Yes, there some dementia-specific documents at subnational levels. We could identify four of them. They are the law 6.926 in the Federal District (Federal District Government, 2021), the PL 131/2018 in the state of Rio Grande do Sul (Projecto de Lei n131/2018, 2018), the PL 769/2019 in the municipality of São Paulo (São Paulo Chamber of Deputies, 2019), and the PL 12/2020 in the city of Novo Hamburgo (Novo Hamburgo Municipal Chamber, 2020). They relate to policy for prevention, treatment, and support for people living with Alzheimer’s disease and other dementias and their family carers.

Besides, there are some policy documents that include strategies to improve the quality of care and accessibility to mental health services for older people in general, with dementia being explicitly cited as one of the conditions included. These documents are the State of Paraná Plan for Older People (Paraná Government, 2014), the State of Pará Plan for Older People (Pará Government, 2017) and the Municipality of São Paulo Healthcare Plan (São Paulo City Hall, 2015). Even though no documents exist for dementia specifically, the municipality of São José dos Campos, for example, offers dementia training for doctors, nurses, and dentists. This training is based on discussions of dementia-related clinical cases with a multidisciplinary team. Furthermore, there is an “Ageing Workshop” for training health community agents and nursing assistants in an array of topics relating to ageing, including dementia also in São José dos Campos. In Brazil there are 5,570 municipalities which are decentralised from the federal government; thus, it is possible that other unknown local initiatives exist.

References:

Federal District Government. (2021). LEI N^o 6.926—Política distrital para prevenção, tratamento e apoio às pessoas com doença de Alzheimer e outras demências. https://www.tjdft.jus.br/institucional/relacoes-institucionais/arquivos/lei-no-6-926-de-02-de-agosto-de-2021.pdf

Novo Hamburgo Municipal Chamber. (2020). Projeto de Lei Municipal 12/2020—Novo Hamburgo. Camara Municipal. https://portal.camaranh.rs.gov.br/pm3/informacao_e_conhecimento/noticias/novo-hamburgo-podera-ter-politica-de-enfrentamento-ao-alzheimer

Paraná Government. (2014). Plano Estadual dos Direitos da Pessoa Idosa do Paraná: 2015 a 2018. http://www.cedi.pr.gov.br/arquivos/File/2015/publicacoes/Plano_Estadual_Idoso_publicado.pdf

Paraná Government. (2017). Plano Estudual de Atendimento à Pessoa Idosa: 2016-2019.

São Paulo Chamber of Deputies. (2019). Projeto de Lei da Câmara Municipal de São Paulo, n 769, de 2019. https://splegisconsulta.camara.sp.gov.br/Pesquisa/DetailsDetalhado?COD_MTRA_LEGL=1&COD_PCSS_CMSP=769&ANO_PCSS_CMSP=2019

São Paulo City Hall. (2015). Plano Municipal de Saúde de São Paulo 2014-2017. City Hall of Sao Paulo.

There is no dementia-specific document operationalised at subnational levels in Hong Kong.

A dementia specific initiative has been operating in Kerala since 2014 (a state in South India). The Department of Social Welfare, Government of Kerala, and the Kerala State Social Security Mission (KSSM) with ARDSI as its knowledge partner, have been jointly implementing the Kerala State Initiative on Dementia (KSID).

This initiative has the following mandates (Social Justice Department and ARDSI, 2014):

• Creating comprehensive dementia awareness in the community (information, education and communication materials and website content prepared/developed and disseminated by ARDSI) (Social Justice Department and ARDSI, 2014),
• Equipping social and health care personnel with the skills required to provide dementia care (ARDSI currently provides training to the personnel on dementia Care) (Social Justice Department and ARDSI, 2014),
• Establishing memory clinics in medical colleges for early diagnosis and intervention (ARDSI has published memory clinic guidelines) (Social Justice Department and ARDSI, 2014),
• Establishing Model Dementia Day Care and Full-time Care Centres in all districts (one each functional at Cochin and Trissur districts of Kerala) (Social Justice Department and ARDSI, 2014),
• Setting up telephone helpline services for dementia information and support (ARDSI has set up a Dementia National Help Line at Cochin) (Social Justice Department and ARDSI, 2014)
• Developing protocols for the diagnosis, treatment, and care of the dementia (ARDSI has developed standard operating procedures for Day care centres and full-time Dementia care centres) (Social Justice Department and ARDSI, 2014).

References:

Social Justice Department and ARDSI (2014). Kerala State Initiative on Dementia. Alzheimer’s Disease International.

There have not yet been many dementia-specific documents, although age-friendly policies have been implemented at regional levels. A good example of a specific regional policy is the dementia-friendly village of Ketewel in Bali (Radha, 2018). There are also clinical guidelines on diagnosis and management of dementia issued by the Indonesian Neurologists Association (PERDOSSI) in 2015 (PERDOSSI, 2015).

References:

PERDOSSI. (2015). Panduan Praktik Klinik: Diagnosis dan Penatalaksanaan Demensia. PERDOSSI.

Radha, W. (2018). Penuhi hak lanjut usia, TP PKK Prov. Bali Dorong Pemberdayaan Lansia melalui Kegiatan Produktif. MetroBali. http://metrobali.com/penuhi-hak-lanjut-usia-tp-pkk-prov-bali-dorong-pemberdayaan-lansia-melalui-kegiatan-produktif/

No data was sourced due to the embargo on the Mental Health Strategic Plan.

No, there are not.

Dementia pathways are operationalised through regional health pathways which are localised and provide region specific information and guidance. There are nine regional pathways in NZ – Northland, Auckland, Midlands, Whanganui & MidCentral, Wellington/Wairarapa,Hutt, Nelson Marlborough, West Coast, Canterbury, and Southern (Health Navigator, 2019).

References:

Health Navigator. (2019). Dementia | Mate korongenge. Health Navigator New Zealand. Available from: https://www.healthnavigator.org.nz/health-a-z/d/dementia/#Clinical%20pathways.

No, South Africa does not have dementia-specific documents operationalised.