Living Alignment for Elderly Persons in Uganda
Uganda, the Government, UNHCR and other local and international development partners still have long way to go in achieving this year’s theme of “Leaving No One Behind: Promoting a Society for All”.
Elderly persons, specifically those living in urban centers like Kampala, are amongst the most vulnerable categories of people, and still face challenges accessing the basics of life such as food, shelter, clothing, water and medical care. Their concerns have largely been left out in the formulation and implementation of development and protection policies and programs. Not addressing older person’s concerns means not addressing the concerns of 2 per cent of the vulnerable population in Uganda, a critical minority group. Although the 2% figure may seem insignificant, the World Health organization has projected that a demographic revolution is underway throughout the world, and that the total of older persons will double by 2025 and will reach virtually two billion by 2050 - the vast majority of them in the developing world. Therefore government and CSO/NGO like FRENDA must enact policies that are geared at formalizing the institutional/residential care for older persons in place to mitigate the challenge of decreasing cares for older persons and combat a multitude of different disease conditions like; episodic attacks of stroke, osteoarthritis (disease condition affects the bone joints) diabetes, hypertension, heart disease and dementia (gradual deterioration of brain cells), which massively contributed to their disability. In such a situation, they solely depended on care rendered by others for survival and in that regard; we (FRENDA) come up with the project of providing Living arrangements program for elderly people in Uganda.
On paper, things do not look too bad for older people in Uganda. The government has a dedicated department for the elderly (along with disability), which lives within the Ministry of Gender, Labor and Social Development, and it has drafted a national policy for older people. The country's constitution makes special mention of making "reasonable provision for the welfare and maintenance of the aged", an act of parliament allows for the election of older people into local government and issues affecting older people have been included in the Poverty Eradication Action Plan and strategic plans on agriculture, health and Aids. Uganda is also a signatory to the Madrid International Plan of Action on Ageing, which calls for the poverty of older people to be halved in line with the Millennium Development Goal (MDG) to halve world poverty by 2015. The plan was agreed in 2002. But, of course, the reality is much different.
At an event hosted by Help Age International, Linda Nakakande, the NGO's country coordinator for Uganda, told the media that issues related to old age get very little attention and very few older people have a voice. The Ugandan media, she says, satirises older people and does little to champion their rights. "Old age is not made public, it's not talked about properly in the media," says Nakakande. "There is a negative attitude about old people. The issues they face are not being highlighted."
According to the Aged Family Uganda (TAFU)’s report of 2019, around 1.3 million people in Uganda are over 60, which, admittedly, is a small percentage in a country where population stands at around 32 million, and is projected to grow to 38 million over the next five years, and where, according to the Uganda Bureau of Statistics, a large proportion of the population is below the age of 15. But many of these older people have lost family to HIV/Aids, meaning they can't rely on traditional family support as they get older and will often be required to look after grandchildren following the death of parents. Around half of Ugandan orphans are looked after by grandparents. In its report, Unreported lives: the truth about older people's work, Help Age notes that "we are living in an increasingly ageing world". And 66% of ageing population now lives in low and middle-income countries, a figure that is predicted to rise to 80% by 2050. Poverty and family commitments ensure that many older people around the world are forced to keep working well into their old age. According to UN figures, more than 80% of men aged 65 and over are still working for a living in parts of Africa, including Uganda. The figure for women stands at 70%. The majority of them work in the informal sector (more than 90%), which means few older people are entitled to state pensions.
Uganda's efforts to support its older population seem to come down to the usual suspects - lack of financial resources and the political will to implement change. Five years on from the Madrid agreement, in 2007 a review of the progress being made to implement the action plan in Uganda, conducted by HelpAge, acknowledged that the government had developed a range of programs "which have the potential to include older people", such as including older people in its poverty eradication policies. But it concluded that these programs did not reach the majority of older people. The review noted that the Ministry of Gender, Labor and Social Development had plans to prioritize a policy for older people, a social protection policy and a social pension’s program by 2012. While a national policy on older people has been drafted, no concrete moves have been made to offer them greater protection. The Ministry of Finance has ruled out a non-contributory pension as too costly and open to abuse. Many people do not have birth certificates so verifying age will be problematic. But will there be an appetite to prioritize the needs of older people when there is pressure to cut the rates of maternal and child mortality, reduce HIV/Aids and malaria cases and ensure universal primary education by 2025?, that’s thy FRENDA believes what's needed is a bigger push by the international community on the rights of older people to be recognized, and to ensure agreements like those signed in Madrid are implemented.
Population ageing has become a global concern in the past two decades. Improved health care systems, decreased fertility rates and reduction in child mortality have contributed to the phenomenon. There is a remarkable variation across continents, regions and countries with Western countries contributing to the majority of the older population. The World Health Organization (WHO) recommends 50 years and above instead of 60 to define older people in sub Saharan Africa. This is primarily because of low life expectancy in the region. In addition, people aged 50 and older have health and functional limitations akin to those experienced by people 60 or above in developed countries. Worldwide, the proportion of older persons (aged 60 years and above) stands at 11% and it’s anticipated to double by 2050 (UNDESA). In sub-Saharan Africa, older persons comprise 5% of the population. In Uganda, the current population of older persons is estimated at 1.6 million (5% of the population) and it is expected to increase to 5.5 million in 2050 according to UBOS and ICF International.
