DESK REVIEWS | 03.02.05.01. Are there any planned changes (reforms) to the organisation and financing of the long-term care system?
DESK REVIEW | 03.02.05.01. Are there any planned changes (reforms) to the organisation and financing of the long-term care system?
After enacting the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, and launching the Integrated Programme for Older Persons in 2015, old-age homes have begun to emerge as one of the key institutions for long-term care in India. This has intensified the need to establish a licensing and regulatory authority for old-age homes and similar institutions. Moreover, minimum standards and mechanisms for quality assurance must be put in place.
At present, the National Health Policy 2017 (MoHFW, 2017) addresses long-term care in the following manner: India needs to develop its own cost-effective and culturally appropriate approach to addressing the health care needs of older persons. It emphasises a community-centred approach where care is provided in synergy with family support, with a greater role for formal caregivers at the community level, with good continuity of care at secondary and tertiary levels. A closely related concern is the growing need for palliative care for life threatening illness and where people approach the end of life. Palliative approaches include measures to relieve pain and suffering and provide support to the patient and the family (UNESCAP, 2016). The Ayushman Bharat scheme proposes setting up 1,50,000 health and wellness centres, which in addition to primary healthcare will also provide care of older persons, and palliative healthcare services (MoHFW, 2019a).
Ministry of Health and Family Welfare. (2017). National Health Policy-2017. Ministry of Health and Family Welfare, Government of India. Available from: https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf
Ministry of Health and Family Welfare. (2019a). Ayushman Bharat Health and Wellness Centres: Accelerating towards health for all April 2018 – September 2019. Government of India. Available from: https://ab-hwc.nhp.gov.in/download/document/340b49eb2c0937e7b79ad8c1d6b975ad.pdf
UNESCAP. (2016). Long-term Care of Older Persons in India. Available from: https://www.unescap.org/resources/long-term-care-older-persons-india
Indonesia is nearing the end of its National Medium-term Development Plan 2015-2019. Long-term care is expected to also be included in the consecutive long-term development plan. However, it is unclear whether this involves reforms to the organisation and financing of the long-term care system (UNESCAP, 2014, p.12).
UNESCAP. (2014). Report of the Regional Expert Consultation on Long-term Care of Older Persons. https://www.unescap.org/sites/default/files/Report%20Reg-Consultation.pdf
As previously explained, there are currently two working groups collaborating towards the generation of a National Care System that could potentially lead to the creation of some LTC policies or strategies in the next years. In addition, in recent months (by August 2020) as ministries and federal institutions develop their six-years plans as required at the beginning of each presidential period, three institutions have included care-related objectives that may bring changes towards the generation of a National Care System, including long-term care.
The first institution to include actions toward supporting those in need of care and their carers was the National Institute for Women, one of the few institutions that has been working towards the generation of a National Care System in previous administrations. With the objective of increasing awareness about all individuals having care needs during the life course, of achieving a fairer distribution of unpaid domestic work and care between women and men, and of modifying intergenerational cultural norms towards gender equality, the 2020-2024 Program establishes the need to develop and implement a national care strategy in which co-responsibility between the State, the private sector, the community, and households prevails.
Specifically, its Priority Strategy 2.3 to increase awareness on the need to recognise, reduce, and redistribute household work and care among the family, the state, the community and the private sector, includes three main actions (2.3.1-2.3.3): a) to encourage actions between the state, families, communities and the private sector that allow positioning Care as a human right and the revaluation and redistribution of care work, as well as promoting equality between women and men; to collaborate with other ministries and public institutions in order to develop a National Care System; and to promote organisational culture actions within the Federal Public Administration that allow balancing work responsibilities with personal care needs.
Second, the Welfare Secretary (previously the Social Development Secretary), in its Welfare Sector Program 2019-2024 (DOF 26/06/2020) (Secretaría de Bienestar, 2020) includes the need to incorporate the Right to Care as part of All Human Rights in Mexico. Specifically, in its Priority Objective 1 to contribute towards guaranteeing a basic set of human rights in an effective and progressive way, starting with those most in need, the document states the urgent need for the National Government to develop and ensure the Right to Care as a social right, with the aim of decreasing discriminatory practices, development and wellbeing inequalities present within the current system of care characterised by the lack of public support to those in need of care and their carers. By establishing the need to include the Right to Care within Mexican legislation, the Program envisions access to care services as a right for all individuals who might need to be cared for during the life course but focusing on particular groups with care dependency such as older adults, people with disabilities and young children.
Within Priority Objective 1, Priority strategy 1.1 defines the need to work towards granting access to care services for girls and boys, for people with disabilities and older adults in order to improve their well-being. The strategy includes three main actions:
- implementing care services for girls and boys, people with disabilities and older adults;
- contributing to the coordination and implementation of a National Care System based on the care services of the sector;
- ensuring early childhood care service for children with and without disabilities, with a human-right and differentiated approach, for mothers, single fathers, or guardians who are looking for a job, studying or working.
The third program that includes strategies or actions that could support LTC, is the Health Sector Program 2020-2024 developed by the Secretary of Health. Priority Objective 2 aims to increase the efficiency, effectiveness, and quality of all processes within the National Health System to provide comprehensive public health and social care. This program also includes a main action to establish specific actions and strategies for the care of carers of people who are ill, and/or have disabilities or special needs, to prevent excessive burden to the carers.
In addition, Priority Objective 5, which aims at improving health protection by prioritising the prevention of health risks through timely and optimal treatment and control of diseases, includes the Priority Strategy 5.1 to improve coverage, equitable access, and quality in health services for the timely diagnosis and treatment of NCDs, and includes three main actions (5.1.8-5.1.10) related to LTC. These are: to efficiently and safely promote palliative care; to ensure quality of life and relief of patients with advanced disease and in terminal phase; to promote support for patients living with NCDs under a comprehensive and multidisciplinary approach that facilitates self-management and the acquisition of skills oriented towards their quality of life; and to establish protocols for the recognition and support of individuals who care for others who are ill, especially those who care for people with disabilities or special needs.
 Planning and budgeting within Mexico’s Public Administration is based on a National Planning System, which is structured under the guidelines of the Planning Law and with the active participation of public, social and private sectors. This system is reflected in a National Development Plan that, every six years, is presented to Congress by the President for its revision and approval where appropriate, usually within the first six months of each new administration. Once the National Development Plan is published, all Ministries and Decentralised Federal Institutes have to develop and publish their National Plans for the period. These plans define the priority objectives and main actions they will implement throughout the period and which must be aligned with the National Development Plan.
 The National Care System would include three main groups/care needs: early childhood care; older adults and people with disabilities and therefore would go beyond LTC for those with care dependency and their carers, by including nurseries, child care, extended hour schools, etc.
Secretaría de Bienestar. (2020). Programa Sectorial derivado del Plan Nacional de Desarrollo 2019-2024. Programa Sectorial de Bienestar. https://www.gob.mx/bienestar/documentos/programa-sectorial-de-bienestar
There is currently a shift from emphasising the funding of State care homes, to more community-based care (e.g., provisions for caring through the home care cash benefit) (Lloyd-Sherlock, 2019b). However, this shift is slow as currently the bulk of long-term care is still focused on the funding of residential care facilities.
Lloyd-Sherlock, P. (2019b). Long-term Care for Older People in South Africa: The Enduring Legacies of Apartheid and HIV/AIDS. Journal of Social Policy, 48(1), 147–167. https://doi.org/10.1017/S0047279418000326