The Better Health for Older People in Africa project

The Better Health for Older People in Africa project (BHOPA) 2019–2022 was implemented by HelpAge through its country offices in Kenya and Mozambique. In Kenya we worked with Kenyan Aged People Require Information, Knowledge & Advancement, and Population Research Institute, and in Mozambique with Associação Cristã Interdonominacional para Desenvolvimento Comunitário and Diocese dos Libombos. The project focused on making health systems more inclusive, responsive, and accountable to the needs and rights of older people, particularly those with chronic diseases and disabilities.

As part of this project:

• 29,000 older people accessed health and care information and services, including through referrals, at the community level
• 1,000 Older People’s Association members were trained on healthy ageing
• 220 community health workers were trained on healthy ageing and supported to provide healthy ageing services
• 360 older citizen monitoring groups received capacity building
• 50 clinical officers and 220 nurses were trained on integrated care for older people.

In Mozambique, the project helped improve access to free care in public hospitals for older people, by raising awareness among older people and health workers of the free medical services available in public hospitals. In Kenya, the work contributed to increasing the numbers of older people registering as members of National Health Insurance Fund. A Community Health Volunteers Training Manual for Healthy Ageing and Older Persons’ Health was developed and approved. The training of health and care staff and volunteers also led to more responsive services, outreach programmes, and referral processes.

The project contributed to advancements at national policy level, particularly in Kenya where there were limited health and care policies for older people before the project. A National Healthy Ageing and Older Persons’ Health Strategy (2022–2026) is now in place.

Scaling-up Non-Communicable Diseases Interventions in South-East Asia project

Scaling-up Non-Communicable Diseases Interventions in South-East Asia (SUNI-SEA project) is a collaboration between ten consortium partners, implemented in Indonesia, Myanmar and Vietnam. The project aims to improve the prevention and control of hypertension and diabetes by strengthening primary healthcare, and achieving meaningful engagement of people and communities.

In Vietnam and Myanmar, the SUNI-SEA project community interventions are implemented by Older People’s Associations in collaboration with primary health care staff. Last year, the project teams focused on consolidating the community interventions. These included non-communicable diseases (NCDs) screening activities using a bespoke phone application, health promotion and referring people with NCD risks to the health facility. Five hundred and fifty-three people also participated in skills building activities for volunteers, local club managers and health staff. Older people attended stakeholder meetings and advocacy events. Policy briefs were developed based on the learning from the project in both countries.

Universal Health Coverage (UHC)

A blanket failure to invest in primary health care means at least half the world’s population lacks access to essential health services. Universal health coverage is defined as everyone, everywhere being able to access the health and care services they need, when and where they need them, without suffering financial hardship. Progress towards UHC is essential for promoting healthy ageing, delivering social and economic development, and building resilient and equitable societies that respond effectively in times of crisis.

We started the rollout of our UHC strategy in 2022, kicking off with a small grants initiative that distributed 15 grants to 12 network members, two partners and one country office across 13 countries. This helped deliver advocacy and campaign activities involving more than 1,500 older people around special events like World Health Day, as well as multistakeholder and media engagements to demand better services for older people. We held information sessions on the rights to health and care for older people, and collected evidence through focus group discussions on the barriers they face in accessing services. We also trained 20 partners to strengthen their leadership and expertise on UHC. And the release of our report, Achieving Universal Health Coverage fit for an ageing world helped us engage with the World Health Organization (WHO), UN agencies and government officials to drive progress on the issue.

Covid-19 vaccination rollout

The global Covid-19 vaccination rollout was the biggest and fastest in history, but uptake among older people was dangerously low. As late as 18 months after the outbreak, only 17 per cent of people in low- and middle-income countries had received their primary course of vaccination.

A key focus for HelpAge and our partners and network members in 2022 was addressing barriers to older people receiving their vaccinations and designing community-based approaches to enhance vaccine uptake.

