lastname@example.org.
Commonwealth Health Partnerships 2015
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