African Research on Ageing Network (AFRAN)

Policy-Research Dialogue:

Advancing Health Service Provision for Older Persons and Age-related Non-

communicable Disease in sub-Saharan Africa: Identifying Key Information and

Training Needs

8-10 July, Abuja, Nigeria

REPORT REPORT REPORT REPORT AND AND AND AND OUTCOMESOUTCOMESOUTCOMESOUTCOMES

Prepared by:

Dr. Isabella Aboderin

AFRAN Coodrdinator

Oxford Institute of Ageing

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TABLE OF CONTENTS

I.I.I.I. INTRODUCTIONINTRODUCTIONINTRODUCTIONINTRODUCTION……………………………………………………..……………………………………………………..……………………………………………………..…………………………………………………….. 2222

II.II.II.II. BACKGROUNDBACKGROUNDBACKGROUNDBACKGROUND………………………………………………………..………………………………………………………..………………………………………………………..……………………………………………………….. 2222

1. Demographic Trends ……………………………………………… 2

2. Health Implications of Ageing in SSA…………………………… 3

3. Policy Agendas: International, Regional, National…………… 3

III.III.III.III. PURPOSE, GOALS AND AIMSPURPOSE, GOALS AND AIMSPURPOSE, GOALS AND AIMSPURPOSE, GOALS AND AIMS……………………………………….……………………………………….……………………………………….………………………………………. 4444

IV.IV.IV.IV. RESULTS AND CONCLUSIONSRESULTS AND CONCLUSIONSRESULTS AND CONCLUSIONSRESULTS AND CONCLUSIONS……………………………………………………………………………………………………………………………………………………........ 5555

1. Existing policy on health service provision for

older persons/age-related NCD…………………………………. 5

2. Implementation Status of Policy…………………………………. 7

3. Impediments to Effective Policy Action………………………… 7

4. Key shortcomings in primary, secondary and

tertiary care delivery……………………………………………….. 8

5. Key Information Needs……………………………………………. 11

6. Key Training Needs………………………………………………… 12

V.V.V.V. THE WAY FORWARD: PLAN OF ACTIONTHE WAY FORWARD: PLAN OF ACTIONTHE WAY FORWARD: PLAN OF ACTIONTHE WAY FORWARD: PLAN OF ACTION………………………..………………………..………………………..……………………….. 13131313

1. Research Projects to be Forged…………………………………. 13

2. Training Projects to be Forged………………………………….. 16

VVVVI.I.I.I. REFERENCESREFERENCESREFERENCESREFERENCES………………………………………………………….………………………………………………………….………………………………………………………….…………………………………………………………. 18181818

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I.I.I.I. INTRODUCTIONINTRODUCTIONINTRODUCTIONINTRODUCTION

On 8-10 July 2008, the African Research on Ageing Network (AFRAN), in close

partnership with the International Association of Gerontology and Geriatrics

(IAGG) and additional support from Help the Aged, UK, convened a policy research

dialogue on “Advancing Health Service Provision for Older Persons and Age-

related Non-communicable Disease in sub-Saharan Africa: Identifying Key

Information and Training Needs” in Abuja, Nigeria.

The dialogue brought together some 35 experts - health professionals,

academics and policy makers from four key African countries (Kenya, Nigeria,

South Africa, Senegal) and a number of international resource persons - in three

days of structured discussions and specialist presentations. This report provides a

concise overview of the background, rationale, purpose and aims of the dialogue,

and results and concrete outcomes generated.

II. II. II. II. BACKGROUNDBACKGROUNDBACKGROUNDBACKGROUND

1) 1) 1) 1) Demographic TrendsDemographic TrendsDemographic TrendsDemographic Trends

Sub-Saharan Africa’s (SSA) populations are ageing. While the median age and

proportion of persons age 60 years and over1 will remain lower than in other

world regions, the absolute number of older persons in SSA is projected to rise

sharply from 37.1 million in 2005 to 155.4 million in 2050 – a more rapid

increase than in any other world region and for any other age group (UNPD,

2008). Contrary to misconceptions, moreover, older people in Africa will on

average live many years beyond age 60. Indeed, life expectancy at age 60 in SSA,

currently 15 years for men and 17 years for women, does not differ markedly

from that in other world regions (UN, 2006).

