THE SITUATIONAL ANALYSIS OF OLDER PERSONS IN UGANDA: STUDY FINDINGS - - PowerPoint PPT Presentation
THE SITUATIONAL ANALYSIS OF OLDER PERSONS IN UGANDA: STUDY FINDINGS Kampala, September 2018 CONTENTS OF THIS PRESENTATION Study background Overview: Situation of older persons Context: Ageing in Uganda Accessibility of services
Kampala, September 2018
In early 2018, the study was commissioned by the Ministry of Gender, Labour and Social Development to:
persons in Uganda
formulation of Older Persons’ Act
released on October 1, 2018, on Older Persons’ Day
Overarching questions Study objectives
What is the current situation of older populations (60+ and above) in Uganda? a) Understand the socio-economic, cultural, health and disability situation of persons in Uganda b) Provide an overview of differences by
What are the priority actions that need to be taken at the policy level to improve the lives of older persons in Uganda? a) Provide an overview of challenges and achievements of services provision to older persons b) Identify actionable priorities to inform policy level strategies for older persons
Literature Review
literature gaps, study questions and themes
and legal frameworks
literature Qualitative Research
contributions of older persons, and
and interviews with older persons and caregivers,
Quantitative Research
and socio-economic profiles
well-being status and access to services of
regions, gender, socio- economic status
national level data sets
LIMITATIONS
primary data collection
sample size
beyond 75 years
disability
for persons beyond 49 years
WHY?
experiences of ageing in Uganda
at sub-county, district and national level
WHY?
Present national level disaggregated data on older persons:
HOW?
Enables us to:
Enables us to:
Accessibility, Acceptability and Quality framework (AAAQ)
Civil and Political Rights Economic, Social and Cultural Rights (ESCR)
Freedoms & Functionings
60 years
women
Kigezi
Kampala
Share and total number of older people, by 15 sub-regions
0 Mil 4 Mil 8 Mil 12 Mil 16 Mil
2020 2030 2040 2050 2060 2070
1.5 million
6 million
15 million
3 million
16 13 10 8 6 4
16 13 10 8 6 4 17 14 11 8 6 5 18 14 11 8 6 5
20 60-64 years 65-69 years 70-74 years 75-79 years 80-84 years 85+ years
Life expectancy in years
Male 2006 Expectation of life Male 2016 Expectation of life Female 2006 Expectation of life Female 2016 Expectation of life
Life expectancy of older persons at five-year age group, by sex and calculation year
Average number of reported sick days increases significantly with age
Age-related issues for older persons in Uganda include
4 12
6 10
12 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+
Number of sick days Five year age groups
Male Female
Average number of sick days in the last 30 days for those reporting an illness, by sex and five-year age groups
‘It’s common for people at that age not to be able to see. This is taken as something that comes with age and so they don’t take him to the hospital about it’
3 3 3 4 7 7 11 17 20 26 29 46
4 5 11 11 18 18 26 35 39 45
50
5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+
Male Female
Ageing-related disability:
Disability strongly related to socio-economic conditions and health More older women have a disability in comparison to older men Order of prevalence of various types of disability remains unchanged across all regions Prevalence rates of disability are much higher in Acholi, a post-conflict region
Percentage of older persons with a severe functional limitation, by sex and five-year age group
0% 5% 10% 15% 20% 95+ 90-94 85-89 80-84 75-79 70-74 65-69 60-64 Male Female Age group Sex
Walking Seeing Remembering Hearing
10 20 30 40 Poverty headcount rate (%) 20 40 60 80 Age UBOS equiv. scale Per capita Oxford scale OECD-mod. scale Square root scale
Above $10 PPP a day Between $ 5.5 and $ 10 PPP a day Between $ 3.2 and $ 5.5 PPP a day Between $ 1.9 and $ 3.2 PPP a day Below $ 1.9 PPP a day
(responses vary)
economic activities
active unless severely disabled or chronically ill
care of young children
increased
ageing family members has eroded
in service provision
HISTORICAL RELEVANCE Older persons as socio-cultural leaders
and gender norms over generations
knowledge, for e.g. art and history and healthcare
within communities
communal land
Relevant in their families and communities by striving to adhere to traditional gender roles
the household
cared for by their spouses and younger members
Striving to maintain their dignity and autonomy through work and income
and being able to cover their basic needs
part of their identity
person, thus perceived to ‘stay younger for longer’
