DESK REVIEWS | 04.01.02. Which government sector is primarily responsible for Dementia?
DESK REVIEW | 04.01.02. Which government sector is primarily responsible for Dementia?
The Ministry of Health. In Brazil dementia is considered a health issue, therefore it is part of the responsibilities of the Ministry of Health (Brazilian Ministry of Health, 2006b).
Brazilian Ministry of Health. (2006b). Política Nacional de Saúde da Pessoa Idosa. Brazilian Ministry of Health.
The Ministry of Health carries primary responsibility for Dementia. The recognition of dementia as part of the ministry’s portfolio was shown through the launch of the National Dementia Strategy. In addition, the Coordinating Ministry for Human Development and Cultural Affairs, the Ministry of Social Affairs, and the Ministry of Home Affairs (which coordinates plans in advocating local and regional policies) collaborate with the Ministry of Health in the development and implementation of the dementia action plan.
Furthermore, there are two independent commissions reporting to official bodies that are involved in shaping the dementia policy landscape:
- the National Commission of Older People (Komisi Nasional Lanjut Usia), which was established in 2004 as an independent, non-structural coordinating body between the government and the people, focusing on giving advice and consideration to the President in policy-making regarding older people’s social welfare improvement and assisting the President in coordinating the implementation. Despite being stated as independent, the presidential decree establishing it described that the head of the commission is a Minister who is responsible to government affairs in the social field (Presidential Decree No.52/2004 on National Commitee on Elderly (Keppres No. 52/2004 Tentang Komisi Nasional Lanjut Usia), 2004). The Komisi Nasional Lanjut Usia is no longer active since 2018. It was disbanded by the Ministry of Administrative and Bureaucratic Reform of the Republic of Indonesia due to “bureaucracy simplification and lack of performance” (Sitohang, 2019);
- the Regional Commissions of Older People (Komisi Daerah Lanjut Usia) whose responsibility includes monitoring and evaluation of regional programmes on older people’s welfare and report to their local governors (Permendagri No. 60/2018 Tentang Pedoman Pembentukan Komisi Daerah Lanjut Usia Dan Pemberdayaan Masyarakat Dalam Penangangan Lanjut Usia Di Daerah, 2008).
Permendagri No. 60/2018 tentang Pedoman Pembentukan Komisi Daerah Lanjut Usia dan Pemberdayaan Masyarakat dalam Penangangan Lanjut Usia di Daerah (Ministry of Home Affairs Regulation No. 60/2008 on Guideline on the formation of regional commission on elde). (2008). (Testimony of Ministry of Home Affairs Republic of Indonesia).
Presidential Decree No.52/2004 on National Commitee on Elderly (Keppres No. 52/2004 tentang Komisi Nasional Lanjut Usia). (2004). (Testimony of President of Republic of Indonesia).
Sitohang, M. Y. (2019). Matinya Komnas Lansia dan Jalan Lain Meningkatkan Kesejahteraan Lansia Indonesia. Pusat Penelitian Kependudukan LIPI.
The Ministry of Health is responsible for dementia detection and management, but this is not reflected in the existing literature. However, if the World Health Organization or the media or organizations creating awareness would like contributions on guideline development on dementia such as risk reduction of cognitive decline and dementia, they often invite expert opinion or participation from the Ministry of Health, particularly department of Mental Health.
There are currently no specific programs for Dementia, or Ministries with the mandate to oversee all dementia-related issues. When people do seek care for cognitive or behavioural complications (likely not identifying possible dementia) they do so through health services. In this context, no specialised services are available and thus, people accessing health services in any of the available institutions, are subject to the existence/availability of other specialist services (geriatrics, neurology, psychiatry) where they could be referred to and probably get some diagnosis. However, there are no standardised treatment protocols in place covering all health and social security institutions, and there are also no specific social care programmes for people with dementia or their carers.