Within the overall picture for SSA some clear sub-regional variations exist. The

rise in the number of older people will be greatest in East, West and Central

Africa. Southern Africa will see much smaller increases in absolute numbers, but

has the largest and fastest growing population share of older persons (UN, 2008).

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2) 2) 2) 2) Health Implications of Ageing in SSAHealth Implications of Ageing in SSAHealth Implications of Ageing in SSAHealth Implications of Ageing in SSA

Population ageing and rising exposure to modifiable risk factors, such as tobacco

use, an unhealthy diet and a lack of physical activity, are fostering a growing

burden of age-related NCD in SSA. Most prominent among the diseases are

hypertension, diabetes, heart disease and stroke (WHO, 2005, 2006). Available

data suggests that heart disease and stroke are the leading causes of mortality

among older adults in SSA (WHO, 2005, 2006; Steyn et al. 2006).

At an individual level, evidence shows that older persons suffer additionally from

other NCD - particularly musculo-skeletal conditions, visual impairments, and

mental disorders such as dementia and depression, and consequent functional

limitations (e.g. Steyn et al. 2001; Steyn, 2006; Steyn, Fourie & Temple, 2006;

NPHCDA, 1999; Bakare et al. 2004; Oguntona et al. 2004; Clausen et al.

2005a,b,c; Gureje, Kola & Afolabi, 2007; Gureje, Ogunniyi & Kola, 2006; Gureje et

al. 2006; Kahn et al. 2006)

Yet, only limited understanding exists of the magnitude, patterns, dynamics,

social determinants, and individual and societal impacts of ill-health in older ages

across SSA societies.

3) 3) 3) 3) Policy Agendas: International, RegionalPolicy Agendas: International, RegionalPolicy Agendas: International, RegionalPolicy Agendas: International, Regional, , , , NationalNationalNationalNational

In response to the broad demographic ageing and health trends, two key recent

supranational policy frameworks - the United Nations Madrid International Plan

of Ageing 2002 (MIPAA) and the African Union regional Policy Framework and Plan

of Action on Ageing 2003 (AU-Plan) - call on governments to forge policy action

to promote older persons’ health and advance well-being into old age. The

frameworks, to which all SSA countries are signatory, emphasise a need for

measures to advance health service provision and training in order to ensure

effective, fully accessible, prevention, control and management and disability care

for age-related NCD (UN, 2002; AU/HAI, 2003).

Fuelled by MIPAA and the AU Plan, several SSA nations have formulated policies

on the health of older persons and/or age related NCD. Yet - and despite the fact

that a first review and appraisal of MIPAA implementation in Africa (as in other

world regions) was conducted in 2007 (UNPD, 2007) - there is a lack of insight on

what specific strategies have been formulated, approved or executed across

countries. Indications are that (with a few notable exceptions) very little effective

policy action has ensued, with SSA health systems remaining largely inaccessible

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and/or unresponsive to older persons and age-related NCD (Aboderin & Ferreira,

2008; Aboderin & Gachuhi, 2007; McIntyre, 2004; WHO, 2006; Unwin et al. 2001;

Sanders, Todd & Chopra, 2005; Ogunniyi & Aboderin, 2007)

However, there is a dearth of systematic information across countries regarding

the nature and specific shortcomings of health service provision, and the key

impediments to effective policy action.