biological and social relations
determines to a large extent their socio-economic vulnerability
family structures and informal care
households most prevalent followed by skipped generation households
10 12
10 22 6 6 11 10 63 51 0% 100%
Male Female
Older persons living alone Skipped generation household Older persons only Older persons and working age Multigenerational households
Distribution of living arrangements of everybody and older persons, by sex
10 16 6 11 57
No severe disability
Older persons living alone Skipped generation household Older persons only
15 17 6 11 51
With a severe disability
Older persons and working age Multigenerational households
5 8
0% 10%
Male Female
Distribution of orphanage status of children in skipped generation households and other households that include an older person
78 11 6 5
Children in skipped generation households
Mother and Father Alive Only Mother Alive
92 5 21
Children in all other households
Only Father Alive Both dead
23 36 28 40 31 23
31 85 65 28
100 5
1
4 1 5
9 2
4 2 5
9 3
4 3 5
9 4
4 4 5
9 5
4 5 5
9 6
4 6 5
9 7
4 7 5 +
Five year age groups
Male Female
Peace is a 55-year old woman who is HIV positive and a caregiver
niece whose parents died of HIV/AIDS in the 1980s. She received anti-retro viral treatment on time and now lives what she considers a healthy life. She often worries about her ability to care for her mother, given her chronic medical condition which may deteriorate at any time, especially as she advances in to old age. Eventually the next woman relative, her niece will become the only source of support.
Percentage of children taking on care responsibilities, by living arrangement
33 26 24 25
0% 40% Skipped generation household Multigenerational households Households without older persons Total
Percentage of older persons caring, by sex and living arrangement and sex
18 62 28 15 42 27 50 100 Older persons living alone Skipped generation household Older persons only Older persons and working age Multigenerational households Male Female
children under the age
children in a skipped generation household is stunted.
49 30 29 29
0% 50% Older persons living only with children Multigenerational households Household without
Total
“Some of the children who died left very tiny babies and as an older person it became a challenge to find ways to take care of these babies’
69 70 60 55 45 66 32 64 54 13 7 15 7 13 9 23 12 10 4 7 8 15 11 7 19 10 8 10 9 12 13 16 11 13 5 21 3 7 5 10 15 7 13 9 6 100 Poorest 2 3 4 Richest Rural Urban Male Female Consumption Quintile Residence Sex of household head Subsistence farming Wage employment Non-agricultural enterprise Remittances Others
Main income source for households headed by older persons, by sex, location and consumption quintile Older women: subsistence farming, handicrafts petty trade, agriculture labour, brewery Older men: cash crops - banana and coffee plantations, maize, selling livestock
Older persons rely heavily on remittances as one key source of income in comparison to other households Older women rely more heavily on remittances in comparison to older men
68 62 64 47 41 40 65 100 Older persons living alone Skipped generation household Only older persons Older person and working age Multigenerational households Male Female Living Arrangement Sex of household head
Percentage of households headed by older persons receiving remittances as major income source, by sex and living arrangements
A majority report ‘too old to work’ which indicates ageing-related functional limitations (disabilities)
72 6 4 3 5 41 55 42 18 4 29 50 80 5 19 7 5 14 27 8 100
Youth (15-24) Working age (25-59) 60 - 69 years 70 - 79 years 80+ years
Male
55 3 25 41 4 6 4 24 43 28 13 4 42 62 79 4 12 8 3 5 12 17 100
Youth (15-24) Working age (25-59) 60 - 69 years 70 - 79 years 80+ years
Female
39 46 65 69 73 61 54 35 31 27 100 Youth (15 - 24 years) Working age (25 - 59 years) 60 - 69 years 70 - 79 years 80+ years Seasonally or irregularly Frequently
Percentage of households with regular income, by age group
Food insecurity and poor nutrition increases the likelihood of of ageing-related illness and disability
with age
FCS, followed by skipped generation households
28 7 4 5 4 14 8 9 5 6 5
20 13 15 13 10 7 13 14 14 16 12 13 7 8 52 80 81 82 89 89 73 77 77 79 82 84 87 89 100 Older persons living alone Skipped generation household Older persons only Older persons and working age Multigenerational households Household without older person 85+ years 80-84 years 75-79 years 70-74 years 65-69 years 60-64 years Working age (18-59) Child (0-17) Living arrangement Age group Poor Borderline Acceptable
