DESK REVIEWS | 04.02.02.01. Is dementia integrated into or covered by a different national plan (such as a mental health plan)?
DESK REVIEW | 04.02.02.01. Is dementia integrated into or covered by a different national plan (such as a mental health plan)?
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).
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://22.214.171.124/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.
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).
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).
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.
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.
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
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 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).
 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).
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