III. III. III. III. PURPOSPURPOSPURPOSPURPOSEEEE, GOAL AND AIMS, GOAL AND AIMS, GOAL AND AIMS, GOAL AND AIMS

In light of the above situation, the key purpose purpose purpose purpose of the dialogue was to stimulate

exchange and consultation between practice, policy and research and between the

four participant countries in order to:

1. Identify the principal impediments to effective policy action on older

persons’ health/age-related non-communicable disease, and key

associated information and training gaps, across countries

2. Develop relevant Africa-owned, cross-national collaborative research and

training responses to address the gaps

In so doing the overall goaloverall goaloverall goaloverall goal of the dialogue was to contribute to the forging of

evidence and relevant training to promote effective policy action on ageing and

health in SSA as stipulated in MIPAA and AU Plan. In pursuit of this goal the

sssspecific aimspecific aimspecific aimspecific aims were to

1. Establish, for each participant country, a clear picture of the status and

shortcomings of policy and health service provision for older persons/age-

related NCD – and associated key information and training gaps

2. Identify key information and training gaps across countries

3. Identify opportunities, approaches and first steps for forging cross-

national, collaborative research and training responses

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IV. IV. IV. IV. RESULTSRESULTSRESULTSRESULTS AND CONCLUSIONSAND CONCLUSIONSAND CONCLUSIONSAND CONCLUSIONS

Five thematic dialogue sessions were held, in each of which individual country

briefings were presented, followed by open discussion and exchange between

countries. Through the joint deliberations, the Abuja dialogue generated the

following key cross-cutting insights and conclusions1

1) 1) 1) 1) Existing pExisting pExisting pExisting policyolicyolicyolicy on hon hon hon health ealth ealth ealth service provision for service provision for service provision for service provision for older persons/ageolder persons/ageolder persons/ageolder persons/age----related NCDrelated NCDrelated NCDrelated NCD

All countries have formulated one or more policies, targeted either specifically at

older persons or the general population, which pursue a broad goal of ensuring

effective, accessible health service for older persons and/or age-related NCD.

The policies fall into two distinct substantive categories:

a) Policies relating to individuals’ free (at no cost) access to health services

b) Policies relating to specific health care provision for older persons/age-

related NCD

Within the broad categories, the specific content and scope of policies show

similarities but also clear variations across countries. (see Table 1 for an overview

of policy types across countries)

Policies on free access to health services

Free access policies specifically targeted at older persons include: Senegal’s ‘Plan

Sésame’ (introduced in 2006), which provides free health care for all persons age

60+, even though health care is not free for the general population. South Africa’s

free health care (according to Dept. of Social Welfare guidelines) at primary,

secondary and tertiary levels for frail older persons and beneficiriaries of a social

old age grant pension.2

Kenya and Nigeria do not have comparable access policies targeted at older

persons. Both countries, however, provide subsidized primary health care for all

citizens with elements that are provided free of charge, such as basic

consultations and the dispensing of drugs on the essential drugs lists (EDL)3.

1 Detailed information on the status of policy, practice, training and research in individual countries is

contained in the individual country presentations, which will be made available on the AFRAN website. 2 For the general population, South Africa provides means tested primary, secondary and tertiary care.

3 In Nigeria the exact cost arrangements regarding PHC provision vary between federal states.

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Policies on specific health care provision for older persons/age-related NCD

Kenya and Nigeria, but not Senegal or South Africa, have formulated policies on

the provision of specific preventive and/or curative health care responses for

older persons. In Kenya the policies focus mainly on disease prevention/health

education measures and are part of the Kenya National Health Sector Strategic

Plan II and Annual Operation Plan II 2005-2010. The more comprehensive

Nigerian policies are incorporated in the Draft Nigeria National Policy on the Care

and Well-being of the Elderly (2003).

All countries, meanwhile, have forged general policies, strategies or visions

regarding the provision of health services to prevent and manage age-related

NCD. All such strategies emphasise the key role of PHC as the principal vehicle

for the delivery of health care to the population.

