Política pública y de salud para el anciano en África del Sur del Sahara

hay falta de cuidados de salud especializados y enfocados a las reales necesidades de los ancianos, siendo que la escasez de profesionales de salud no contribuye favorablemente para esta situación. Se observa baja oferta de infraestructura destinadas a los ancianos y la mayoría de ellas son de bajo nivel. Aunque haya modelos de atención, así como políticas de apoyo social y de salud para las personas mayores, aún hay iniquidades/desigualdades en el acceso a ellas, sobre todo para las poblaciones más desfavorecidas.

Conclusión:

las políticas sociales y de salud para las personas mayores en el África subsahariana están por debajo de sus necesidades, siendo necesario garantizar una intervención económica, política y social adecuada.

Descriptores:
Anciano, Servicios de Salud para Ancianos; Política Pública; Asistencia a los Ancianos, África del Sur del Sahara

	Title	YearCountry	Delineation/participants number	Interventions	Outcomes
1	Disability Transitions and Health Expectations among Adults 45 Years and Older in Malawi: The Cohort-Based Model	2013 Malawi	Longitudinal n = 1.075 (2006) n = 1.665 (2008) n = 1.317 (2010)	Application of the SF-12 questionnaire to elderly people in a rural area in Malawi. The questionnaire consists of self-reported health and disability issues), and it is a health measurement research tool that has been validated in sub-Saharan Africa and globally.	Disabilities related to functional limitations proved having a negative effect on individuals’ work activities and are negatively related to subjective well-being.
2	“My Legs Affect Me a Lot. ...I Can No Longer Walk to the Forest to Fetch Firewood”: Challenges Related to Health and the Performance of Daily Tasks for Older Women in a High HIV Context	2014 South Africa	Qualitative n=30	Qualitative interviews with women over 50 (sociocultural context: South Africa, rural area and endemic HIV) about the relationship between health and daily activities, paying attention to the fulfillment of social roles.	The endemic context of HIV creates stressful situations (e.g., trying to survive, caring for sick adult children in a stigmatizing environment, raising grandchildren and losing those who should be their own caregivers in old age) that intervene in the health of individuals and their ability to participate in daily activities. Older women make links between compromised health and the (lack of) ability to perform the daily activities normally expected of them.
3	Culturally diverse care for older people: what do we expect of caregivers?	2014 South Africa	Qualitative	Interviews on focus group about nurses’ expectations regarding caregiver training programs to ensure culturally diverse care. Data were collected from residential care homes within the boundaries of the Johannesburg metropolitan area.	Nurses’ expectations were grouped into subthemes: communication and aspects that promote communication (highlighting the need for knowledge of culture and cultural differences between caregivers and caregivers); expectations regarding educational sessions and planning (importance of having in-service education programs that focus on cultural issues and sensitivity); expectations of how an understanding of different cultures could be promoted and facilitated (notably through family cooperation); expectations regarding knowledge sharing by different cultural groups (knowledge of cultural practices and different religions); concerns and challenges that influence expectations (such as institution involvement).
4	Existing and evolving in two minds: beliefs in relation to health and illness expressed by older south Africans	2014 South Africa	Ethnographic n=16		The understanding of the world in which body and mind are inseparable emerges and relationships provide the basis for improving and maintaining health and promoting the cure of disease. The transition experienced by older people in South Africa influences beliefs about health and disease, noting the need to adapt to existing parallel health systems, Western biomedicine and traditional African medicine. There is a need to tailor care for the elderly to their unique needs to minimize the risk of developing stereotypes, cultural misunderstandings, prejudice and discrimination.
5	Enrollment of older people in social health protection programs in West Africa and Does social exclusion play a part?	2014 Ghana and Senegal	Quantitative Cross-sectional n = 435 (Ghana) n = 2,933 (Senegal)	Household cross-sectional surveys conducted in Ghana and Senegal to study whether older people are aware of and enroll in existing insurance programs in these two countries (Senegal’s Sesame Plan and Ghana’s National Health Insurance - NHIS) and to explore if economic indicators and social exclusion determine the enrollment of the elderly in these programs.	Older people, vulnerable to social exclusion, are less likely to enroll in the Sesame Plan, and politically vulnerable older people are less likely to enroll in NHIS. Additional efforts need to be made to specifically enroll older people in rural areas, ethnic minorities, women and isolated people due to lack of social support. The importance of modifying program resources, notably by eliminating the NHIS registration fee for seniors and setting up ID card administration offices in remote communities in Senegal.
6	Perceptions and experiences of access to public health by people with disabilities and older people in Uganda	2014 Uganda	Qualitative 2 focus group	Focus group discussions and interviews with key informants with older people in the Kamwenge district of Uganda; and with people with disabilities from the Gulu region. The interviews were conducted in local language by trained interviewers.	Older people and those living with disabilities express feelings of marginalization, including political marginalization, discrimination and unequal access to health services, which are the factors responsible for their poor health. At the same time, existing clinical services appear to be of poor quality, with little or no access to facilities, trained professionals and medicines, and no rehabilitation and mental health services available.