We worked in partnership with the WHO to develop an updated Covid-19 vaccination roll-out plan, as well as offering technical assistance to network members and partners across 11 countries (Colombia, the Democratic Republic of Congo, Kenya, Kyrgyzstan, Peru, Sierra Leone, Sri Lanka, Tanzania, Uganda, Zambia and Zimbabwe). In Kenya, Kyrgyzstan, Sri Lanka, Tanzania and Uganda, our partners successfully lobbied their national governments to amend their vaccine plans to include strategies to reach older people. In collaboration with these governments, door-to-door vaccinations were conducted to reach older people with disabilities, and those who were house-bound.

Older People’s Associations played a key role in mobilising communities. Many worked with their country’s Ministry of Health to encourage people to attend awareness meetings – the government would in return ensure vaccinations for attendees.

Partners in nine countries trained leaders of Older People’s Associations and community health volunteers to become vaccine champions, spreading the word in remote and hard-to-reach communities and addressing fears and mis-information. By encouraging inter-generational conversations between old and young, we were able to ensure that people from all generations were sensitised about the Covid-19 vaccination.

As a result of this work and through additional projects secured by our partners with our support, more than half a million older people across Colombia, Kenya, Kyrgyzstan, Peru, Sri Lanka and Uganda were able
to access the Covid-19 vaccine.

Covid-19 laid bare many things about the world’s health systems, one of the most alarming being the ageism and often complete lack of support for older people in many countries’ immunisation programmes.

In Tanzania, the government set an ambitious goal of vaccinating 70 per cent of the population against Covid-19 by June 2022. In recognition of the fact that older people were a vital group, they needed to persuade them to get vaccinated if they were to achieve their target. The government partnered with UNICEF and HelpAge to help roll out their immunisation programme.

Our role was to directly engage older people and promote community-led prevention and vaccination. Working with UNICEF, we targeted 18,650 older people across five regions, supporting community dialogues and mobilising home-based care givers and health workers to disseminate accurate information on vaccines. We provided outreach services to those who couldn’t visit clinics, in particular those who were housebound or with physical challenges. More than 2,000 people from 80 Older People’s Associations, 25 women’s groups and 20 youth groups were trained to promote Covid-19 preventative measures, collect community feedback and respond.

We also organised peer-to-peer discussions and paired young people with older people, encouraging different generations to discuss the need for vaccination and the importance of not spreading the virus.

To ensure people didn’t miss their second dose, we followed up with registration cards to remind people of their next appointment, setting up mobile vaccination points in remote areas so that they were easier to reach.

By September 2022, a total of 262,839 people (including 33,820 older people, 2,130 people living with disabilities and 62,336 young people) had received their vaccination through the programme.

Fighting age discrimination

Spurred by the discriminatory healthcare laws and policies put in place by many countries as a result of Covid-19, in 2022 we researched and launched our global report, Advancing equality for older people. The report examined the legal frame-works for prohibiting age discrimination across 12 countries, analysing them for consistency with international standards. It identified gaps and helped raise awareness on the inadequacy of both the international human rights framework and national legislation in protecting older people’s right to equality and non-discrimination.

After the report’s global launch, partners and network members in four countries (Jordan, Kenya, the Philippines and Tanzania) followed up with a range of activities calling for comprehensive anti-discrimination legislation from their governments. Our partners The Coalition of Services of the Elderly, Inc. in the Philippines, for example, organised online discussions, national consultations, and radio broadcasts, while Ageing Concern Foundation in Kenya created a technical working group and organised awareness-raising activities with media.

Age-friendly cities and communities

The Let’s Go Guide launched in July 2022, is all about demonstrating how easy (and cost effective) it is to make communities more age-friendly. The guide showcases exciting, innovative, small-scale and low or no-cost projects having a big impact on the lives of older people in communities across the Americas. Projects included a pop-up intergenerational photography exhibition in Quillon, Chile, highlighting the issues faced by older residents. Or in Valparaiso, Chile, local artists worked with older people to create a mural reflecting their links with the neighbourhood, reinforcing a sense of belonging and ownership.