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Table 1: PolicTable 1: PolicTable 1: PolicTable 1: Policy on older persons’ health/agey on older persons’ health/agey on older persons’ health/agey on older persons’ health/age----related NCD in the four participant related NCD in the four participant related NCD in the four participant related NCD in the four participant

countriescountriescountriescountries

Free Access

Specific Health Care Responses

Old age-targeted

General

For older persons

Generally for NCD

Kenya

No

Yes • subsidized PHC with

free aspects, e.g. free EDL drugs

Yes • part of National Health

Sector Strategic Plan II and Annual Operation Plan II 2005-2010

Yes • part of National

Health Sector Strategic Plan II and Essential Package for Health 2005-2010

Nigeria

No

Yes • subsidized PHC with

free aspects, e.g. free EDL drugs

Yes • part of draft National

Policy on the Care and Well-being of the Elderly (2003)

Yes • part of revised

National Health Policy (2004)

Senegal

Yes • Plan Sésame

(2006) – free health care for all persons aged 60+

No

No

Yes • part of National

Action Plan on NCD, (date??)

South Africa

Yes • free health care for

frail older persons & social pension recipients (date??)

Yes

• free PHC, means-tested SHC and THC

No

Yes • part of National

‘Strategic Vision for NCDs’ (date??)

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2) Imple2) Imple2) Imple2) Implementation status of policy mentation status of policy mentation status of policy mentation status of policy

The various old age-targeted policies across countries are at differing stages of

implementation. Nigeria’s draft policy on the Care and Well-being of the Elderly

is not yet operational (i.e. has not yet been ratified). Kenya, Senegal and South

Africa, in contrast, have ratified and begun to implement their specific policies

targeted at older persons. All countries’ general policies regarding free health

care access or health care provision for age-related NCD are operational and are

being implemented.

However, all countries report (to varying degrees) limitations and major

impediments to the effective realization of the goals of both old age-targeted and

general policies. These are discussed below.

3) 3) 3) 3) Impediments to effective policy actionImpediments to effective policy actionImpediments to effective policy actionImpediments to effective policy action

Three principal, inter-related impediments were identified that operate variously

to inhibit effective policy action on older persons’ health and age-related NCD

(see Figure 1):

1. Incoherent, patchy policy formulation

While covering important ground, both old age-targeted and/or general policies

on specific health care responses lack (to differing degrees) coherence and

breadth, for example, with regard to a multisectoral focus or clarity on the relative

need for age-segregated vs integrated approaches.

2. Obstructed ratification of and/or insufficient allocation of funding for policy

implementation

The failure of the executive to ratify or endorse old age-targeted policies, as in

Nigeria, or to allocate sufficient funding for the implementation of policies on

older persons’ health/age-related NCD most directly reflects a lack of political

will, awareness or interest. This arises within the context of an explicit public

health priority focus on infectious disease (specific focal diseases vary across

countries), and maternal and child health in a bid to achieve the Millennium

Development Goals (MDGs) (UN, 2000). Indirectly, a lack of political awareness or

will reflects a lack of effective civil society pressure and advocacy from

practitioners.

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3. Ineffective delivery of services

In large part a consequence of impediments 1 and/or 2, above, the effective

delivery of health services for older persons and/or age-related NCD across the

four participant countries is constrained by deficient health system resources –

such as the workforce, shortages of drugs and equipment, and/or a lack of

relevant health-staff training. In addition, service delivery is hampered by

structural and organizational barriers that limit older persons’ access to health

facilities.

Figure 1: Impediments to effective policy actionFigure 1: Impediments to effective policy actionFigure 1: Impediments to effective policy actionFigure 1: Impediments to effective policy action

4) 4) 4) 4) KeyKeyKeyKey shortcomings in shortcomings in shortcomings in shortcomings in primary, secondary and tertiary care primary, secondary and tertiary care primary, secondary and tertiary care primary, secondary and tertiary care delivedelivedelivedeliveryryryry

Deliberations on the specific status of current health service provision for older

persons/age-related NCD highlighted six key shortcomings that hinder (to

varying degrees) the effective delivery of primary, secondary and tertiary health

care (PHC, SHC, THC) across the four participating countries (see Figure 2).