Risks
and forced to purchase expensive foods
drought and flooding
persons to sell food instead of consuming
male family members or financial resources are unable to improve housing
children to fetch water
waiting times and associated costs
squat even in improved pit latrines
20 22 19 29 28 49 21 67 76 67 73 73 88 70 71 69 72 73 71 83 69
100 Older persons living alone Skipped generation household Older persons only Older persons and working age Multigenerational households Urban Rural Living arrangement Residence Improved drinking water Permanent roof Improved toilet
Economic violence: land grabbing and conflict
Widows at risk of land eviction by family Central Uganda: squatters at risk
land Land grabbing by private investors Lack of land title puts older persons at risk
Other types of violence and neglect
At risk of theft and physical violence by young men Emotional torture and harassment Coerced by sons into selling land for boda bodas
Psycho-social abuse
Verbal abuse Accusations of witchcraft Social exclusion and discrimination by service providers
Gender based violence
Older women living with spouse at risk of intimate partner violence Older women living alone at risk
strangers
enjoyment of the highest attainable standard of physical and mental health
subjected to torture or to cruel, inhuman or degrading treatment
and home
standard of living
in the health sector
urban areas with certain lifestyles
providing care to older persons
and staff
HC4s
diabetes
illnesses and NCDs
unit, with burden falling on women
specific the long-term care needs, including palliative care
for older persons that do not receive sufficient care at home
government workers
enjoyment of the highest attainable standard of physical and mental health
subjected to torture or to cruel, inhuman or degrading treatment
and home
standard of living
Who: ROTOM and CARITAS How: Training, sensitising and incentivizing community health extension workers to prioritise
Who: Sightsavers and Queen Elizabeth Diamond Jubilee Trust’s Trachoma Initiative How: Using a SCG pay points as a service location for free cataract and trachoma diagnosis and treatment Who: Health Centre IV, Rukungiri How: Older persons co-operative model to fund treatment of diabetes through adequate provision of equipment and medicines
before the law
home
torture or to cruel, inhuman or degrading treatment
Political structures
and recognised by law
sub-county level
Challenges
the councils
persons
100 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75-
Five year age group Formally borrowed Informally borrowed Don't know source No credit
Percentage of persons with access to credit/loans, by type
Challenges Less than 50% of the total population of Ugandans access any form of credit Access to credit reduces with age Why?
savings and debt insurance
risk
economically active
Challenges for retirees from the formal sector, especially public services
approved for public service pension
access Senior Citizen’s Grant
Percentage of people living in households receiving any form of pensions
1.6 2.2 0.9 0.4 0.9 1.8 0% 1% 2% 3%
Youth (15 – 24 years) Working age (25 – 59 years) 60 - 64 years 65 - 69 years 70 - 74 years 75+ years Total
The SCG is documented to improve children’s schooling and nutrition, boost local economies and provide additional income to entire households For SCG recipients, the likelihood of being in poverty dropped by almost 18 percentage points The poverty rate among recipient households would fall by 21% if everyone over-65 years were to receive the SCG The poverty rate among recipient households would fall by 33%, if the SCG were raised to UGX 40,000 per month
Illustration of difference-in-difference of poverty rates between SCG beneficiaries and comparison group
PILOT DISTRICTS Over 60% of older persons across pilot districts are receiving the pension Over 80% of older persons targeted in 10 of the pilot districts ROLL OUT DISTRICTS Less than 40% of older persons being targeted in roll out districts
Availability
closer to their communities
Accessibility
Acceptability
workers
health care system
Quality
ageing related issues
equipment and medication
to enable ageing with dignity
and disability in policy and institutional structures
Social protection throughout the lifecycle to prepare for
Integrated service provision for older persons Shift in policy discourse Shift in social perceptions
Ability to contribute Decision making power Ability to cover needs Relevance and respect
condition and older persons as human beings with rights
active and older persons with long-term care needs