To encourage communities to start their own initiatives, we worked with our partners Pan American Health Organization and American Association of Retired Persons, and network members to provide technical support to seven selected initiatives across Argentina, Brazil, Chile, Colombia, Costa Rica, Dominican Republic and Peru. These projects contributed to growing momentum around the age-friendly cities movement in the region and made a valuable contribution to understanding how cities and communities can begin their journeys.

Influencing national ageing policies

In order to highlight how national policies impact the lives of older people in India, Indonesia, Iran, Malaysia, the Maldives, Nepal, Singapore, Sri Lanka and Vietnam, we launched Policy-in-practice case studies analysing governments’ ageing policies.

The case studies revealed that none of the countries were fully able to demonstrate a rights-based approach that empowers older people and strengthens their inclusion and participation in society. They also highlighted the need for more specific criteria with which to systematically appraise and categorise policy interventions as adopting a rights-based approach, and recommended good practices that would deliver meaningful improvements. These may now be considered in the UN’s next steps for developing fuller guidance to support implementation and adaptation of ageing policies across the Asia-Pacific region.

Vibrant Older People’s Associations

HelpAge has worked with Older People’s Associations and similar community-level organisations for more than 30 years. These groups are key to creating a vibrant community of older people who can learn from each other and advocate for better recognition from their governments. In 2022 we focused on helping to strengthen, grow and adapt organisations, so they can better fight for the rights of older people in their communities and countries.  

We did this through:

• Training workshops in Cambodia, Ethiopia, Kenya, Uganda and Vietnam on subjects including social protection, livelihoods, psychosocial support, addressing ageism, rights and voice training and access to information.
• An online learning exchange bringing together network members and HelpAge staff to share experiences and approaches to working with
  Older People’s Associations. More than 60 network members and staff from Bangladesh, Cambodia, Cameroon, Jordan, Kenya, Lebanon, Myanmar, Pakistan, South Korea, Tanzania, Thailand, UK, Vietnam and Zambia took part in the sessions.
• A Cambodia delegation made a study visit to Vietnam, where Older People’s Associations are making incredible progress.

Age-inclusive data

HelpAge undertook an assessment of Sustainable Development Goals (SDGs) indicators on older people in The Gambia, India, Sudan, Tanzania and Ukraine, in collaboration with Statistics without Borders, a volunteer outreach group of the American Statistical Association. The assessment presented data on the state of older women and men, their families and communities, with information gathered from the labour force, household income and expenditure surveys, and the Demographic and Health Surveys administered in these countries over 2007–2018.

The evidence shows that clear data on the situation for older people is prevented by a variety of factors such as missing data, social dynamics and small sample sizes. In order to capitalise on the findings, we worked with the Leave No One Behind Partnership to bring network members into national coalitions in Denmark, Malawi and Palestine. These coalitions developed action plans for generating community-based data on marginalised groups to complement and fill gaps in official SDG data produced by the UN.

Alongside our partner Pan American Health Organization (PAHO), we are supporting an Age-Friendly Cities campaign across Latin America and the Caribbean. To inspire communities, partner organisations and groups to set up their own age-friendly projects, we helped produce the Let’s Go Guide packed with ideas on how to turn communities into great places to grow older.

Small grants and technical support were on offer too, leading to some exciting work across cities. For example, older people in Bogota, Colombia, used their knowledge of the land to reinvigorate local community gardens (see picture above), while bright blue tricycles were put into use in Santa Catarina, Brazil, helping older people monitor and improve their health.

Following this, in 2022, HelpAge’s age-friendly cities and communities work focused on voice training – empowering communities to engage directly with their local authorities, to source funding and support for the projects they want to see in their neighbourhoods.

