Healthcare in the ‘Golden Years’: Who gets the bill?

It is tough to watch your parents age. Having to witness your caretakers become dependants can be quite the emotional ordeal. Aging is accompanied by chronic health conditions, such as alzheimer’s, arthritis, kidney disease, cancer, and high blood pressure, which make it increasingly difficult to live independently. The post-retirement phase of life or ‘golden years’ are usually accompanied by a myriad of inevitable personal, social and health factors that must be taken into account to minimise any impending anxiety and stress. It is important to consider that the older you or your loved ones get, the more likely it is that long-term care is going to be essential. Depending on where you are in the world, this care could either be government-funded, or completely private.

In most African countries, there is a cultural mandate and expectation that the responsibility of managing the wellbeing and welfare of the elderly or older adults should fall on their offspring or close relatives. Nursing homes, assisted-living facilities, convalescent homes, etc. are rarely considered as viable options for the elderly. To put it simply, the consideration to house your aging parents in a facility that is not your home, would be deemed as negligent or hyperbolically, a taboo. And frankly, beyond personal or private care, there aren’t many other options. 3% of Nigeria’s 206 million population are over the age of 65 years old; and currently, there are only approximately 25 functioning assisted-living facilities or nursing homes for senior citizens.

Older adults are largely dismissed and grossly underrepresented in health-related policies. According to the 2020 Healthcare Budget, as published by the Budget Office of the Federation of Nigeria, only 6,294,379 Nigerian Naira (approximately €14,000) is allocated to ‘Operationalization Of Elderly Health Care Program In Nigeria/Advancing The Health & Wellbeing Of Adolescents And Young People Through Provision Of Adolescent And Youth Friendly Services’. The only other mention of elderly care in the budget is for the ‘Construction Of Day Care Centre For The Elderly In Iyin Ekiti, Ekiti State’ which was allocated 132 million Nigerian Naira (approximately €283,557). In totality, this represents approximately 0.92% of the annual national budget for healthcare. This pales in comparison to the annual cost of elderly care in Sweden (one of the top 4 countries for aging), which was SEK 121.7 billion (USD 13 billion, EUR 11.6 billion) in 2017; this is funded by municipal taxes and government grants, and the costs paid by the elderly themselves are subsidised and based on specified rate schedules.

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The elderly population in Africa is amongst the most vulnerable to economic hardships. With age comes growing demands in healthcare that require adequate geriatric medical services; these usually come with extortionate medical costs and premiums. The absence of befitting policies, social security systems, pension schemes and health coverage for older adults ultimately results in poor health outcomes. To put it into context, more than 170 million Nigerians pay out-of-pocket for access to medical services. This translates into about 60% of all health spending being financed directly by households without insurance. As of 2016, only 7.9 million people (~4.2% of the population) were covered by the National Health Insurance System- majority of these being civil servants and their dependents. The situation is even more dire in rural areas, where many elderly adults may not have been formally employed with a company or government organization, and are largely dependent on income from menial jobs and manual work on farms. The elderly in these areas are mostly uninsured and tend to suffer from multiple health conditions which are undetected and unaccounted for.

Nigeria, Rwanda and Cameroon are the only three countries within Sub-Saharan Africa which are yet to enact policies for senior citizens into their legislature. Other countries in the region (e.g. Mozambique, Uganda, Tanzania, Zimbabwe, Kenya, Ethiopia and Malawi) have done a better job in ratifying or implementing bills or policies which focus on the aging population. Only Senegal, Ghana and South Africa have implemented free healthcare for the elderly or exempted them from paying health insurance premiums.
This has grave consequences (pun intended) not only for the current elderly population, but also for the 62% of Nigerian who are under the age of 25. That population group will be inheriting a system which is not built to take care of them in their old age, with no policies, social security and funding. It is never too late to start looking into what the ‘golden years’ will look like for you or your loved ones, and most importantly, who is getting the bill.

For immediate elder care services, check out: GeroCare Nigeria and Rock Garden Homes

Dr. Helen Zidon is the Deputy Head of Medical Information at Aspen Pharma Group, where she oversees the medical information functions of Aspen territories globally for multiple widely used pharmaceutical products. She is a public speaker and advocate for Global and Public Health, accessible and streamlined medical care, and the incorporation of Medical Technology in medical academia and medical practice.