THE SITUATIONAL ANALYSIS OF OLDER PERSONS IN UGANDA: STUDY FINDINGS Kampala, September 2018
CONTENTS OF THIS PRESENTATION • Study background • Overview: Situation of older persons • Context: Ageing in Uganda • Accessibility of services • Key takeaways
STUDY BACKGROUND
PURPOSE OF THE STUDY In early 2018, the study was commissioned by the Ministry of Gender, Labour and Social Development to: • Understand the situation of older persons in Uganda • Highlight priority areas for the formulation of Older Persons’ Act • Produce glossy publication to be released on October 1, 2018, on Older Persons’ Day
STUDY QUESTIONS AND OBJECTIVES Overarching questions Study objectives a) Understand the socio-economic, cultural, health and disability situation of persons in Uganda b) Provide an overview of differences by • Gender What is the current situation of older populations • Disability (60+ and above) in Uganda? • Living arrangements • Location • Other relevant disaggregators a) Provide an overview of challenges and achievements of services provision to older persons What are the priority actions that need to be taken b) Identify actionable priorities to inform policy level strategies at the policy level to improve the lives of older for older persons persons in Uganda?
OVERVIEW OF METHODOLOGY Literature Review Qualitative Research Quantitative Research LIMITATIONS • Objective : Identifying • Objective : Understanding • Objective : • Budget constraints for literature gaps, study • key risks, vulnerabilities, • developing demographic primary data collection questions and themes contributions of older and socio-economic • Reliance on small persons, and profiles sample size • Review of existing policy • successes and challenges • determining health and and legal frameworks of existing services for well-being status and • Limited disaggregation beyond 75 years older persons access to services of older persons across • Source : Primary research • Source : Academic and grey • Underestimation of regions, gender, socio- literature • Focus group discussions disability economic status and interviews with older • Absence of UNDHS data • Source : Analysis of existing persons and caregivers, for persons beyond 49 national level data sets • Key informant interviews years
QUALITATIVE METHODS: COLLECTING PRIMARY DATA WHY? 1. Bring forth older persons’ voices on their HOW? experiences of ageing in Uganda • Semi-structured individual interviews (SSIs) 2. Develop a contextualised picture of their • Focus group discussions (FGDs) • Role and relevance • Participatory tools • Risks and vulnerabilities • Key informant interviews (KIIs) • Care systems • Knowledge of and access to services WHO? WHERE? • Older persons • West: Rukungiri • Caregivers • Central: Mubende and Kampala • Community and clan leaders • East: Sironko and Tororo • Government and non-government stakeholders • North: Arua and Pader at sub-county, district and national level
QUANTITATIVE METHODS: ANALYSING EXISTING DATASETS WHY? HOW? • National Population and Housing Census (2016); Present national level • Uganda Demographic and Health Survey (2016); disaggregated data on older persons: • Uganda National Household Survey (2016/17) • Uganda National Panel Survey (2009/10) • Key demographics • Livelihoods • Poverty and living conditions • Sex • Ageing and health DISAGGREGATORS • Location • Urban/rural • Ageing and disability • 15 sub-regions • Access to services • Living arrangements • Disability • Consumption quintiles
CONCEPTUAL FRAMEWORK CAPABILITIES FRAMEWORK HUMAN RIGHTS FRAMEWORK - Sen and Nussbaum Enables us to: Enables us to: • Incorporate historical perspective • Understand the role of the state in present day • Understand active ageing • Analyse service provision using the Availability, Accessibility, Acceptability and Quality • Address the myth of sickness and frailty framework (AAAQ) Individual Civil and Political Freedoms Rights Household & Individual State Functionings Economic, Social Community and Cultural Rights (ESCR)
OVERVIEW: SITUATION OF OLDER PERSONS
OLDER PERSONS IN UGANDA IN 2018 Share and total number of older people, by 15 sub-regions • 2.9 per cent of population is above 60 years • 17 per cent of households have an older person • 55 per cent of older persons are women • Highest share of older persons in Kigezi • Lowest share of older persons in Kampala