Typical consequences include (i) poor or incorrect detection, diagnosis, secondary

prevention and management of age-related NCD or other syndromes associated

to old age (e.g. depression or falls); (ii) limited primary prevention services; and

(iii) health facility-based accidents or care deficiencies (such as inadequate patient

feeding)

Formulation Ratification/ Funding

Health care delivery

Lack of:

• Coherent, comprehensive approaches, e.g regarding:

• Multisectorality • Age-segregation vs

integration

Lack of:

• Health system resources ($$$, workforce, drugs, equipment)

• Sufficent staff traning • Buy-in from practitioners • Guards against programme

overuse/abuse • Structural/organisational

measures to facilitate access

1 2 3

Lack of:

• Political will or interest

• Civil society pressure

• Advocacy by practitioners

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Figure 2: Figure 2: Figure 2: Figure 2: KKKKey shortcomings in health care delivery for older persons/ageey shortcomings in health care delivery for older persons/ageey shortcomings in health care delivery for older persons/ageey shortcomings in health care delivery for older persons/age----related NCD related NCD related NCD related NCD

1. Limited NCD/old age-care competence and responsiveness among staff

All countries reported a clear lack of NCD/old age-care competence and

responsiveness among health staff at all levels. This reflects a cross-cutting gap

in the availability of relevant gerontological and geriatric training for both student

and already qualified health staff. Senegal and South Africa offer such

undergraduate and postgraduate training only in a small number of specialist

centres4, while virtually no training is available in Nigeria and Kenya.

2. Lack of requisite drugs and equipment

Across all countries, health facilities, especially at primary care level, lack

requisite equipment and drugs needed for effective diagnosis and treatment of

geriatric conditions and/or age-related NCD. However, the extent of the

shortages differs between countries. In Nigeria, even basic drugs (e.g. for

hypertension, diabetes or arthritis management) are not on the free EDL and are

mostly unavailable at PHC level, as are basic NCD diagnostic tools (such as

diabetes testing kits or sphygmomanometers). In Kenya, while basic NCD related

drugs are included in the EDL, they are frequently not obtainable in PHC facilities.

4 Specifically the University Geriatric Teaching hospital of the Senegalese National Retirement Institute

(IPRES), and the universities of Cape Town and KwaZulu Natal, respectively

Lacking old age care/NCD competence and responsiveness at all staff levels

Lack of requisite equipment & drugs

Insufficient coordination between: –PHC, SHC and THC (referral) –Disciplines/services within SHC/THC

Workforce shortages

Age-unfriendly design

Access limitations (distance, transport, waiting times/areas,$$$)

Poor primary prevention services

Facility-based accidents, Care deficiencies

Limited/incorrect detection, diagnosis, secondary prevention, management of age-related NCD/ other old age health conditions

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Patients must, therefore, de facto purchase them (either privately or at SHC or

THC levels). In South Africa and Senegal, basic relevant drugs and equipment are

typically available at PHC level. In all countries, meanwhile, more specialized

geriatric care medications or equipment are frequently not obtainable even at SHC

and THC levels.

3. Insufficient coordination between and within care levels

Across all countries insufficient integration and coordination between PHC, SHC

and THC levels undermine referral processes, while a lack of service integration

within facilities militates against effective management of more serious cases.

4. Access barriers

In addition to access barriers related to user fees (in countries without old age-

targeted financial access measures) and costs of prescribed medication, older

persons’ access to health services may be inhibited by a number of structural and

organizational factors. These include (i) the distance of health facilities and

associated transport costs or difficulties, (ii) a lack of amenities (such as toilets or

adequate waiting/seating areas), and (iii) the length of waiting times and queues

in health facilities

5. Workforce shortages

Across all countries, and particularly in South Africa and Kenya, workforce

shortages due to insufficient staff recruitment and retention – especially in rural

areas, curtail the response capacity of, and contribute to stress and potentially

ageist attitudes among existing staff.

