Primary care units exist even in small towns/villages, rural and urban areas in Brazil, but there are greater numbers in big cities. There are efforts by the government to reach areas of difficult access. In some regions of the country the primary care unit is mobile, for example, it can be a big boat that goes on the river to reach small villages.

No. The community-based services provided by the healthcare sector and by the long-term care sector are territory-wide.

According to the Clinical Practice Guidelines (CPGs) for the management of dementia, families providing care in the community are advised to access support from community health workers like Accredited Social Health Activities (ASHAs)/volunteers of palliative care services or local chapters of organisations such as ARDSI (Shaji et al., 2018).

In addition, other dementia organisations like NMT and private attender agencies like Portea, Life Circle Elder Care and more, run few home-based care programs primarily in urban areas where paid attenders are available to support home-based care.

References:

Shaji, K.S., Sivakumar, P.T., Rao, G.P., Paul, N., (2018). Clinical Practice Guidelines for Management of Dementia. Indian J. Psychiatry 60, S312–S328. https://doi.org/10.4103/0019-5545.224472

Community-based services, such as Pos Layanan Terpadu (Posyandu) Lansia (Integrated Service Post for Older People) are available not only in capital and main cities but also in rural areas. However, there’s still unequal distribution. For example, there are 52.450 Posyandu Lansia in East Java province, while 10 provinces in Indonesia (Aceh, Bengkulu, Gorontalo, Riau Islands, Lampung, South Kalimantan, Southeast Sulawesi, West Nusa Tenggara, Papua, West Sulawesi, and West Sumatera) still had no Posyandu Lansia in 2015 (Ministry of Health Republic of Indonesia, 2017). This suggests that services generally are more readily available in urban areas.

Since the annual cognitive screening for older people in primary care has been regulated in the new Ministry of Health bill (Ministry of Health Regulation No. 4/2019 on Technical Standard to Fulfill Quality of Basic Service in Minimum Standard of Healthcare Service, 2019), it should be available in all Puskemas (government-owned primary care centres) across country. However, considering that there are remote areas which are difficult to access by the Puskesmas staff, we have to see if this regulation is widely implemented across the country. So far, we were unable to identify data to confirm that community-based services are available in all areas.

References:

Ministry of Health Regulation no. 4/2019 on Technical Standard to Fulfill Quality of Basic Service in Minimum Standard of Healthcare Service (Permenkes no. 4/2019 tentang Standar Teknis Pemenuhan Mutu Pelayanan Dasar pada Standar Pelayanan Minimal Bidang. (2019). (Testimony of Ministry of Health Republic of Indonesia).

Ministry of Health Republic of Indonesia. Profil Kesehatan Indonesia 2017. Jakarta: Ministry of Health Republic of Indonesia [Internet]; 2018. Available at: https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/Profil-Kesehatan-Indonesia-tahun-2017.pdf

There are more private residential homes in urban centres compared to rural areas. According to a press statement in 2016, Nairobi  County alone had several retirement and assisted living from less than ten the previous decade (Achuka, 2016). It is possible that the pressure of working and taking care of older persons is unlikely to take place in the cities hence family carers resort to retirement homes for the ageing parents. However, it is important to note that there are no public residential homes but only hospital-based palliative care services where people with dementia and at advanced stages are taken if they cannot afford private residential homes.

References:

Achuka, V. (2016). The new age dilemma of caring for ageing parents. Daily Nation, 14 May. Nairobi, Kenya. https://nation.africa/kenya/life-and-style/lifestyle/the-new-age-dilemma-of-caring-for-ageing-parents-1198666?view=htmlamp

No public services are available. While some community-based day centres are available for people with dementia, these services are offered in the private sector. Currently, FEDMA has knowledge of 9 day-centres for people with dementia and around 50 support groups in the country. These services are provided at the state level by the institutions affiliated to FEDMA.

Eligibility for community-based services is assessed based on need and is funded nationwide. However, despite funding availability, not all community services are available nationwide, and this is especially evident in smaller, more rural towns and communities.

Community-based services are skewed to more urban areas and rely on private organisations that provide nursing care for those who can afford to pay for it, as well as non-profit organisations (e.g., FBOs and NGOs) that cater for the needs of less wealthy older persons (at a lesser cost than private care).