Yes. There are many policies for older people in Brazil in which dementia is indirectly and sometimes directly integrated into. Examples are:

– The “National Healthcare Policy for Older People” (Política Nacional de Saúde da Pessoa Idosa) that aims to recover, maintain, and promote autonomy and independence of older people (any Brazilian citizen aged 60 years and over) through collective and individual healthcare measures in line with SUS (Brazilian Ministry of Health, 2006b).

– The “National Policy for Primary Care” (Política de Nacional de Atenção Básica) considers changes and updates in the primary care system. The policy emphasizes the importance of the primary care as the main gateway to access the entire public healthcare system (Brazilian Ministry of Health, 2012).

– The “Family Healthcare Strategy” (Estratégia de Saúde da Família) aims to promote quality of life for the Brazilian population and intervene in factors that put health at risk, such as lack of physical activity, tobacco smoking, poor diet, etc. Healthcare teams work closely with people, allowing the professionals to know the person, their family, and the neighbourhood (Brazilian Ministry of Health, 2019c).

– The “It is Better at Home Program” (Programa Melhor em Casa) is a service indicated for people who have temporary or definitive difficulties to leave home and reach a healthcare unit or for people who depend on home-care services. The program aims to provide the patient with care closer to the family’s routine, avoiding unnecessary hospitalizations and reducing the risk of infections (Brazilian Ministry of Health, 2019h). 

– The “Technical Guidelines for Implementing a Healthcare Pathway for Integral Health for Older People” (Orientações Técnicas para Implementação da Linha de Cuidado para Atenção Integral à Saúde da Pessoa Idosa) was a document developed to orientate Brazilian states, municipalities, and the Federal District regarding how to provide integral healthcare for older people. The guidelines take in consideration both the identification of older people’s healthcare needs and their functional capacity (Brazilian Ministry of Health, 2018e).

– The “Training Notebook of Primary Healthcare Professionals for Older People’s Health”  (Caderno de Formação – Ação: Capacitação dos Profissionais da Atenção Básica sobre a Saúde da Pessoa Idosa) is used in trainings of primary healthcare professionals and brings educational information about the general health of older people (including information on dementia) (Brazilian Ministry of Health, 2017a).

References:

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

Brazilian Ministry of Health. (2012). Política Nacional de Atenção Básica. http://189.28.128.100/dab/docs/publicacoes/geral/pnab.pdf

Brazilian Ministry of Health. (2017a). Caderno de Formação – Ação: Capacitação dos Profissionais da Atenção Básica sobre a Saúde da Pessoa Idosa.

Brazilian Ministry of Health. (2018e). Orientações Técnicas para a Implementação de Linha de Cuidado para Atenção integral à Saúde da Pessoa Idosa no Sistema Único de Saúde—SUS. Ministério da Saúde do Brasil.

Brazilian Ministry of Health. (2019c). Estratégia Saúde da Família.

Brazilian Ministry of Health. (2019h). Programa Melhor em Casa.

There is no dementia-specific strategy in planning and provision of support services for older people with dementia.

However, dementia is covered by the health care and long-term care policy in Hong Kong. Starting from 2014-2015, the Government has provided Dementia Supplement (DS) on a recurrent amount of about $230 million annually as additional support for dementia care in residential care homes to employ additional professional staff. Also, an additional recurrent funding of about $22 million annually was allocated for District Elderly Community Centres (DECCs) to employ more social workers to strengthen the support for older people with dementia and their family carers. Besides, the Hospital Authority (HA) has allocated an additional funding of $12 million to increase the use of new anti-dementia drugs and about 2,700 patients benefited from it (Secretary for Labour and Welfare, 2017, June 27; The Government of the Hong Kong SAR, 2015, June 17).

Apart from the existing financial allocation on services for dementia care, the Government has conducted reviews on the service provision for older people with dementia through an expert group of the Review Committee on Mental Health under the Food and Health Bureau (FHB) since 2013. Also, the 2014 Policy Address has announced that the Elderly Commission under the Labour and Welfare Bureau (LWB) should review and strengthen the medium and long-term care planning for older people including dementia as one of the main issues. In 2017, the Mental Health Review Report (MHRR) and the Elderly Services Programme Plan (ESPP) have been submitted to the Government. Afterwards, the Government has been implementing follow-up actions according to the strategic directions and recommendations in the MHRR and ESPP (Legislative Council Secretariat, 2017, February 21).