6. Age un-friendly design/lack of auxiliary care staff

Age-unfriendly design of most health facilities, coupled with a lack of auxiliary

care staff, increases the risk of older patient accidents (such as falls) and care

deficiencies (such as inadequacies in patient feeding)

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5) 5) 5) 5) Key Information NeedsKey Information NeedsKey Information NeedsKey Information Needs

In light of the above, the dialogue crystallized four key cross-cutting information

needs that should be addressed as a priority in order to address key impediments

to effective policy action (see Box 1). Significantly, these information needs are

consistent with broader research requirements identified in the United Nations

Research Agenda on Ageing for the 21st Century for the Africa region (RAA 21)

(UN, 2005),and the initial AFRAN framework for policy-relevant research on health

and ageing in Africa (Aboderin, 2005)

Box 1: Box 1: Box 1: Box 1: Priority Priority Priority Priority crosscrosscrosscross----cutting information needs to advance effective policycutting information needs to advance effective policycutting information needs to advance effective policycutting information needs to advance effective policy actionactionactionaction 1. Audit of: → the relative frequency and nature of age-related NCD/older patients

presenting at health facilities; → nature of, and patients’ satisfaction with service responses → perspectives of health staff 2. The Burden of age-related NCD and impaired function at older ages:

→ Risk factor, morbidity, mortality incidence/prevalence trends → Relative access to health care (age-related) → Impact on families and economic productivity

3. Older persons' health perspectives, attitudes and behaviours (and their social

and environmental determinants) 4. Evaluation, and documentation of existing good policy or practice

Considerable relevant evidence or planned research in the four areas already exist

across the countries. Relatively more research exists particularly in South Africa,

as well as Senegal and Nigeria, and relatively less in Kenya. However, most data

sets are small-scale and limited in scope, and virtually no nationally

representative data exist in any of the countries. Consequently, no current

evidence on its own - or in combination - comprehensively addresses the

information needs. This highlights an urgent need for the development of cross-

national, collaborative research to address the information needs, building where

possible on evidence or research plans already existing in participant countries.

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6) 6) 6) 6) Key Training NeedsKey Training NeedsKey Training NeedsKey Training Needs

The dialogue distilled two principal key training needs that need to be addressed

as a priority to enable the advancement of effective health service provision for

older persons and age-related NCD across all four countries (see Box 2).

The training responses should be developed by building on the fairly considerable

geriatric and gerontological training expertise that already exists, specifically in

South Africa and Senegal, and where needed, on relevant expertise or experience

from other developing world regions (for example Latin America) by way of

fostering South-South collaboration and support.

Box 2: Priority crossBox 2: Priority crossBox 2: Priority crossBox 2: Priority cross----cutting training needs to advance effective pcutting training needs to advance effective pcutting training needs to advance effective pcutting training needs to advance effective policy actionolicy actionolicy actionolicy action

1. Development of basic NCD/old age care responsiveness at PHC level

A most pressing need exists for the forging of basic NCD/old age care responsiveness among all levels of existing staff most essentially at primary health care level. Responsiveness, in this context means:

• Understanding and application of simple, culturally appropriate procedures for the

promotion, prevention, detection, diagnosis, treatment and referral of chief age-related NCD/old age health conditions

• Availability and use of apposite health promotion (e.g. Information, Communication,

Education (ICE)) materials to support promotive and preventive procedures 2. Under- and postgraduate geriatric and gerontological training

A vital need exists for the development of Africa-apposite geriatric medicine and gerontological training modules to be incorporated into:

• Existing undergraduate medical and nursing curricula • Postgraduate training for already qualified medical and nursing staff and other

relevant health professionals

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V.V.V.V. THE WAY FORWARD: THE WAY FORWARD: THE WAY FORWARD: THE WAY FORWARD: PLAN OF ACTIONPLAN OF ACTIONPLAN OF ACTIONPLAN OF ACTION

In a bid to begin to address the identified priority research and training needs, the

dialogue participants collectively resolved to forge a set of concrete, cross-

national research(3) and training projects(2). For each project, the dialogue

established an initial working group, a basic approach and a set of first action

steps to take the development forward. These are outlined below.

