Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka evidence from NEESAMA

Figures & data

Table 1. Population demographics, 2018 [22].

	Bangladesh	India	Nepal	Pakistan	Sri Lanka
Population, total	161,356,039	1.353 billion	28,087,871	212,215,030	21,670,000
Population growth (annual %)	1.050	1.037	1.654	2.056	1.048
Population aged 65 and above, total	8,323,375	83,591,151	1,608,781	9,152,355	2,269,547
Population aged 65 and above (% of total population)	5.158	6.18	5.728	4.313	10.473
Life expectancy at birth, total (years)	72.052 (2017)	69.165 (2017)	70.169 (2017)	66.947 (2017)	76.648 (2017)
Literacy rate, adult total (% of people ages 15 and above)	73.912	74.373	67.908	59.132 (2017)	91.71
GDP (current US$)	274.025 billion	2.719 trillion	29.04 billion	314.588 billion	88.901 billion
GDP per capita (current US$)	1,698.263	2,009.979	1,033.912	1,482.403	4,102.481
Poverty headcount ratio at $1.90 a day (2011 PPP) (% of population)	14.8 (2016)	21.2 (2011)	15.0 (2010)	3.9 (2015)	0.8 (2016)
Current health expenditure (% of GDP)	2.365 (2016)	3.658 (2016)	6.294 (2016)	2.753 (2016)	3.893 (2016)

Table 2. Human resources for older persons’ health.

	Bangladesh	India	Nepal	Pakistan	Sri Lanka
Physicians (per 1,000 people) [22]	0.472 (2015)	0.758 (2016)	0.598 (2014)	0.978 (2015)	0.881 (2015)
Geriatricians	Not available	Not available	1^1	5–10^2	3 [63]
Psychiatrists (per 100,000 people)	0.130 (2016) [26]	0.292 (2016) [26]	0.356 (2016) [26]	0.185 (2011) [60]	0.517 (2017) [26]
Old-age psychiatrists	0 (2017) [27]	Indian Association of Geriatric Mental Health members: 583 [28]	1 (2019)^1	5–10 (2020)^2	Not available
Nurses and midwives (per 1,000 people) [22]	0.267 (2015)	2.094 (2016)	2.041 (2014)	0.502 (2015)	2.794 (2015)
Nurses working in mental health sector (per 100,000 population)	0.873 (2016) [26]	0.796 (2016) [26]	0.558 (2016) [26]	7.384 (2011) [60]	3.278 (2017) [26]
Social workers working in mental health sector (per 100,000 population)	Not available	0.065 (2016) [26]	Not available	1.702 (2011) [60]	0.285 (2017) [26]
Psychologists working in mental health sector (per 100,000 population)	0124 (2016) [26]	0.069 (2016) [26]	0.523 (2016) [26]	0.259 (2011) [60]	0.246 (2017) [26]
Community health workers (per 1,000 people) [22]	0.476 (2012)	0.581 (2016)	0.684 (2004)	0.087 (2015)	Not available
Physical therapists	2,135 (2019) [29]	Indian Association of Physiotherapists members: >50,000, includes physiotherapists, and physiotherapist students undergoing the graduation and PG courses from recognised physiotherapy colleges [30]	402 (2019) [31]	15,000 (2017) [32]	360 (2020) [33]
Occupational therapists	Bangladesh Occupational Therapy Association members: 280 [34,35]	5000 (2015) [78]	10 (2019) – all members trained abroad^3	~19,000, includes occupational therapists, physical therapists, speech-language pathologists, psychologists, medical interns and dietitians [36]	Not available
Speech and Language therapists	Not available	Indian Speech and Hearing Association members: >3440, includes speech-language pathologists, audiologists, and speech, language, and hearing scientists [37]	20–25 audiologists who practise speech therapy^1	7 [38]	100 [39]

Table 3. Average healthcare expenditure, 2017 [68].

	Bangladesh	India	Nepal	Pakistan	Sri Lanka
Government ($ per person)	7.24 (5.50–9.32)	18.25 (13.35–23.78)	11.21 (8.44–14.34)	10.41 (7.81–13.52)	64.74 (50.91–81.63)
Pre-paid private ($ per person)	1.18 (0.56–2.26)	6.88 (3.35–12.39)	4.60 (2.11–8.68)	1.76 (0.87–3.15)	9.27 (4.68–17.40)
Out-of-pocket ($ per person)	29.22 (20.94–40.33)	43.20 (32.03–60.02)	30.59 (22.14–41.48)	22.15 (15.49–30.71)	72.92 (55.37–95.34)
Development assistance for health ($ per person)	2.72	0.60	3.65	2.74	4.65
All-cause total ($ per person)	40.36 (31.49–51.66)	68.93 (54.44–87.48)	50.06 (39.51–63.09)	37.06 (29.22–46.28)	151.59 (124.15–182.03)
All-cause total (% of GDP)	2.48 ((1.92–3.21)	3.53 (2.80–4.49)	5.49 (4.29–7.02)	2.81 (2.19–3.51)	3.95 (3.24–4.77)

Figure 1. Type of healthcare financing, as % total healthcare expenditure, 2017 [68].

Table 4. Old-age social pension adequacy [71].

