Dr Saidu Ahmed Dumbulwa
National Project Coordinator
HEPIQ-C Project
Dr Saidu Ahmed Dumbulwa
Population ageing in Nigeria
Nigeria’s aging population is ever increasing from 4.5% in 1991 to about 10% in 2019 with an estimate of about 18 million out of the 200 million population. It is estimated that thousands of the elderly people die every year from chronic diseases that can be prevented or controlled to achieve healthy and productive life. While, those affected with chronic diseases such Dementia are socially stigmatized in the developing countries, calling them different names. It’s quite unfortunate.
Despite recently observed progress in population health generally, there still remains an urgent need to accelerate progress in improvement of healthcare of the aged with adequate social security otherwise, we will be off-track toward attaining the SDG’s, especially the health-related SDG 3. For example, the Nigeria aging population is equal to the population of almost three to five small African Countries with no adequate policies or framework and human resources to address the threat posed.
Underlying reasons:
The underlying reasons for the current state of Nigeria’s ageing population healthcare include:
i) Structural issues: Geriatric Centre’s.
ii) Lack of effective health financing policy
iii) Supply side constraints of health system (Public and private sector)
Focus on health workforce is lacking, Geriatricians and gerontologist are grossly inadequate to deliver quality services. The private sector itself is fragmented and not keen to invest in the healthcare for the aged.
iv) Demand-side constraints are linked to lack of affordability which limit health-seeking of older person due to absence of health insurance and or lack of out-of –pocket expenses to procure services. In some areas the health facilities are equipped, however no skill staff on geriatric care, rather receive general practice consultation or even attend patent medical vendors and traditional healers which may cumulatively increase the morbidity and mortality associated with old age.
v) Identified challenges to implement effective health and social care delivery as at then were:
- Lack of adequate data of the Senior Citizens
- Poor health care services for the older person’s
- Poor capacity of health care providers to address issues relating to older persons across all levels.
- Lack of health specialist on geriatric care and gerontology to train healthcare workforce that will cascade downward from Tertiary (Teaching Hospitals/Federal Ministry) to Secondary (State Ministries/General Hospitals), and Primary (Local Government/Primary Health Care Centres) healthcare levels.
- Lack of funding for research on geriatric care and gerontology.
- Lack of inter-country collaboration within and outside Africa on training, fellowship and research on both geriatric care and gerontology.
- Lack of community support for older persons
vi) Identified issues that older people face in accessing health and social care services in Nigeria
1) Lack of affordable health insurance for the elderly people
2) Out of pocket expenses to procure health services
3) Problem of Age-compliant public buildings, and transportation
4) Lack of education and awareness and the need to know and access their health and social care needs.
5) Lack of community and family support to the older people
6) Poor social support and rehabilitations.
PARADIGM SHIFT THROUGH HEPIQ-C (Health care package for improving quality of care of ageing population)
In line with the context and statement made by Mr President at the Revitalization of Primary Health Care Development Centres in Kuchingoro, Abuja 2017 which stated that his government is committed to improving the quality of care of the vulnerable population, children women and the elderly. The HEPIQ-C Project initiative was launched to represent an important paradigm shift in the health and social care of the older person. It is a shift from traditional thought of care for the elderly to a specialized
global trend that is results-based, healthcare oriented approach to improve quality of care for productive long life of the Nigerian older persons.
The initiative was used to develop healthy ageing policy framework, and other strategic document. It is a drive with focus on improving health, and health social outcomes of older persons, through performance-based project execution leading to system strengthening of the Nigeria’s basic health care services and setting a model for other African countries. With this target approach, the quality of lives of elderly population will improve with subsequent economic growth.
The “HEPIQ-C Project” is aimed at addressing the fundamental pillars that ensures healthy aging through significant reduction of the leading causes of morbidity and mortality of the older persons in Nigeria. The initiative in summary comprises of four components, namely:
i) Clinical care: Establishment of Geriatric Centre’s in Nigeria.
ii) Training of Healthcare workforce on Healthy Ageing.
iii) Research and Development on Healthy Ageing: Research on chronic diseases of the aged, such as Dementia etc.
iv) Health-social Support: Community based geriatric support, Home based care etc.
INSTITUTIONAL ARRANGEMENT (National Senior Citizen Centre)
The government agencies and private sector, and coalition of elders collectively pushed to the passage of National Senior Citizen Centre which resulted to an agency that will address the health and social needs of the elderly in Nigeria. This singular effort of Mr President of assenting the bill will address substantial part of problems of the older persons. In addition to the above, Mr President approved also, the allocation of 1 per cent of the consolidated revenue CRF to the health sector to improve health care of the vulnerable population mainly children,women and elderly as Basic Health Care Provision Fund (BHCPF). Fifty per cent of the fund goes to the National Health Insurance Scheme (NHIS) to procure services for health insurance to the vulnerable groups, forty five per cent to the National Primary Health Care Development Agency (NPHCDA) for training healthcare workforce and procurement of consumables for the day to day activities of the primary health care centres and five per cent for the health emergency at the federal ministry of health.
Therefore, be as it may the Nigerian government have done a lot in creating a source of funds with perpetuity to address the issue. This scaffolding journey for the healthcare for the aged which is in tandem with the global trend, involves all tiers of government, private health sector, and development partners and academia.
Also as part of the agenda, Federal ministry of health have signed with MOU UK universities in area of training and research and also formed a National Research Committee on Ageing. And for the clinical care the government is set to establish six regional geriatric centres at the tertiary hospitals.
At the moment, Nigeria is leading the West African Countries on healthy ageing through training of healthcare workforce in geriatric and gerontology; from certificate courses to post graduate residency training (Consultancy).
Achieving Healthy Ageing:
The quality of care of about 18 million Nigerians who are over sixty years expected to change and live a better productive life. Healthy ageing could be achieved through this initiative;
i) Strengthening the health system targeting the primary, secondary prevention of the Non-Communicable diseases, through the four pillars of the HEPIQ-C project.
ii) Health financing of health care of the aged through the Basic Health Care Provision Fund and private health sector finance, corporate social responsibility of organised private sectors.
iii) Improve overall clinical geriatric care through effective governance.
iv) Explore the potential of private health sector on the care for the older person’s to curb the menace of medical tourism
v) Community participation and volunteerism in social care.
At the heart of this laudable project initiative is the idea of collective involvement across tiers of government; public and private sector. The journey to the global trend just began, and the road is far; not hard to reach. The spirit of inclusiveness brings us together for persevering work to contribute in helping to improve the quality of life and wellbeing of our older persons.
Let me use this opportunity to salute the frontline colleagues who are critical to the recorded success of the paradigm shift of healthcare for the Aged in Nigeria through the HEPIQ-C Project. More specifically,the geriatricians and researchers especially in Dementia working hard to save and improve the lives of the older persons.
In conclusion, Nigeria currently stands on threshold of transformation of health and social care for the Aged. HEPIQ-C initiative is indeed a bold step in accelerating improvement of healthcare for the aged outcomes. We are optimistic this will unlock the demographic dividend of our country. The lives and wellbeing of our Senior Citizens connotes an asset for the country. Together with you all, we sail through with good health and wellbeing. This is a positive development, which demonstrates Government’s commitment to its health agenda and a testimony that we can get it right in Nigeria
