International Day of Older Persons, 1 October (2)

2 October, 2019

Dear Neil, thanks for sharing this piece.

LMICs like Nigeria, the most populous country in the Africa continent, have no social safety net that guarantees any kind of basic safeguard for its citizens (‘roof over their head’, ‘food’, ‘healthcare’, ‘basiceducation’, ‘some pocket money when out of work’, etc). None has achieved universal health coverage or even come near it, and most are struggling with the whole idea. None to my knowledge has a structured comprehensive social care programme. To grow old in an LMIC has become a curse!

LMICs have been rightly focused on communicable diseases, maternal and child care. And so they must do, and continue to do. But in the time being, notice must be taken of non communicable diseases (NCDs) lurking ‘silently’ in the health space and beginning to account for most deaths in some cases.  Older people suffer most from these NCDs which at present is not receiving sufficient attention. Awareness is generally lacking, because of poverty, ignorance, superstition and some harmful traditional and cultural beliefs and practices. Every death is caused by ‘your enemy’ or evil spirit, still. Even when a known alcoholic succumbs to liver failure, an older person in the family is accused to have ‘exchanged his life with the dead younger alcoholic who is dead’. The consequences is often deadly for the accused.

However, this International Day for Older People is particularly important because, perhaps, the greatest ‘silent killer’ is what happens to the millions of older people in the population, their neglect; lack of policy or where there is a policy, the lack of implementation; even though the number of older people is on the increase due to marginal achievements in health improvement efforts. Lifespan overall may be short but when they live long enough to be considered old people there is nothing to support that segment of the population.

To worsen matters, the legendary African family and village community self support system has largely disappeared for a myriad of reasons: rural to urban/city migration, job seeking and education far away from basic family settlement, and indeed immigration to other countries and continents seeking a better life, etc.

We read the paragraphs in your posting, quoted below, and wish that the statistics therein will stimulate and motivate LMICs to think ofways to support the Older people in their countries. It is time for all LMICs to establish functional comprehensive social care systems, including for example Home care/Hospital-at-home Care for the older people, etc. The relevant quotes are:

'Between 2017 and 2030, the number of persons aged 60 years or over is projected to grow by 46 per cent (from 962 million to 1.4 billion) globally outnumbering youth, as well as children underthe age of 10. Moreover, this increase will be the greatest and most rapid inthe developing world (A/RES/73/143). Population ageing is poised to become oneof the most significant social transformations of the 21st century. Older people have always played a significant role in society as leaders, caretakers and custodians of tradition. Yet they are also highly vulnerable, with many falling into poverty, becoming disabled or facing discrimination. As health care improves, the population of older people is growing. Their needs are also growing, as are their contributions to the world.

Joseph Ana

HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007.


Joseph is a member of the HIFA Steering Group:

Email: jneana AT