1) 1) 1) 1) Research Research Research Research projectsprojectsprojectsprojects to be forgedto be forgedto be forgedto be forged

a)a)a)a) Audit of Audit of Audit of Audit of old age/ageold age/ageold age/ageold age/age----related NCD relrelated NCD relrelated NCD relrelated NCD related ated ated ated health shealth shealth shealth serviceerviceerviceervice patient load patient load patient load patient load Project

• An ‘Audit’ of the nature and extent of older persons’ health problems and

age-related NCD presenting at public health facilities in Senegal and South Africa

Approach

• Analysis of existing Health Management Information System (HMIS) data,

routinely collected at primary, secondary and tertiary care levels in Senegal and South Africa. (Nigeria and Kenya HMIS unfortunately do not collect routine data on age-related NCD)

Working Group

Dr. Mamadou Coumé – Senegal Prof. Bilkish Cassim – South Africa Dr. Marie Strydom - South Africa Dr. Isabella Aboderin - AFRAN/Oxford Institute of Ageing Mr. Jaco Hoffman - AFRAN/Oxford Institute of Ageing

Funding

• To be funded with research seed money provided to AFRAN at the Oxford Institute of Ageing, by Help the Aged, UK

Timing

• It is envisaged that the audit will commence by December 2008

First Steps

• Jaco Hoffman and Isabella Aboderin will, over the next few weeks, initiate

discussion among the working group,to establish the exact approach, scope and implementation modalities for the audit.

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b)b)b)b) FFFFourourourour----country study on the ‘burden’ of old age illcountry study on the ‘burden’ of old age illcountry study on the ‘burden’ of old age illcountry study on the ‘burden’ of old age ill----health/agehealth/agehealth/agehealth/age----related NCDrelated NCDrelated NCDrelated NCD Project

• A four-country collaborative study in South Africa, Kenya, Senegal and

Nigeria, to examine key aspects regarding the ‘burden’ of old-age ill-health and age-related NCD

Approach

• The approach, exact focus and methodology for the study will be

developed by the working group, building on suggestions generated by the dialogue. These include:

– Incorporation of a focus on mental- and/or cognitive ill-health

– Exploration of the burden of ill-health on families/economic productivity

– Building on already established research plans for: • A ‘health survey of older persons in the Inanda, Ntuzuma, Kwamashu area

of Kwa-Zulu Natal’ developed by the Department of Geriatrics, University of Kwa-Zulu Natal

and/or • A ‘study to understand and foster the functioning and involvement of

contributive elders (SUFFICE)’ developed by the Institute of Ageing in Africa, University of Cape Town

Working Group

Prof. Bilkish Cassim, South Africa Dr. Sebastiana Kalula, South Africa Dr. Fred Bukachi, Kenya Dr. Mamadou Coumé/Dr. Kamadore Touré – Senegal Prof. Adesola Ogunniyi/Dr. Lawrence Adebusoye – Nigeria Dr. Isabella Aboderin – AFRAN (Oxford Institute of Ageing) Prof. Robert Cumming – Australia/Uganda

Funding

• Through application to relevant funding agencies. Application will also be made for a seed grant to support the comprehensive development and planning of this project

Timing

• It is envisaged that the seed grant application will be submitted latest by

December 2008

First Steps

• Isabella Aboderin will, over the next few weeks, initiate an electronic working group discussion to refine ideas on the study focus and scope with a view to developing a coherent project concept note and seed grant application. Opportunities for seed grant funding will be explored and pursued by Isabella Aboderin and Jaco Hoffman at the Oxford Institute of Ageing.

16

c)c)c)c) ThreeThreeThreeThree----countrycountrycountrycountry study on falls, fractures and musculostudy on falls, fractures and musculostudy on falls, fractures and musculostudy on falls, fractures and musculo----skeletal conditions in skeletal conditions in skeletal conditions in skeletal conditions in

older personsolder personsolder personsolder persons Project

• A three-country epidemiological study in South Africa, Uganda and

Nigeria, to explore the prevalence/incidence, risk factors and policy implications of falls, fractures and musculo-skeletal conditions among rural and urban older persons

Approach

• Conception of this study predates the Abuja dialogue. However, the dialogue discussions served to reaffirm its relevance, to crystallize requirements to its scope and focus and to extend the number of study partners. The precise methodology and approach for the study are being developed by the working group.