Living arrangements is a critical issue in the discourse on population ageing. Living arrangements depict familial and non-familial relationships with whom the older persons share / reside in the same household. Living arrangements provide immediate and adjacent social care and support to frail older persons. Living alone is where an older person lives alone in a household.
In the past two centuries, patterns of living arrangements among older persons in the western world have drastically changed. Trends of older persons living alone have steadily increased. Studies have documented that improvement in the housing structure, need for privacy in later years, departure of adult children due to marriages, widowhood and divorces are associated with living alone in later years. For example in Japan, 15% of older persons were living alone in 2005 according to (NIA). The proportion of older persons living alone varies from continent to another. A comparative study of living arrangements among older persons indicated that the percentage of those living alone was higher in Africa (2%) than in Asia (1%) and Latin America (1.4%). Among those age 65+, the percentage living alone was higher in Africa (9.7%) compared to Asia (7.3%) and Latin America (8.4%). Generally, the prevalence of older women living alone was higher than that of older men in the three continents.
Living alone poses a high risk of poor health conditions and outcomes among older persons. Most studies have documented that living alone leads to poor psychological wellbeing, depression, higher mortality and loneliness among older persons. In addition, living alone threatens the financial and social wellbeing of older persons in later years. For instance, in Uganda, the social security scheme for older persons is partially developed, selected districts receive unconditional cash transfers. Currently, Uganda is implementing the social assistance grants for empowerment (SAGE grant) where some older persons (age 65 and older), receive an equivalent of $8 per month. However, this scheme is only operational in about 14 out of 112 districts in Uganda. Therefore, families and kinships are primarily responsible for supporting older persons in their later years. The prevalence of living alone among older persons in Uganda was 9%. This is about the same level as that of 23 other African countries including Kenya, Tanzania, Rwanda and Uganda among others.
Although in the developing countries, the phenomena of living alone is uncommon, the structure of living arrangement is starting to shift and this is expected to change in the next two decades. This is higher than the prevalence of living alone in other developing countries like India and lower than that (over 50%) reported in China.
The factors which are strongly associated with living alone are marital status and being poor (negative association). Others included age, region of residence, source of household earnings, being disabled but not ill health. Marital status has the strongest association with living alone among older persons. Divorced or widowed older persons have increased odds of living alone in Uganda. This confirms the findings in a Ugandan study indicated that more divorced / separated men (53%) than women (19%) were living alone. Older women usually care for orphans as result of HIV, The unavailability of drugs for non-communicable diseases, the lack of adequately trained staff to care for older people and poor equipment and services discouraged the respondents from going to hospital. Long queues, poor service by health workers and long distances to the hospitals also restricted their access to health care.
Low socio-economic status or poverty decreased the odds of living alone. Poor older persons (who spent less than a dollar per day) are more likely to live alone. In Uganda, poverty is common among older persons and their vulnerability creates inequitable access to services. Since over 70% of older person had informal education and most of them depended on farming, their income is quite low hence increasing their vulnerability to poverty. A study in Uganda indicated that absence of pension benefits was associated with loneliness among older persons.
Advancement in age (70–79) increased the risk of living alone in Uganda. Increment in age reduces physical abilities and health status, which necessitate the need for assistance through co-residence, non-communicable diseases with poor health outcomes were more common among the oldest old. Living alone could be associated with stigma or HIV/AIDS epidemic which leave older persons without relatives to co-reside with. This is a bigger issue for older women than older men. Older women are at a higher risk of living alone because of advanced age. Women have a higher life expectancy and are more likely to be widowed with advancement in age compared to older men.
Region of residence is associated with living alone among older persons in Uganda. Older persons in western region are less likely to live alone compare to those in central Uganda. Similarly, older men were less likely to live alone in western region compared to central region. The possible explanation is the communal culture in western Uganda since some are pastoralists for example the Banyankole. On the other hand, central Uganda includes Kampala, which is the capital city and other neighboring towns. Older persons in urban areas face a higher risk of being isolated and living alone. Another explanation for older people in central Uganda living alone more than other regions is the cultural issue. In central Uganda, adult children prefer to establish homes away from their parents in order to be independent. Among older women only, those in northern region were more likely to live alone compared to those in central region. This resonates with the effect of the 20 years’ civil war in the region, which left many men dead and increase widowhood among them.
Disabled older persons are more likely to live alone compare to those who were not. Disability and old age are highly stigmatizing experiences associated with a high degree of vulnerability. It is common to find older persons who are isolated and living alone and assumed to be “witches” by the community around. A study in India also found that disabled older persons were more likely to live alone as result of social isolation and deprivation from the family. Similar findings were reported in china. In addition, the strains and burden of caring for disabled older persons are high on the care givers as postulated in the “privacy model” and therefore, family members could avoid them for such a reason.