In the 2017 Policy Address, the Government has announced a series of new initiatives to enhance dementia care and support at the community level, including outreaching services and additional 1,000 Community Care Service Voucher for the Elderly to older people with moderate or severe impairment. The Financial Secretary has allocated about $2.9 billion for strengthening elderly and rehabilitation services, including territory-wide public education on dementia, provision of technology products and speech therapy in elderly service units. Besides, the Government has launched the Dementia Community Support Scheme to provide multi-disciplinary community support services through medical-social collaboration for persons with mild or moderate dementia and family carers since 2017 (The Government of the Hong Kong SAR, 2018, July 4).

References:

Legislative Council Secretariat. (2017, February 21). Care services for elderly persons with dementia. Retrieved from https://www.legco.gov.hk/research-publications/english/essentials-1617ise10-care-services-for-elderly-persons-with-dementia.htm

Secretary for Labour and Welfare. (2017, June 27). Panel on Welfare Services and Panel on Health Services, Joint Subcommittee on Long-term Care Policy, Follow-up to the meeting on 28 March 2017. Hong Kong Retrieved from https://www.legco.gov.hk/yr16-17/english/panels/ltcp/papers/ltcp20170328cb2-1748-1-e.pdf

The Government of the Hong Kong SAR. (2015, June 17). LCQ16: Dementia [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201506/17/P201506170682.htm

The Government of the Hong Kong SAR. (2018, July 4). LCQ17: Elderly Services Programme Plan [Press release]. Retrieved from https://www.info.gov.hk/gia/general/201807/04/P2018070400621.htm

There are existing programmes and policies under the MoHFW and MSJE that are relevant for persons with dementia and also have scope for inclusion of dementia. These are summarised in Part 3.

Dementia has not been mentioned in other national plans, not even in the national plan of Older People’s Health (Ministry of Health Regulation No. 25/2016 on National Action Plan on Older People’s Health, 2016). However, diabetes and hypertension, two chronic conditions which are risk factors of dementia are covered by the Prolanis program (BPJS Kesehatan, 2014).

References:

BPJS Kesehatan. (2014). Panduan Praktis PROLANIS (Program Pengelolaan Penyakit Kronis)/PROLANIS Guideline. In BPJS Kesehatan.

Ministry of Health Regulation No. 25/2016 on National Action Plan on Older People’s Health (Permenkes No. 25/2016 tentang Rencana Aksi Nasional Kesehatan Lanjut Usia 2016-2019). (2016). (Testimony of Ministry of Health Republic of Indonesia).

The Mental Health Strategic Plan (MHSP) FINAL DRAFT (2018-2023) was shared with the STRiDE Jamaica team by the Director, Mental Health Unit, Ministry of Health, and Wellness, in May 2019, prior to its public dissemination. Until it is published, or permission is given by the ministry to represent here, this information is embargoed until further notice.

Nevertheless, at the press launch of the ADI 2019 Caribbean Regional Meeting in Kingston, Jamaica, in November 2019, the Director of the Mental Health Unit, Ministry of Health, and Wellness, announced that this strategic plan is due to be in cabinet by 2020 and will be made publicly shortly. The director shared that one of the dementia-specific issues addressed within the plan is the need for more public education programmes, including on how to detect dementia and improving the training of health workers in the early recognition and treatment of dementia. The plan will also address improved training and support of caregivers and options for rehabilitation of patients, which, though not dementia specific, has the capacity to support caregivers of persons with dementia.

He also indicated that the Mental Health Unit has re-organised and expanded its services. One example is a new campaign titled ‘Speak Up, Speak Now,’ aimed at reducing stigma, which was launched on World Mental Health Day in 2019. The campaign is supported by a new Mental Health and Suicide Prevention Hotline.

There is no mention of dementia in any policy document in Kenya whether at national or at county level. It is understood that the mental health policy would also cover people living with dementia as its definition provides a wide realm of potentially eligible people: “older persons especially those without social protection and social networks are often vulnerable to mental disorders” (Ministry of Health, 2015c), page 19.  They should therefore be targeted for mental health interventions.

References:

Ministry of Health. (2015c). Kenya mental health policy 2015-2030: Towards Attaining the Highest Standard of Mental Health. Nairobi, Kenya. https://publications.universalhealth2030.org/uploads/Kenya-Mental-Health-Policy.pdf

In Mexico, the National Development Plan (NDP) is the guiding document of the Federal Government in which they describe the national objectives, strategies, and priorities of the integral and sustainable development of the country. It is prepared during the first semester of the six-year term of each federal government and its validity ends with the corresponding constitutional period.

Given that a large proportion live in poverty and without access to social protection system, the National Development Program PND 2019-2024 includes a program for the Welfare of Older Persons, which is based on providing economic support (US $66.61 by month) to women and men over 68 years. However, to date, neither National Health Sector Programs nor National Old Age Health Care Programs have included dementia. Therefore, at the federal level, the issue of dementia is not placed within the national policy.