7	Prevalence and correlates of disability among older Ugandans: evidence from the Uganda National Household Survey	2014 Uganda	Quantitative Cross-sectional n = 2.382	Secondary analysis to data from a sample of older adults from the Uganda National Household Survey, focusing on prevalence and disability reporting.	Factors associated with disability were: advancing age, rural residence, living alone, divorced / separated / widowed marital status, dependence on monetary support, health problems and non-communicable diseases. The need to implement strategies that promote the health and functionality of the elderly is stressed.
8	Prevalence and patterns of multimorbidity among the elderly in Burkina Faso: cross-sectional study	2014 Burkina Faso	Quantitative Cross-sectional n = 389	Interviews, clinical examination and medical record review for persons aged 60 and over in Bobo-Dioulasso in an urban area.	The prevalence of multimorbidity among participants was 65%. The most emerging chronic diseases were hypertension (82%), malnutrition (39%), visual deficits (28%) and diabetes mellitus (27%). In people aged 70 years and over, malnutrition and osteoarthritis were more evident.
9	The key actors keeping elders in functional autonomy in Bobo-Dioulasso (Burkina Faso)	2014 Burkina Faso	Longitudinal Descriptive n = 351	Evaluation of the functional status of elderly (60 years and over) of Bobo-Dioulasso through the Functional Autonomy Measurement System (SMAF -).	In general, the elderly participants have good functional capacity or mild disability (68%), 32% have moderate to severe disabilities. The fact that older people die before (3%) or during (14%) moderate to severe disability reflects the poor quality of medical and / or social care to promote their functional autonomy. Maintaining the functional autonomy of the elderly is the responsibility of two groups: the elderly themselves and their families. There are no community, private or public structures to keep the elderly functionally autonomous. There are major gaps in the contribution of the social system to keeping older people in functional autonomy. Faced with functional disability at home, the elderly tend to die.
10	Health and age in Nairobi’s informal settlements-evidence from the International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH): a cross sectional study	2015 Kenya	Quantitative Cross-sectional n = 1.878	Data from the International Network for Demographic Assessment of Populations and their Health (INDEPTH) and the WHO Study on Global Aging and Adult Health (SAGE Wave 1) were analyzed.	With regard to quality of life and functional limitations, women reported worse quality of life and greater limitations than men in all domains, except self-care.
11	Informing evidence-based policies for age and health in Ghana	2015 Ghana	Knowledge translation process (health policy production for Ghana)	Definition of priority problems and responses to health problems (epidemiological data, policy review, local visits and key element interviews); evidence of interventions in low and middle income countries; discussion of policies as well as elaboration and presentation in health services.	Knowledge translation may be useful in middle-income countries, but needs adaptation to local environments. The lack of research on health interventions in this context is a barrier to the implementation of appropriate strategies, so flexible methods are needed.
12	Does Health Insurance Premium Exemption Policy for Older People Increase Access to Health Care? Evidence from Ghana	2015 Ghana	Qualitative/ Quantitative n=461 focus group n = 4.124 (quantitative study)	Individual and focus group interviews; visits and interviews with families living within 10 km of primary care facilities about their family, economic and health insurance-related conditions.	People over 60 are more likely to enroll in free health insurance than younger people. Non-registration is related to the lack of knowledge about insurance and its exemption. Social exclusion is a determining factor regarding the enrollment of the elderly in social programs. Exemption from the health insurance premium is a determining factor in health care.
13	Late-life depression: Burden, severity and relationship with social support dimensions in a West African community	2015 Nigeria	Quantitative Cross-sectional n = 350	Assessment of social support and depression (for persons aged 60 and over) through the Multidimensional Perceived Social Support Scale (MSPSS) and the Geriatric Depression Scale (GDS)	The low level of social support is associated with depression, especially social support from family and significant others. The severity of depression correlates negatively with the availability of social support. Perceived social support is assumed to be a significant determinant of depression in these older people. There is a need for intervention in the area of preventive mental health for depression.
14	Depression in elderly people living in rural Nigeria and its association with perceived health, poverty, and social network	2015 Nigeria	Quantitative n = 458	Initial application of the Mini-Mental and Geriatric Depression Scale (GDS-30) to people aged 65 and over for at least 6 months in 2 rural areas in Nigeria. When the score on GDS-30 was higher than 11, the Geriatric Mental State Program (GMSS) was used.	Late depression is associated with socioeconomic factors (such as poor social network and poverty) and health. However, economic difficulties are significant predictors of late depression. The social network and perceived health were related factors, but without significance. There was a higher prevalence of late depression compared to studies conducted in other developing countries.