	Bangladesh	India	Nepal	Sri Lanka
Monthly benefit (local currency)	500 takas	200 rupees	2,000 rupees	2,000 rupees
Monthly benefit ($)	6	3	19	13
% of older people (65+) receiving social pension	34.90	17.74	46.80	No data
% of population over age of eligibility covered	34.9	17.7	79.9	32.8
% of GDP per capita	5.2	2.2	30.8	3.8
% of $1.90 poverty line (PPP)	29	20	110	72
Cost of social pension as % of GDP	0.102	0.035	0.703	No data

Table

	Bangladesh	India	Nepal	Pakistan	Sri Lanka
Retirement age (years)	Public sector (freedom fighters): 60, the government has implemented a court directive to lengthen service by 1 yearPublic sector (non-freedom fighters): 59^1	Public sector: 60,^2 raised to 65 years for central government doctors^3 Private sector: 58^2	Public sector: 58, but deferred in certain instances Health professionals and Parliament workers: 60 Teachers: 63 Court workers: 65^4	60 (men), 55 (women), with at least 15 years of contributions; miners can claim the pension earlier under certain conditions^5 Government has proposed for retirement age to be increased to 63^6	55^7
Old age social pension	Old Age Allowance Targeting approach: income-tested Eligibility criteria: age ≥65 (men) and ≥62 (women) with an annual income of <10,000 takas ($118), not receiving any other government or nongovernment allowance, only one member of a family can receive the pension Monthly benefit: 500 takas ($6) (paid every 3 months)^5,8 Government plans to introduce a universal pension scheme for private sector jobholders^9	Indira Gandhi National Old Age Pension Scheme Targeting approach: income-tested Eligibility criteria: age ≥60, with an annual income not exceeding a certain limit, which may vary across states Monthly benefit: 200 rupees if age 60–79500 rupees if aged ≥80; additional amounts may be paid and vary by state^5,10 Indira Gandhi National Widow Pension SchemeTargeting approach: income-tested Eligibility criteria: widows aged ≥40, with annual income not exceeding a certain limit, which may vary by stateMonthly benefit: 300 rupees^5,10	Old Age Allowance Targeting approach: pensions-tested Eligibility Criteria: age ≥65 (≥60 for Dalits, single and divorced women, and residents of Karnali Zone)Monthly benefit: 2000 rupees; 1,000 for members of the Rautes, Chepang, and certain other ethnic groups (paid every four months)^5,11	Social insurance system^5,12	Senior Citizen’s Allowance for Strengthen Elderly Targeting approach: income-testedEligibility criteria: age ≥70 with income below a certain thresholdMonthly benefit: 2000 Sri Lankan rupees^13
Social protection for people with dementia	No financial benefits/social protection for dementia carers^14	Indira Gandhi National Disability Pension Scheme Targeting approach: income-tested Eligibility criteria: aged ≥18, with an assessed degree of disability ≥80% and annual income not exceeding a certain limit, which may vary across statesMonthly benefit: 300 rupees (central contribution), additional amounts may be paid and vary by state^5	Department of Health Services provides 100,000 Nepalese rupees to patients diagnosed with Alzheimer’s disease, to cover the cost of healthcare from four enlisted hospitals (National Academy of Medical Sciences, Tribhuvan University Teaching Hospital and Patan Academy of Health Sciences in Kathmandu Valley and BP Koirala Institute of Health Sciences in Dharan)^20	No government policy for people living with dementia^21	Not available
		Integrated Programme for Older Persons Scheme Provides funding for up to 90% of the project costs to eligible agencies for establishing and maintaining old-age homes, day care centres, mobile medicare units and delivering non-institutional services to older persons–includes the running of day care centres for patients with dementia^15 Assistance for construction of old-age homes for older persons Scheme Provides funding for construction of old-age homes–Scheme is presently under formulation^15
		Rashtriya Vayoshri Yojana Provides physical aids and assisted-living devices to senior citizens belonging to the below the poverty line (BPL) category^16 Pradhan Mantri Jan Arogya Yojana Provides coverage of up to 500,000 rupees per family per year for secondary and tertiary hospitalisation to over 107.4 million eligible poor and vulnerable families (approximately 500 million beneficiaries)^17
		Welfare of Parents and Senior Citizens Act 2007 Mandates needs-based maintenance (food, clothing, residence, medical attendance and treatment) for parents/grandparents from their children to protect the life and property of senior citizens^15 Income Tax Act 1961Section 80 U: deduction can be claimed by an individual if they are certified by the medical authority to be a person with disability^18 Section 80DDB: deduction can be claimed by an individual for themselves or a dependant relative, for expenditures incurred for medical treatment of specified diseases,^18 including dementia^19
State care homes	Community-based services for dementia are available, but in the capital and main cities only^14 Six aged care homes (Santi Nibas) in six divisions^22	Six full-time residential care facilities and around ten day-care services exclusively for people with dementia^23 Welfare of Parents and Senior Citizens Act 2007 contains enabling provisions for setting up of old-age homes for providing maintenance to senior citizens^15	70 old-age homes (OAHs), of which 11 get government grants^24 One government-run residential facility (Pashupati Bridrashram), with the capacity for 230 older adults^24,25	Very few old-age homes located in Karachi, run by charities, though none specifically for people with dementia^26 Families are more likely to accept home help than send persons with dementia to a nursing home^21 No tradition of old-age homes, reliance is on older adults co-residing with family^27	Most residential care homes are run by local, often faith-based, voluntary social service organisations: two-thirds have 30 places or fewer, 18% have more than 50 places and there are a growing number of private fee-paying long-term care residential homes, most in or near Colombo, caring for 10–30 people^28

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Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.