DESK REVIEWS | 04.01. Governance

DESK REVIEW | 04.01. Governance

Yes. Dementia is included in the portfolio of the Brazilian Ministry of Health, as part of healthcare policies for older people. Some examples are the National Healthcare Policy for Older People, the Alzheimer’s disease Clinical Therapeutic Protocol, and the Older People’s Statute (Brazilian Ministry of Health, 2006a, 2017c; Presidency of Republic of Brazil, 2003).

References:

Brazilian Ministry of Health. (2006a). Política Nacional de Saúde da Pessoa Idosa. http://bvsms.saude.gov.br/bvs/saudelegis/gm/2006/prt2528_19_10_2006.html

Brazilian Ministry of Health. (2017c). PCDT Alzheimer. Brazilian Ministry of Health.

Presidency of Republic of Brazil. (2003). Estatuto do Idoso. Presidency of Republic of Brazil; National Congress of Brazil’s Information System. http://www.planalto.gov.br/ccivil_03/leis/2003/l10.741.htm

 

The Ministry of Social Justice and Empowerment (MSJE) is the Nodal Ministry for welfare of senior citizens in India (Ministry of Social Justice and Empowerment (MSJE), 2022b, pp.14). Both the Ministry of Health and Family Welfare (MoHFW) and the MSJE have a number of programmes that are relevant to and applicable to persons with dementia. Few programmes are summarised in Table 4.1.

Table 4.1. Overview of national programmes

Main national programmes Aspects of programmes relevant to dementia
National Programme for Healthcare of the Elderly (NPHCE) (MoHFW, 2011) Provision of preventive, general and rehabilitative geriatric care services.
National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases (CVD) and Stroke [NPCDCS] (MoHFW, 2017b) While it does not specifically mention dementia, it addresses risk factors and co-morbid conditions of persons with dementia.
National Programme for Palliative Care (NPPC) (MoHFW, 2019) End of life care for persons with terminal illnesses is currently primarily provided for persons with cancer and AIDS. Provision should be expanded to persons with dementia.
National Mental Health Programme (NMHP) (MoHFW, 2017a) Prevention, treatment, and rehabilitation of mental health disorders.
Atal Vayo Abhyudaya Yojana (AVYAY) (MSJE, 2022a)

 

This is an umbrella scheme that brings together several sub-schemes for senior citizens that address the needs for basic welfare (shelter, food, medical care etc.), nutrition for the elderly, provision of assistive living devices etc. It mentions care homes for persons with dementia under the Integrated Programme of Senior Citizens scheme (IPSrC).
Ayushman Bharat (MoHFW, 2022) Consists of two main pillars: 1) Ayushman Bharat-Health and Wellness Centres (AB-HWCs); 2) Ayushamn Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY),

Under the AB-HWCs scheme, there will be provision of elderly and palliative care services at the primary care level.

Source: MoHFW (2011; 2017a; 2017b; 2019; 2022); (MSJE, 2022a)

References:

Ministry Of Health and Family Welfare. (2011). OPERATIONAL GUIDELINES National Programme For Health Care Of The Elderly (NPHCE). Available from: https://main.mohfw.gov.in/organisation/Departments-of-Health-and-Family-Welfare/national-programme-health-care-elderly-nphce

Ministry of Health and Family Welfare. (2017a). Directorate General of Health Services: National Mental Health Programme.

Ministry of Health and Family Welfare. (2017b). National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases, and Stroke (NPCDCS).

Ministry of Health and Family Welfare. (2019). National Programme for Palliative care (NPPC): National Health Mission.

Ministry of Health and Family Welfare. (2022). Ayushman Bharat-Health and Wellness Centres. Ministry of Health and Family Welfare, Government of India.