We developed an age-friendly cities and communities module for our Voice Training Toolkit training HelpAge network members, Older People’s Associations, civil society organisations and leaders of older people on how to increase space for older people’s voices on issues that affect their urban environment. The initiative includes an intergenerational aspect, to strengthen community relationships between older and young people, and incorporates advocacy action planning to increase conversations with local authorities.

The module includes a training of trainers element, allowing the materials to be scaled for workshop size and adapted based on context. The goal is that an increased number of communities will have more older and young people working together to raise the voices of older people, especially regarding their urban surroundings, in areas such as public spaces and transportation.

Jesus was part of an Urban Gardens project, where communities came together to plant fruit and vegetable orchards in communities within urban spaces. When asked if this activity contributed to healthy ageing amongst older people, he says:

#GreyAndGreen Manifesto

In November 2022 we launched our #GreyAndGreen Manifesto committing to put older people at the forefront of climate solutions. The manifesto set out how we can unite and galvanise the thousands of older people who are either impacted by or among the great fighters and solvers of this crisis.

We held a consultation with 50 experts to discuss the challenges of climate change and their impact on older people. The result was the creation of a roadmap of climate actions to help achieve the manifesto priorities. This roadmap provides a summary of activities necessary to achieve the inclusion of older people in climate actions. Already, 25 network members have signed up.

Our top five priorities:

1. Ensure that older people are engaged, supported and involved in climate mitigation and adaptation initiatives.
2. Spearhead the leadership of older people by amplifying their voice when demanding climate action and holding leaders accountable.
3. Bring older and younger people together to take a collective stance on climate change.
4. Promote international solidarity on climate change.
5. Collect the data and shout the facts about how the climate catastrophe affects older people.

We pledged to work in partnership with members of the HelpAge global network, building on their skills and capacities to support and raise the voice of older people in the climate crisis.

HelpAge will provide technical, convening and resource development support to network members, informed by the need for urgent action to combat climate crisis.

Climate change: Our strategic approach

In November 2022, a scoping report on climate change was commissioned to guide HelpAge’s strategic direction on climate change, bringing the links between climate change and population ageing together.

We carried out external stakeholder consultations and tested the recommendations in a workshop. The report has identified four strategic pathways for HelpAge aligned with its 2030 Strategy:

1. Integrate ageing into foresight and planning to provide a new perspective on climate action.
2. Consider the needs of older people and an ageing population worldwide to create transformative resilience.
3. Create opportunities for intergenerational solidarity for climate actions.
4. Explore the nexus of climate and care economy within policy and research.

These strategic pathways have been presented to the board and an action plan developed to guide its implementation

Reina Epiayu, 84, belongs to the Mapashirra community, one of the Wayuu indigenous desert communities of La Guajira in northern Colombia. The Colombian Caribbean coast is particularly vulnerable to the effects of extreme weather events associated with climate change, and experienced torrential rain and flooding in 2022. This contaminated the water reservoirs, creating a lack of safe drinking water, and severely damaged the crops resulting in high food insecurity for the Wayuu community.

HelpAge worked with Secretariado de Pastoral Social Riohacha and Cadena Colombia to set up a humanitarian response to the crisis. The Wayuu are matriarchal societies, where older women hold primary power positions and are decision-makers with traditional and ancestral wisdom. The response therefore focused on setting up a dialogue with the older people of the indigenous communities in order to learn from their deep understanding of local climate patterns and the best measures for adaptation. Older people were nominated as leaders of water committees to manage the water systems and ensure knowledge would be transferred to younger generations.

Abandoned or damaged water systems were repaired, operational and technical capacities were strengthened, and robust intergenerational water committees now ensure constant maintenance and smooth functioning of the water systems.

Two hundred people from the Wayuu communities now actively manage the water systems, which provide water to approximately 1,000 people living in indigenous communities nearby. Reina Epiayu says the well has given hope to her community, and that the children are much happier. Turning on the faucet and having clean water just a few metres from her house is a luxury she has never had before.