Overall Objective
•Provide a standard collective shelter for disabled older persons with chronic conditions such as diabetes, heart disease and hypertension, widows due to HIV/AIDs and marginalized poor to cater for their health and basic needs.
Specific objectives
•Advocate for the policies, the power and roles of older persons to all stakeholders, including Government of Uganda, UNHCR and its partners, donors, local and international civil society organizations to give special attention to the conditions of older person attain equal opportunity in accessing services and resources.
• Developing direct programs to address their issues, and mobilizing adequate resources to respond to the issues of elderly persons and ensure access to the basics of life including food, shelter, and medical care
• Engaging elderly persons as active participants capable of creating change and making decision. They should be viewed as a resource and a power for creating positive change in individuals, families and communities
• Empowering those still able to work with skills and resources to be self-sufficient, in order for them to enjoy a dignified life.
Methodology
According to the latest State of Uganda’s population report 2014, the country has the world’s youngest population, with more than 78 per cent below 30 years. It should, however, be noted that Uganda is slowly but surely becoming an ‘elderly country’ thanks to the country’s progress in reducing infant mortality coupled with the declining birth rates and rising life expectancy.
The population of older persons has gradually increased in the past two decades. Currently, the population of older persons aged 60 years and above, is 1.3 million. Nearly, one in 10 people in Uganda are above 60 years. This population is projected to quadruple in the next three decades.
The consequences of an ageing population pose a threat on social, economic, living arrangements and health status in later years. Note that growing old does not necessary translate into a burden if the country is prepared. This is explained by the fact that ageing is a transitional process, which is pre-determined during our life course. Having productive and healthy lifestyles during childhood, youthful and mid-life ages, are crucial in pre-determining the successful ageing in later years. Therefore FRENDA is here by seek to provide the following;
•Build homage for vulnerable older people with Disabilities
In Uganda, professional/institutional care giving for older persons with disabilities is not well defined as care offered from the family members, neighbors, community or any other support groups is common. Although the national policy for older persons emphasizes family members being primarily responsible for supporting and caring for older persons, the reality is that family structures are changing. Recent research finding showed that one in 10 older persons is living alone in Uganda. These changes have been compounded with older person being childless, having adult daughters leaving the household due to marriage and participation in labor work force, formation of nucleated family, modernization and erosion of traditional social cohesion. Therefore, Building homage for older people with disabilities help them access good health care management for chronic conditions, prevent isolations, stigma and prevent high mortality.
•Provide Health care management
The studies have documented that with advancing age, the likelihood of developing health complications, chronic disease and disability increases and, the demand for long-term care escalates due to functional limitations. In Uganda, findings indicate an increase in prevalence of disabilities and dependence on other people for help among older persons. Disabilities pose a negative impact on older person’s capacity to participate in normal daily activities, making them dependent on others for their survival in life. Hence, this translates into the need for a care giver throughout their life time. Literally, care giving is an extended assistance rendered to any individual who is incapacitated and or unable to perform daily activities independently. While the concept of care giving rotates on two notions - either paid versus not paid - this article critically aimed at the concept of unpaid care rendered to older persons.
Setting up Income Generating Projects
In Uganda, Art and craft are part of culture. Crafts has been developed through the traditions of the people. Where Art is the creation of work of beauty through the application of skills, resulting from knowledge and regular practices. It includes crafts like; basketry, jewelry, mats and wood curving. So as FRENDA, will help the old persons with disabilities to market and acquire skills and knowledge to enable them earn a living in life.
Target Group and Beneficiaries
The need for this project was identified during the field visits and local community meetings as marginalized elderly people mostly women expressed concerns over there mental and physical disability to cater for themselves yet they have multiple grand-children as their parents died of HIV/AIDs to whom they take care of. The target population will be disabled older persons with chronic conditions such as diabetes, heart disease and hypertension, widows due to HIV/AIDs and marginalized poor older persons.
Project Activities
i) Project Initiation,
ii) Procurement of land,
iii) Procurement of resources & materials,
iv) Construction,
v) Procurement of equipment’s like beds & mattress,
vi) Recruitment of Staff,
vii) Identification of the target population
viii) Coordinate the Project & motivate the Staff involved,
ix) Monitoring and Evaluation,
x) Reporting.
Expected outcomes
• High levels of access to medical services by vulnerable elderly people because of the low or no expenses required in managing the illnesses they live with; and in most cases are unable to move long distances to medical centers in order to access treatment.
• Unlimited access to food and housing, especially as they have a big care burden of grandchildren and other vulnerable persons. The majority of elderly refugees in Kampala live in slum areas, where houses are in terrible condition, characterized by coldness, flooding and no beddings.
Many have to depend on their grandchildren for support, or resort to begging or picking food remains from the markets.
• Developed the platforms to speak on their own issues and the public is largely aware of their concerns. In rare situations where they get an opportunity to speak, their issues are not considered a priority, as they are taken as typical ageing issues with no urgent need for redress.
•The establishment of community outreach interventions that provide home care services for disabled older people with disabilities will also solve the challenges of access to the health facilities.
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