Brazil’s last presidential election was in October 2018 and the new government started its activities in January 2019. As many changes are still taking place in this new government, it is difficult to predict potential dementia policy changes over the next years. We are aware that a new department was created this year in the Ministry of Health (Secretaria de Atenção Primária) and dementia is one of their priorities. Prof. Cleusa Ferri has been invited to go to Brasilia to talk to the Secretary of that Secretariat.

With the concerns on long waiting times and inadequate provision of health and social care services for persons with dementia, some stakeholders have recommended the Government to strengthen the existing dementia care service model and develop dementia-specific policy in Hong Kong. They suggest putting more efforts on public education to raise awareness and reduce stigma, health assessment and early diagnosis in primary care setting, long-term care and intervention to achieve age in place, and carers training to reduce caregiving burden (Legislative Council Secretariat, 2017, February 21).

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

There are certain activities that may influence policy for dementia in the future. The ARDSI has submitted a draft strategy report in 2018 which provides an overview of targets and activities that are needed in a national dementia policy (ARDSI, 2018). This is available to view online at: https://ardsi.org/pdf/Dementia%20India%20Strategy%20Report%202018.pdf

More recently, the Department of Health and Family Welfare, Government of Karnataka, NITI-Aayog and the National Institute of Mental Health and Neurosciences (NIMHANS) have launched the Karnataka Brain Health Initiative (KBHI) (KBHI, 2022). KBHI aims to address neurological disease burden (including dementia) through using evidence-based tools/protocols to diagnose and manage dementia and includes training of primary health care physicians to reduce delays in diagnosis and facilitate timely treatment (Alladi, 2022; KBHI, 2022).

References:

Alladi. S (2022). Primary Health Care doctors training by neurologists. Twitter. Available from: https://twitter.com/alladi_suvarna/status/1502244487191416833?cxt=HHwWgsCqjdzZhdkpAAAA

Alzheimer’s and Related Disorders Society of India.  (2018). Dementia India Strategy Report. Alzheimer Disease International. Available from: https://ardsi.org/pdf/Dementia%20India%20Strategy%20Report%202018.pdf

Karnataka Brain Health Initiative (2022). Forum for Karnataka Brain Health Initiative. National Institute of Mental Health and Neurosciences. Available from: https://brainhealthnimhans.in/#

On January 7, 2020, STRiDE Jamaica’s team lead met with the MOHW to advocate for a National Dementia Plan. STRiDE Jamaica was advised that while a stand-alone dementia policy was not feasible, dementia may be integrated in a wider health policy. It is hoped that as an outcome of Jamaica’s involvement in the STRiDE project (2017-2021), this will be achieved in the next 5 years.

Currently, the Ministry of Health, facilitated by Africa Mental Health Research and Training Foundation and ADOK is developing  a National dementia Plan with funding from the STRiDE project and London School of Economics (London School of Economics (LSE), 2018; C. Musyimi et al., 2019).  This is expected to increase awareness on dementia in community settings through evidence-based tools. Furthermore, members of the project work towards making dementia care a priority at policy level. The expected knowledge increase around dementia care is likely to result in a rise in the number of people receiving a timely diagnosis and adequate care and support for people with dementia and their carers. The aim of STRiDE is to build capacity to support the development, implementation, and evaluation of national strategies to deliver appropriate, equitable, effective, and affordable dementia care. STRiDE will support the development of a National Dementia Plan by offering recommendations based on a thorough situational analysis and other scientific results from the project. Following these changes, it can be expected that through future funding, guidelines, and protocols, dementia care in Kenya in future will be addressing the needs of people living with dementia, their families and those of health and long-term care professionals.

HelpAge International is also taking the lead in collaboration with Ministry of Health to develop a community care package – training manual for the care of older people in Kenya. It is expected that this manual will cover issues around dementia since it is intended to cover non-communicable diseases including mental illness (HelpAge International, 2019). Discussions around development of healthy ageing strategy are underway through the same partnership. This could result in dementia awareness and addressing risk factors related to dementia within community settings.  Africa Mental Health Research and Training Foundation (AMHRTF) and ADOK are part of the team involved in the development of this manual.

References:

HelpAge International. (2019). Terms of Reference for Development of Home Based Care (HBC)/Community care Package – Training Manual for the care of Older People in Kenya and Mozambique. https://www.helpage.org/silo/files/consultancy-on-development-of-hbc-package.pdf

London School of Economics (LSE). (2018). Strengthening Responses to Dementia in Developing Countries (STRiDE). https://www.lse.ac.uk/cpec/research/projects/dementia/stride

Musyimi, C., Mutunga, E., & Ndetei, D. (2019). Stigma and dementia care in Kenya: Strengthening Responses to Dementia in Developing Countries (STRiDE) Project. In World Alzheimer Report 2019: Attitudes to dementia (pp. 121–122). London, UK: Alzheimer’s Disease International. https://www.alzint.org/u/WorldAlzheimerReport2019.pdf

The new government administration is in its first year, when all the national plans and programs are generated. It is hoped that dementia is at least included as a priority in the Specific Action Program: Aging Care 2019-2024.

There is no anticipated change to dementia policy in the immediate future, despite evidence of a rapidly rising dementia numbers in NZ and the escalating economic and social costs associated with this.

The South African Human Rights Commission (SAHRC) has submitted their recommendations (SAHRC, 2017b) on the Older Persons Amendment Bill in June 2017 (Older Persons Act: Older Persons Amendment Bill, 2017: Comments Invited, 2017). These recommendations include revisions, for example, of (1) definitions, (2) registration clauses added with regards to assisted living facilities, and (3) registration of caregivers to be supervised by a registered nurse. Recommendations for policy changes are related to protecting the rights and care of older persons in general and not dementia-specific. Based on this review, it is unclear if these recommendations have been accepted and if there are expected changes to policies related to the care of older persons (and dementia) in the next 5 years.

References:

Older Persons Act: Older Persons Amendment Bill, 2017: Comments invited, 1 (2017). www.gpwonline.co.za

SAHRC. (2017b). South African Human Rights Commission Older Persons Amendment Bill. Available from: https://www.sahrc.org.za/home/21/files/SAHRC%20Submission%20on%20Older%20Persons%20Bill-%20Dept%20Soc%20Dev-%2030.6.17.pdf