UGANDA: ON THE WAY TO BECOME AN AGEING POPULATION • At present, 15 million Uganda is not a 16 Mil rapidly ageing population 12 Mil • Between 2050 and 2070 , 8 Mil 6 million number of older persons will increase by 4 Mil 3 million more than 2 1.5 million times 0 Mil 2020 2030 2040 2050 2060 2070
INCREASING LIFE EXPECTANCY AT 60 YEARS Life expectancy of older persons at five-year age group, by sex and calculation year • Average life expectancy at 60 years is more than 20 15 years • Average healthy life Life expectancy in years expectancy is 13 years • Women have a higher 18 17 16 life expectancy at 60 16 14 14 13 13 years 11 11 10 10 8 8 8 8 6 6 6 6 5 5 4 4 0 60-64 years 65-69 years 70-74 years 75-79 years 80-84 years 85+ years Male 2006 Expectation of life Male 2016 Expectation of life Female 2006 Expectation of life Female 2016 Expectation of life
AGEING AND HEALTH Average number of sick days in the last 30 Average number of reported sick days increases significantly with age days for those reporting an illness, by sex and five-year age groups Age-related issues for older persons in Uganda include • Arthritis 12 12 • Stroke • Dementia 10 • Hypertension Number of sick days • Diabetes 6 • Ulcers • Cancer • Respiratory problems 4 • Orthopaedic problems • Vision and hearing loss 0 0- 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75+ ‘It’s common for people at that age not to be able to see. Five year age groups This is taken as something that comes with age and so Male Female they don’t take him to the hospital about it’
AGEING AND DISABILITY Disability prevalence 50 increases significantly 46 45 with age 39 6 out of 10 older persons 35 has some difficulty one of the four areas of 29 26 26 functional limitations ( walking, seeing, hearing, 20 18 18 remembering ) 17 11 11 11 1 out of 8 older persons 7 7 have a lot of difficulty in 5 4 4 3 3 3 at least one of functional 0 5- 10- 15- 20- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85+ areas Male Female
AGEING AND DISABILITY Percentage of older persons with a severe functional limitation, by sex and five-year age group Ageing-related disability: Female Sex • Mobility and movement functions Male • Vision and hearing Disability strongly related to socio-economic 60-64 conditions and health 65-69 More older women have a disability in 70-74 comparison to older men Age group 75-79 Order of prevalence of various types of 80-84 disability remains unchanged across all 85-89 regions 90-94 Prevalence rates of disability are much 95+ higher in Acholi, a post-conflict region 0% 5% 10% 15% 20% Walking Seeing Remembering Hearing
MEASURING POVERTY AND WELL- BEING National poverty rate using different methodologies • Size and composition of the population in 40 poverty significantly influenced by the choice of equivalence Poverty headcount rate (%) scales employed 30 • Equivalence rates used 20 by the Uganda Bureau UBOS equiv. scale of Statistics (UBOS) Per capita may underestimate Oxford scale OECD-mod. scale poverty rates among Square root scale 10 older people 0 20 40 60 80 Age
SHARE OF OLDER PERSONS IN POVERTY Above $10 PPP a day • 2 out of 5 older persons live below the Between $ 5.5 and international extreme $ 10 PPP a day poverty line (UGX 2700 per person per day) Between $ 3.2 and $ 5.5 PPP a day • Only 2 out of 50 older persons live on more than UGX13,700 per person per Between $ 1.9 and day $ 3.2 PPP a day Below $ 1.9 PPP a day
CONTEXT: AGEING IN UGANDA
WHO IS CONSIDERED AN OLDER PERSON IN UGANDA? In contrast: Lived experiences of Social perceptions an older person • Someone above 60 -70 years • Older persons are socio-economically (responses vary) active unless severely disabled or chronically ill • Prone to frailty, disability and illness • Older persons play a key role in the care of young children • Grandparent and head of household • Financial demands in old age have increased • Behaves ‘well’ • The culture of reciprocal care of • Lower levels of engagement in ageing family members has eroded economic activities over time • Age-based discrimination embedded • Physically dependent on others in service provision
TYPICAL LIFE-COURSE OF AN OLDER PERSON Type of major events/disruptors Outcomes • Civil conflict and displacement • Experience of long term poverty • Urbanisation • HIV/AIDs • Change in community and family structures • Land conflict and sub-division • Drought and weather related shocks • Change in role and value of older persons ABSENCE OF THE STATE and APPROPRIATE SERVICES
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