15	Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson’s disease	2015 Tanzania	Quantitative Prevalence study n = 2.232	Assessment of functional capacity in three groups of people with neurological disease: dementia, cerebrovascular accident (CVA), and Parkinson’s disease. Participants were people aged 70 or older from 12 villages in the Hai rural district of Tanzania. Barthel index and specific clinical assessment for each condition were used.	High levels of disability occur in people with dementia, stroke and Parkinson’s disease. The people with the greatest disability (moderate or severe) were primarily those with stroke, followed by those diagnosed with Parkinson’s and finally with dementia. The people with dementia identified in this study had not been previously diagnosed, and it is suggested that strategies be developed so that they can begin to be properly diagnosed and interventions that promote the reduction of dementia rates associated with SSA disability, due to the impact and weight it has both for people and for their families.
16	Health Care for Older Adults in Uganda Lessons for the Developing World	2016 Uganda	Case Study	Discussion of a situation based on: health care overview, socioeconomic and cultural contexts, and resources to overcome health service barriers and health policies, and international aid.	Description of the numerous challenges older people face in developing countries and recommendation of geriatric care programs that should result from partnership between government, community development agents and others. These should meet the needs of more contextualized policies and health care aimed at promoting dignified aging.
17	Chronic disease, risk factors and disability in adults aged 50 and above living with and without HIV: findings from the Wellbeing of Older People Study in Uganda	2016 Uganda	Quantitative Cross-sectional n = 471	Chronic diseases were diagnosed by self-report and disability was determined using the WHODAS (World Health Organization Disability Assessment Schedule). Participants were people 50 years of age and older living in three different locations in Uganda.	About half of the population was infected with HIV; In these people, chronic obstructive pulmonary disease as well as ophthalmic problems are more prevalent, being more expressive with advancing age. Diabetes is more prevalent in people without HIV. Chronic diseases are more prevalent in people aged 70 years or older. Sleep-related problems are associated with greater disability. There is an association between sociodemographic factors, chronic diseases and risk factors for disability.
18	Prevalence of factors associated with frailty and disability in older adults from China, Ghana, India, Mexico, Russia and South Africa	2016 China, Ghana, India, Mexico, Russia, South Africa	Quantitative Cross-sectional n = 34.123	Building a disability index and disability assessment using the WHODAS (World Health Organization Disability Assessment Schedule) for people over 50 in 6 countries: China, Ghana, India, Mexico, Russia, South Africa	Both frailty and disability are age-related problems in the context of low- and middle-income countries. With these elderly, it is possible to achieve results of lower disability and fragility, and education and income may be protective factors for disability and fragility in some contexts.
19	Removing user fees for health services: The multi-epistemological perspective on access inequities in Senegal	2016 Senegal	Qualitative n=34	Identification of the causes of inclusion or exclusion of people in a protective scheme for the elderly (Program Sesame)through semi-structured interviews and focus group to people aged 60 or older from 4 regions of Senegal.	The causes associated with exclusion in the Sesame Program fall into three categories: lack of information about the plan; not understanding the need to use the health services included in the plan; and inability to access health services. Social exclusion is a determining factor in this process.
20	Predictors of health care use by adults 50 years and over in a rural South African setting	2017 South Africa	Quantitative Cross-sectional n = 5.795	Questionnaire applied to persons aged 50 and over who live in a rural district of South Africa to describe people’s health problems and determine predictive factors for health care use.	Chronic diseases (communicable and non-communicable) are the main predictors of health care utilization. Education of 6 years or older increases the possibility of the person to resort to health services.
21	Identifying Frailty and its Outcomes in Older People in Rural Tanzania	2017 Tanzania	Quantitative Cohort study n = 1.198 (1^st phase) n = 296 (2^nd phase)	Data collection by applying a 40-item frailty index to 70-year-olds living in 6 villages in the rural district of Hai. Data on mortality and dependence were collected over three years.	The highest frailty index score was significantly correlated with the variables: older age, never having studied, falls, mortality and dependence on activities of daily living. Functional disability and cognitive function are shown to be significant independent predictors of the “mortality or dependence” outcome. Assessing fragility seems to be a useful way to identify those who need support the most. The instrument built for fragility assessment seems to have good construct validity.
22	Long-term Care for Older Adults in Africa Whither Now?	2018	Reflective literature review	Analysis of world and sub-Saharan African studies, including those developed by WHO, and analysis of the current situation in Ghana regarding existing initiatives for the care of older people.	There is a need for innovative policies and public services appropriate to the aging trend of this population. This innovation should include family involvement in caring (leveraging the workforce of African society), person-centered care, caregiver training, integration with health services, equity, favorable conditions for resource development and sustainability. Existing programs must be critically analyzed to be more appropriate, contextualized and thus more successful.

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[1] Corresponding author: Marta Regina Soares de Assunção. E-mail: martaassuncao@icloud.com