Working Group

Prof. Robert Cumming – Australia/Uganda Prof. Bilkish Cassim, South Africa Dr. Sebastiana Kalula, South Africa Prof. Adesola Ogunniyi/Dr. Lawrence Adebusoye – Nigeria Mr. Jaco Hoffman - AFRAN (Oxford Institute of Ageing)

Funding

• A study proposal will be submitted for funding to the Wellcome Trust, UK

Timing

• It is envisaged that the funding application will be submitted latest by March 2009

First Steps

• The working group will continue discussions to finalise a detailed technical and financial project proposal to be submitted to the Wellcome Trust, UK

17

2) 2) 2) 2) TTTTraining raining raining raining projectsprojectsprojectsprojects to be forgedto be forgedto be forgedto be forged

a) a) a) a) BasiBasiBasiBasic geriatric and gerontological training coursec geriatric and gerontological training coursec geriatric and gerontological training coursec geriatric and gerontological training course Project

• Development and delivery of:

– A short training course in geriatric medicine primarily for qualified SSA medical staff

– A short training course in health-related aspects of gerontology primarily for qualified nurses and professions allied to medicine

Approach

• Content and organization of the training course will be developed by the

working group building directly on existing expertise and experience in Senegal and South Africa. It is envisaged that the course will be organised in one of the four participant countries but will draw participants from a wider range of SSA nations.

Working Group

Prof. Bilkish Cassim - South Africa Dr. Sebastiana Kalula - South Africa Prof. Monica Ferreira - South Africa Dr. Fred Bukachi - Kenya Dr. Mamadou Coumé - Senegal Prof. Mamadou Mourtalla Ka – Senegal Prof. Adesola Ogunniyi/Dr. Lawrence Adebusoye – Nigeria Prof. Renato Maia – IAGG (Brazil)

Funding

• Application will be made for a seed grant to support the comprehensive development and planning of this project. A suitable funding source will be identified as part of the planning process.

Timing

• It is envisaged that the seed-grant application will be submitted latest by December 2008

First Steps

• Isabella Aboderin will, over the next few weeks, initiate electronic working

group discussion on the approach, scope and format of the training course. Opportunities for seed grant funding will be explored and pursued by Isabella Aboderin and Jaco Hoffman at the Oxford Institute of Ageing.

18

b) b) b) b) Developing basic PHC Developing basic PHC Developing basic PHC Developing basic PHC NCD/NCD/NCD/NCD/old age care old age care old age care old age care responsivenessresponsivenessresponsivenessresponsiveness Project

• Development of training to foster basic old age care/NCD responsiveness

at PHC level Approach

• The development of training will involve:

– Identification (by an apposite expert group) of five chief age-related NCD/health conditions for which PHC responsiveness is needed as a priority

– Forging of simple, culturally appropriate procedures (and requisite materials) for the promotion, prevention, detection, diagnosis and management of these conditions – building on existing expertise in SSA or other developing world regions

– Delivery of training to relevant PHC staff from the four participant countries

Working Group

Prof. Renato Maia Guimarães – IAGG (Brazil) Dr. Laura Machado – IAGG (Brazil) Dr. Isabella Aboderin – AFRAN/ Oxford Institute of Ageing Others to be confirmed

Funding

• It is envisaged that the development and delivery of training will be

supported by funding from the International Association of Gerontology and Geriatrics (IAGG)

Timing

• Development of the training is envisaged to commence before December

2008

First Steps

• Renato Maia Guimarães, Laura Machado and Isabella Aboderin will, over the next few weeks, finalise discussions on the basic composition of the working and expert group, and the modalities for the process of training development

19

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