The need to incorporate the impact of population ageing into the post-COVID-19 policy and planning reset in Low and Middle Income Countries

Figures & data

Table 1. Progress on action items from the South African plan of action on ageing [14]

Action item in SA plan on ageing	Progress
Undertake research on older persons’ needs	Few studies published from 2006 to 2020: all part of broader international studies (e.g. WHO SAGE and INDEPTH HAALSI). None commissioned by the South African government.
Develop and review health budgets to ensure adequate funding is devoted to the provision of services (free access to older persons)	There is no evidence of this having taken place. A study in which key government and civil society stakeholders were interviewed found that mainstreaming of ageing issues has not taken place in part due to lack of appropriate budget allocations and resources within government departments [18].
Ensure in-service training for health professionals on health needs of older persons	Health professionals receive very little geriatric training and research has shown that health professionals lack the knowledge and skills to address older persons’ particular health needs [20].
Ensure appropriate and continuous training on ageing issues for community health workers	There is no evidence to establish whether this is occurring: unlikely given that no other initiatives have been implemented.
Ensure national coverage of comprehensive health services, including HIV and AIDS services for older adults	This objective is vague and difficult to measure. Primary health services (including care for NCDs and HIV and AIDS management) are widely available to the general population including older persons. However, specialised services are less available and accessible outside of urban areas.
Strengthen integrated geriatric services and training at all levels of the health care systems.	There is no evidence of efforts in this regard. In fact, existing research demonstrates high levels of dissatisfaction among older persons presenting at primary care facilities, low levels of quality of care, and a lack of trust in public healthcare professionals in both rural and urban settings [21,22].
Provide free health services to older persons, especially those with disability who are unable to meet the costs	This objective has been notionally achieved. PHC services, where available and accessible, are free to all older and elderly persons and secondary and tertiary healthcare services are free to all older people in receipt of a social grant (70% of persons over 60 receive social grants).
Develop and implement a strategy for the provision of safe traditional medicine	The Traditional Health Practitioners Act 22 of 2007 aims to regulate the provision of traditional health care to ensure safety and quality of services. A directorate of Traditional Medicine was also established within the NDoH and the Act establishes a Traditional Health Practitioners Council to manage the registration, training and conduct of traditional health practitioners and students. However, registration has been low due to poor knowledge and understanding, as well as suspicion by traditional health practitioners, and there is no code of conduct in place [23].
Provide comprehensive ophthalmic services for older persons	Ophthalmic services appear to be a low priority. They are poorly defined in health policy and there is no specific policy or financing model for eye health, resulting in poor service delivery and poor access to services, particularly in rural areas where there is inadequate equipment. There is a high prevalence of preventable age-related vision loss, pointing to inadequacy of eye-care services and eye health screening and promotion efforts [24–26]. The three leading causes of preventable blindness in older persons in South Africa (refractive error, cataracts and glaucoma) are addressed by national guidelines on refractive error screening for persons 60 years and older and on cataract surgery, as well as the National Guideline on the Prevention of Blindness in South Africa [27], but there is little information available on their implementation.
Provide comprehensive oral health services for older persons	Primary-level oral health services are free in terms of policy. Research has shown that there are significant barriers to use, including a lack of awareness of free services and accessibility challenges [28] and there are no programmes targeted specifically at older persons.
Subsidise the costs of assistive devices for older persons	Occupational therapists in health services can prescribe heavily subsidized basic assistive devices for older persons. However, knowledge of services, availability and waiting times act as constraints to access, and NGOs act to fill this gap.
Develop and implement a strategy for the management of chronic health conditions that are more prevalent in old age	The Draft NDoH Strategic Plan for the Prevention and Control of NCDs 2020–2025 [29] focuses on reducing and managing NCDs. The policy takes a life-course approach, but does not sufficiently focus on older persons’ needs
Implement national programmes on healthy lifestyles	Healthy lifestyle programmes targeting behavioural risk factors for NCDs have been developed as part of the National Strategic Plan for the Prevention and Control of NCDs. The National Health Promotion Policy and Strategy 2015–19 [30] aims to improve longevity by promoting lifestyle change, creating supportive environments and developing personal skills for self-management of chronic conditions. This is achieved through community-based programmes and support groups run by health promoters. The Health for All health promotion tool has also been introduced in Primary Health Care facilities to promote primary and secondary health risk identification and mitigation. However, none of these programmes are targeted specifically at older persons and their age appropriateness is unclear.

NCD – non-communicable disease; NDoH – National Department of Health; NGO – Non-governmental organisation; WHO SAGE – World Health Organisation Study on Global AGEing and Adult Health; Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa.

Department of Social Development. South African plan of action on ageing. Pretoria: Department of social development; 2006. Republic of South Africa. Pretoria, South Africa.

 Google Scholar

Goodrick W, Pelser A. The greying of a rainbow nation: policy responses to the implications of population ageing in South Africa. African Population Studies. [2014 Jun 03];2014, 13.

 Google Scholar

Kalula S, Petros G. Responses to dementia in less developed countries with a focus on SA. IFA Global Ageing. 2011;11.

 Google Scholar

Kelly G, Mrengqwa L, Geffen L. “They don’t care about us”: older people’s experiences of primary healthcare in Cape Town, South Africa. BMC Geriatr. 2019 Apr 4;19:98.

 Web of Science ®Google Scholar

Peltzer K, Phaswana-Mafuya N. Patient experiences and health system responsiveness among older adults in South Africa. Glob Health Action. 2012 Nov 27;5:1–11.

 Web of Science ®Google Scholar

Mothibe ME, Sibanda M. African traditional medicine: South African perspective. Traditional and complementary medicine. Intech Open. 2019;83790. doi:https://doi.org/10.5772/intechopen.83790

 Google Scholar

Department of Health. Directorate – Chronic diseases, disabilities and geriatrics. 2002 Dec. National Guidelines: Prevention of Blindness in South Africa. Available from: https://www.westerncape.gov.za/text/2003/blindness.pdf

 Google Scholar

Molete MF, Yengopal V, Moorman J. Oral health needs and barriers to accessing care among the elderly in Johannesburg. SADJ. 2014 Sep 69;8: 352.

 Google Scholar

National Department of Health. National strategic plan for the prevention and control of non-communicable diseases 2020-2025 (Draft). Pretoria: National Department of Health; 2019.

 Google Scholar

Department of Health South Africa. The National health promotion policy and strategy 2015–2019. Pretoria, South Africa: South African National Department of Health; 2015. https://health-e.org.za/wp-content/uploads/2015/09/The-National-Health-Promotion-Policy-and-Strategy.pdf

 Google Scholar