Ministry of Social Justice and Empowerment (2022a). Atal Vayo Abhyuday Yojana. Available from: https://grants-msje.gov.in/display-avyay

Ministry of Social Justice and Empowerment (2022b). Scheme for Welfare of Senior Citizens. Press Information Bureau. Available from: https://pib.gov.in/PressReleaseIframePage.aspx?PRID=1806506

The Ministry of Health through its Mental Health Directorate and Family Health Directorate work on dementia. The Ministry of Health also launched the National Dementia Plan, which identified other ministries as stakeholders for the action steps, which include the Coordinating Ministry for Human Development and Cultural Affairs, Min. Domestic Affairs, Min. Family Planning, Min. Social Affairs, Min. Education, Min. Finance, and Social Insurance Administration Organisation (Ministry of Health Republic of Indonesia, 2015b). The Ministry of Social Affairs also has a social rehabilitation program for older people, named PROGRES LANSIA, which includes installation/rehabilitation centre for dementia/Alzheimer (Ministry of Social Affairs Republic of Indonesia, n.d.).

References:

Ministry of Health Republic of Indonesia. (2015b). National Strategy: Management of Alzheimer and Other Dementia Diseases: Towards Healthy and Productive Older Persons. Ministry of Health Republic of Indonesia.

Ministry of Social Affairs Repulbic of Indonesia. (n.d.) Program Rehabilitasi Sosial Untuk Lanjut Usia (Progres Lansia). Central Jakarta: Ministry of Social Affairs Republic of Indonesia. Available at: https://intelresos.kemensos.go.id/v4/user/registration/progres/point/2

Yes – see part 4.01.02.

In Mexico, ageing has been recently considered a relevant issue, and therefore it has been positioning within the public agenda in the past two decades. However, there is still no Ministry that oversees clinical or social aspects of dementia. As a consequence, to date, there are no national policies or programmes for dementia, and there are no strategies that aim at diagnosing, monitoring, or providing treatment and behavioural management options for people with dementia and/or their carers.

Dementia is indicated under the Department of Social Development’s Older Persons Act (no.13 of 2006), as for being responsible for developing community-based programmes aimed at prevention and promotion, as well as home-based care with regards to information, education, counselling services and care for Alzheimer’s disease and dementia (amongst others) (see section 11 (2)(c) of the Older Person’s Act, p.13) (Government Gazette, 2006). This Act also refers to dementia and Alzheimer’s disease as conditions for which services at residential facilities should be provided for, specified as care and supervision services as well as public education on ageing and dementia (see section 17 (b) and (d), p.17).

Dementia also falls under the portfolio of the Department of Health as well as the Department of Housing (Human settlements) which is the custodian of the Housing Development Schemes for Retired Persons Act, 64 of 1988 (HDSRP) (SAHRC, 2015).

References:

Government Gazette. (2006). Older Persons Act, No.13 of 2006 (Vol. 13, Issue 1098). Available from: https://www.westerncape.gov.za/other/2012/3/older_persons_act.pdf

SAHRC. (2015). Investigative Hearing Report: Investigating hearing into systemic complaints relating to the treatment of Older Persons. Available from: http://www.sahrc.org.za/construction-site/home/21/files/SAHRC Investigative hearing report.pdf

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).

References:

Brazilian Ministry of Health. (2006b). Política Nacional de Saúde da Pessoa Idosa. Brazilian Ministry of Health.

 

The Ministry of Social Justice and Empowerment and the Ministry of Health and Family Welfare and are primarily responsible for dementia.

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).
References:

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.

The departments of Health and Social Development.

Ageing and Mental health.

There are a number of programmes within the branches of social welfare, ageing, mental health and non-communicable disease management that are relevant for persons with dementia.

Dementia falls under the responsibility of two directorates in the Ministry of Health: The Directorate of Mental Health and the Directorate of Family Health.

Department of Mental Health – see part 4.01.02.

There are no specific programmes for dementia. Within health system institutions, AD and dementia are seen mostly as mental health issues and, therefore, would be seen within these departments or services.

Department of Social Development (DSD): Older persons programme (South African Older Person’s Forum (SAOPF)).

National Department of Health: Non-communicable diseases (NCDs), disability and older persons (which include eye health and palliative care) and in the Mental Health section.

No. Although dementia is a topic discussed by the Division for Older People Healthcare (in the Ministry of Health) there is no dementia-specific representative in the government.

There is no dementia specific representative within the national government.

No information available. [To be followed-up during stakeholder interviews.]

The director of Mental Health is frequently approached to give views on dementia in the context of Kenya, but there is no one specifically assigned to focus on issues around dementia at the national government level.