Aging in Sub-Saharan Africa Recommendations for Furthering Research (2006) / Chapter Skim
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Part I: Report -- 1. Aging in Sub-Saharan Africa: Recommendations for Furthering Research
Part I: Report -- 1. Aging in Sub-Saharan Africa: Recommendations for Furthering Research
Pages 7-45
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Part I Report
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Traditionally in sub-Saharan Africa,1 the main source of support has been the household and family, supplemented in many cases by other informal mechanisms, such as kinship networks and mutual aid societies. With the notable exceptions of Botswana, Mauritius, Namibia, and South Africa, formal pensions (whether contributory or not)
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There are also major differences in the principal health challenges in subSaharan Africa compared with industrialized countries. In much of subSaharan Africa, gains in life expectancy that were achieved throughout the latter half of the 20th century have been eroded by the HIV/AIDS pandemic (see Chapter 2)
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A further effort, the WHO Study on Global Aging (SAGE) , is under way in six countries, two of which (Ghana and South Africa)
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, measurement (Kuhn et al.) , the impact of social pensions (Lam et al.
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Fourth is the need to recognize the considerable diversity across subSaharan Africa with respect to a wide range of indicators. The final central theme is the need to support the development of local research capacity and facilitate research.
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Based on the demographic changes taking place, both the absolute size and the relative proportion of the population age 60 and over are projected over the next 25 years to grow faster than at all younger ages (Table 1-1,
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TABLE 1-1 Demographic Indicators of Sub-Saharan Africa, Selected Years 1965-2030 Changea 1965 1985 2005 2030 1965-1985 1985-2005 2005-2030 Population (in thousands) 255,825 448,051 751,273 1,248,262 2.8 2.6 2.0 Under age 15 113,333 204,441 326,715 462,431 2.9 2.3 1.4 Age 60 and over 12,513 20,961 36,594 71,033 2.6 2.8 2.7 Age 80 and over 652 1,211 2,626 6,550 3.1 3.9 3.7 Percentage of the Population Under age 15 44.3 45.6 43.5 37.0 2.9 –4.6 –14.9 Age 60 and over 4.9 4.7 4.9 5.7 –4.1 4.3 16.3 Age 80 and over 0.3 0.3 0.3 0.5 0.0 0.0 66.7 Median Age 17.9 17.1 18 21.2 –4.5 5.3 17.8 Total Fertility Rateb 6.8 6.7 5.5 3.6 –1.9 –17.7 –34.0 Life Expectancy at Birthb 41.4 48.6 45.9 55.4 17.4 –5.6 20.7 Male 39.9 46.9 45.2 54.5 17.5 –3.6 20.6 Female 42.9 50.2 46.6 56.2 17.0 –7.2 20.6 Dependency Ratio 89.7 94.3 87.2 69.0 5.1 –7.5 –20.9 Child dependency 84.1 88.7 81.4 62.6 5.5 –8.2 –23.1 Old age dependency 5.7 5.6 5.8 6.4 –0.7 3.1 10.4 aChange figures represent the annualized growth rate per 100 people between population estimates and projections and the percent change among all other indicators.
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While some positive news about gradual, modest declines in HIV prevalence are emerging from East Africa and Zimbabwe, HIV prevalence has soared in Southern Africa in recent years (Asamoah-Odei, Garcia Calleia, and Boerma, 2004; Joint United Nations Programme on HIV/AIDS, 2006)
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. Increasingly, it appears that sub-Saharan African societies are being asked to cope with population aging and a catastrophic health crisis with neither a comprehensive formal social security system nor a well-functioning traditional care system in place.
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Similarly, the experiences of African governments that implement some form of social protection scheme can inform others contemplating a similar program. Need to Develop Local Research Capacity and Facilitate Research A current list of local hurdles to research includes lack of access to adequate funding for research and lack of highly skilled local researchers to do the work, as well as sometimes difficult administrative barriers to carrying out research.
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the nature and role of various kinds of formal and informal social protection schemes. Some discussion of each of these topics is provided below.
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More typically, the period between surveys is 10 years or more, and in some sub-Saharan African countries there has not been a large-scale, nationally representative household survey for decades. The measurement of the economic well-being of older people in subSaharan Africa is complicated by a number of conceptual and practical issues.
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Drawing on available recent household survey information collected over the period 1998-2001, the authors present a profile of older people in 15 low-income sub-Saharan African countries. The sample included countries in East and West Africa, Francophone and Anglophone countries, and countries with various levels of HIV prevalence and incidence.
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There are also significant rural-urban differences, with a much higher proportion of single older people who are poor in rural areas compared with urban areas in every country. In summary, evidence on income, wealth, and expenditure in subSaharan Africa that is derived from (small-scale)
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In Southern Africa, for example, life expectancy at birth has fallen from 62 to 48, and it is projected to decrease further to 43 over the next decade (Joint United Nations Programme on HIV/AIDS, 2006)
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While there is a need to describe and monitor patterns of ill health and disability among older people in sub-Saharan Africa as well as monitor the health of other household members who may be under the care of older people and to better understand the relationships between health and poverty, there are numerous challenges to measuring health status in social surveys (see Thomas and Frankenberg, 2002, and the paper by Kuate-Defo in this volume for a more complete treatment of these issues)
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Sub-Saharan African governments typically struggle to provide health care services to older people in rural areas who still tend to have far poorer access to any kind of service relative to urban dwellers. Furthermore, in many sub-Saharan African communities, traditional medicine is often the only affordable and even the only available source of health care to large sections of the population.
