In Brazil, there is the Unified Health System (SUS), and the concept of equity is already incorporated in the government healthcare policies, being one of the three main principles of SUS. The National Healthcare Policy for Older People incorporates equity and universality in the sense that healthcare is offered to all persons aged 60 years and over regardless of whether they have dementia (Brazilian Ministry of Health, 2006b). However, although all people in Brazil are offered the same right of accessing care through the SUS (funded by public sector), people who are better off tend to use healthcare services provided by the private sector through out-of-pocket payments or healthcare insurances. So, there is a selection bias among people who use SUS. But even those using the public services, face different realities depending on where they live because the quality of and access to health services may vary according to neighbourhoods and cities. The SUS principles include universality and equity, but this is different in the different parts of the country.

References:

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

As mentioned in the Mental Health Review Report (MHRR), there is a wide range of subsidised support and care services provided to persons with dementia and their family carers. In terms of financial risk protection, the Government has launched the Pilot Schemes on Living Allowance for Carers of Elderly Persons from Low-income Families since 2014. Under this scheme, a total of 4,000 carers including carers for persons with dementia were benefited as of 2018 (Food and Health Bureau, 2017a, p. 159).

In terms of equitable access and affordability, the Elderly Services Programme Plan (ESPP) proposes recommendations on strengthening the financial sustainability of elderly services through reviewing the existing co-payment and allowance schemes (Working Group on Elderly Services Programme Plan, 2017, p. 40).

References:

Food and Health Bureau. (2017a). Mental Health Review Report.  Retrieved from https://www.fhb.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf.

Working Group on Elderly Services Programme Plan, Elderly Commission of Government of Hong Kong SAR,. (2017). Elderly Services Programme Plan. Hong Kong: Elderly Commission of Government HKSAR Retrieved from https://www.elderlycommission.gov.hk/en/download/library/ESPP_Final_Report_Eng.pdf.

Not applicable.

Equity is incorporated in the policy by upholding the national law on health, which ensures that all people have equal access to healthcare, as the national dementia plan operates within the universal healthcare system. The strategic plan emphasises the availability of standardized care for all older people across healthcare facilities. This includes public access to screening, diagnosis, and treatment. In addition, rights of the workforce alongside with patients’ rights are mentioned (Ministry of Health Republic of Indonesia, 2015b).

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.

No data was sourced due to a lack of dementia policy in Jamaica.

Although it is not directly mentioned, the plan not only refers to equity through awareness raising, but it also aims to emphasise that dementia is a public health problem that can affect anyone, and that generates profound changes in the lives of those who live with it. This includes promoting the fight against discrimination, informing people about their rights and services available to them, should they become victims of abuse or discrimination, recognising the role of caregivers as partners, and incorporating civil organisations to broaden the dissemination.

NZ Dementia framework:

The framework does acknowledge the need for “Health and social support services [to] promote earlier recognition of dementia and participation within their communities” and that the aim is to “provide a positive experience of care and support by strengthening the culture of partnership and engagement with both the person with dementia and their family and whānau.”

Dementia Action Plan:

The Dementia plan acknowledges inequities in availability and access to services. Equity is one of the eight principles of the dementia plan and is acknowledged in the action area on supporting people living with dementia and their family/whānau “services must be equitable in terms of access, tailored to individuals’ needs, and their quality must be assured”.

Not applicable as there is no dementia-specific policy or plan for South Africa.