While Mexico has not yet ratified its adherence, the Inter-American Convention for the Rights of Older Adults includes in its article 19 ‘Rights to Health’ the promotion of the development of specialised integrated social and health care services for older adults with dependency-generating illnesses, including chronic degenerative diseases, Alzheimer’s disease, and other dementias (Organization of American States, 2015).

While ageing issues and older adults have gained importance and have been positioned at the national level as priorities, no specific government sector or Secretariat is responsible for dementia and there are no specific programs for dementia diagnosis and care.

In the previous government administrations, some institutions or programmes included several related activities within their aims to support older adults, for example:

• National Gerontology Program 2016-2018 (National Institute for the Elderly, INAPAM) (INAPAM, 2016): which focuses on the implementation of public policies to support the wellbeing of older adults.
• Program to Support Aging 2013-2018 (Programa de Atención al Envejecimiento) (National Centre for Disease Control and Prevention Programs, CENAPRECE): where the first objective was to establish a culture of living healthy, with a gender perspective among older adults, care for chronic diseases and mental health coverage including the detection and diagnosis of memory alterations. However, we found no data about their degree of implementation nor to inform if these were implemented.
• Specific Mental Health Action Programme 2013-2018 mentions the need for timely detection of mental or behavioural disorders in adults and older adults.
• Specific Action Programme Psychiatric care 2013-2018 indicates the need to contribute to the deinstitutionalisation of mental health patients with severe cognitive impairment and abandonment.
• Specific Action Programme Research for Health 2013-2018 only describes the issue of ageing, putting into context the population pyramid that points at ageing and non-communicable diseases.

References:

INAPAM. (2016). Programa Nacional Gerontólogico 2016-2018.

Organization of American States, O. (2015). Inter-American Convention on Protecting the Human Rights of Older Persons (A-70). http://www.oas.org/en/sla/dil/inter_american_treaties_A-70_human_rights_older_persons_signatories.asp

The actions from the Dementia Plan are intended to support the Healthy Ageing Strategy’s Priority actions 2019–2022. This Plan also has links to and supports other strategies and plans, including:

• Health Ageing Strategy 2016 which sets out the strategic direction for the next 10 years for the delivery of services so that older people live well, age well, and have a respectful end of life in age-friendly communities. The current focus is on the priority actions for 2019 to 2022.
• Better Later Life – He Oranga Kaumātua 2019-2034 which sets out the actions needed for Aotearoa New Zealand to embrace the opportunities that an ageing population and longevity brings.
• The Carers’ Strategy 2008 and the Carers’ Strategy Action Plan 2019 to 2023 which provides resources and support to support care partners.
• The Aotearoa New Zealand Disability Strategy 2016 which has a vision for Aotearoa New Zealand as “a non-disabling society – a place where disabled people have an equal opportunity to achieve their goals and aspirations, and all of Aotearoa New Zealand works together to make this happen”.
• Government Inquiry into Mental Health and Addiction 2018 which provided advice to Government about changes needed to the system.
• The Health and Disability Kaiāwhina Workforce Action Plan 2015-2020 which is a five-year action plan with a 20-year vision for the Aotearoa New Zealand health and disability Kaiāwhina (non-regulated) workforce.

South Africa has an Older Person’s Act (no.13 of 2006) that broadly deals with issues pertaining to older persons and aging in general, and it mentions the care for older persons with dementia or Alzheimer’s disease.

The DSD also has an Older Person’s Programme that is responsible for coordinating services provided to older persons.

The country’s National government has also adopted the Mental Health Policy Framework and Strategic Plan (2013-2020) that promotes an integrated care model that decentralises primary care to home- and community-based services. Although there is no specific mention of dementia in this strategic plan, it is an important document (action plan) as the current focus on improving residential care services in South Africa (i.e., following the Life Health Esidimeni[1] tragedy in 2016), provides the opportunity to place Dementia on the agenda.

The White Paper on the Rights of Persons with Disabilities (Government Gazette, 09 March 2016, no.39792) briefly mentions older persons with dementia (see p.71) (White Paper on the Rights of Persons with Disabilities, 2015).

[1] The Life Health Esidimeni tragedy: Where 143 mentally incapacitated patients died due to starvation and neglect after the Gauteng Department of Health (in  a bid to save costs) terminated an outsourced care contract with Life Esidimeni (service provider) and transferred patients to NGOs etc, who were not prepared or equipped to care for these patients (see https://en.wikipedia.org/wiki/Life_Healthcare_Esidimeni_Scandal).

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

White Paper on the Rights of Persons with Disabilities, 1 (2015). https://www.gov.za/sites/default/files/gcis_document/201603/39792gon230.pdf