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Social protection is the natural outcome of commonly shared principles of solidarity, reciprocity, and redistribution in an extended family. As discussed earlier, economic development and modernization are also associated with a range of economic and social changes that combine to weaken social networks that traditionally provide care and support in later life.
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Changing Roles and Responsibilities of Older People in an Era of AIDS No analysis of the situation of older people in sub-Saharan Africa would be complete without acknowledgment of the fact that the region is experiencing a very severe HIV/AIDS pandemic with important implications for older people. The region is home to more than 60 percent of all people living with HIV, around 25.8 million in 2005 (Joint United Nations Programme on HIV/AIDS, 2006)
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Approximately 6 percent of officially reported AIDS cases in Africa in 1999 affected people age 50 or older (Knodel et al., 2003)
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The authors point out that, partly as a function of a generous social pension program and high rates of rural unemployment and underemployment, older people have maintained their traditional role as a major resource in society, caring for children and maintaining rural households even prior to the HIV epidemic. A recent study of the experiences and needs of older people in Mpumalanga, South Africa, supports this contention.
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Psychological pain from anticipated or enacted negative community reaction D Anxiety concerning economic security E
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Strained social relations SOURCE: Knodel et al.
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The largest social protection programs for older people in subSaharan Africa are occupational pension schemes, but these typically cover only people who have worked in the public sector, in state enterprises, or in large private firms in the modern sector. The self-employed, workers in the informal sector, domestic workers, and the vast majority of the population living in rural areas and engaged in subsistence agriculture or other forms of subsistence living, such as nomadic pastoralism, are still excluded from formal social security schemes and must rely on their families for support and protection when they can no longer work.
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In the case of South Africa's social pension, the scheme is financed through general tax revenue. Given the structure of the schemes and the nature of the labor force in most sub-Saharan African countries, the vast majority of those actually covered by formal social security schemes are neither the poorest of the poor nor women.
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The State Pension was extended to all South Africans in 1944, and the value was equalized for all segments of society in 1993 shortly before the first democratic elections in 1994. In addition to various types of occupational pension schemes that are contributory, some sub-Saharan African countries administer minimal public assistance or social welfare assistance programs to the needy.
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. South African Pension Program No discussion of social protection of older people in sub-Saharan Africa would be complete without a description of the South African social pension program, which is quite unusual in sub-Saharan Africa with respect to its level of coverage and generosity of benefit (Case and Deaton, 1998)
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The authors have found that the fiscal cost of providing a universal noncontributory social pension to all of older people in sub-Saharan Africa would be quite high, around 2 to 3 percent of gross domestic product, a level comparable to -- or even higher than -- the current levels of public spending on health care in some subSaharan African nations. The authors argue that the case for universal social pensions also appears to be weak on welfare grounds, inasmuch as there are other groups competing for scarce safety net resources (such as families with many children)
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. Informal Schemes Given the problems and formidable financial and administrative hurdles to expanding formal social security schemes in sub-Saharan Africa, policy makers also need to know whether there are ways to expand and support any of the various forms of informal social protection schemes that exist around the continent as a means to provide a vital safety net for certain vulnerable populations.
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Much less is known about informal social security systems in sub-Saharan Africa than about formal social security systems, but it is generally believed that informal schemes also suffer from a number of chronic problems and in their current form fail to provide much in the way of long-term protection against various forms of risk (Mchomvu et al., 2002)
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The panel also wishes to emphasize the importance of facilitating research, building local research capacity, and supporting the development of a local research network in sub-Saharan Africa that can support essential studies on the nature and consequences of its population aging and the context in which it is occurring. Top priority for the immediate future should be given to building basic research infrastructure, improving access to data, removing burdensome administrative barriers to carrying out new research, and strengthening international collaboration.9 After consideration of the general state of knowledge about aging in sub-Saharan Africa, recent research developments and emerging opportunities, and the strength of local research capacity, the panel arrived at the following recommendations, grouped under research agenda and funding, enhancing research opportunity and implementation, and translation of research findings that they feel could help improve the future development of the field.
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With such vagaries and uncertainties there is a clear need to enhance understanding of the current situation of older people in sub-Saharan Africa as well as to improve understanding of some of the underlying causal processes that relate social and economic change to older people's wellbeing in the sub-Saharan African context. Given that the proportion of the population that is older is still low, at least relative to other continents, subSaharan African policy makers have an important window of opportunity in which to act.
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In general with ongoing data collection efforts, it is important to find a balance between protecting confidentiality and increasing access by qualified researchers to these valuable data. Sub-Saharan African researchers are likely to benefit most from greater access to African censuses, surveys, and demographic surveillance site data.
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The World Bank's web-based African Household Survey database, the Minnesota Integrated Public Use Microdata Series (IPUMS-International) , and the University of Pennsylvania's African Census Project are good examples of initiatives designed to save previously collected data from destruction that have eased data constraints and produced new findings about older people (see, for example, Mba, 2002)
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More and better research on various dimensions of aging in sub-Saharan Africa cannot happen without an increase in the funding for research, more well-trained local researchers, and improvements in administrative procedures that currently hinder the execution of research projects. Many sub-Saharan African universities were badly neglected in the 1980s and 1990s.
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8. In the Long Term, Sub-Saharan African Governments Must Give Reasonable Priority to Aging Research and Strengthen Local Research Capacity In the long run, the importance of foreign-supported research in the region must be reduced.
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Improve Dialogue Between Local Researchers and Policy Makers There is an ongoing need for continued and expanded dialogue between the research and the policy communities. Researchers need to do a better job of drawing out the main policy and programmatic implications of their work, and policy makers need to better articulate what information they most need for more effective planning and program design.
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