It’s time to invest in healthy and productive ageing
Sri Lanka will face a massive social challenge to provide income,
health and other types of support to its elderly population in just over
two decades, says a new World Bank report “Addressing the needs of an
aging population” released recently. The country’s population will grow
to be as old as Europe or Japan’s today, but will have much lower levels
of income, posing a massive social challenge to provide services to its
“Sri Lanka will need to take appropriate policy measures in advance
so as not to slow down economic growth, minimize impact on public health
and pension spending and reduce the burden on families,” said World Bank
Country Director for Sri Lanka Naoko Ishii. “Investing in healthy and
productive ageing is essential- and specially, given the speed of
population ageing, inaction is not a viable alternative,” she said.
Investing in healthy and productive ageing is essential- and
specially, given the speed of population ageing, inaction is not
a viable alternative
The report examines four key challenges and the related issues of
‘How to reinforce traditional family support to old people’; ‘How to
improve formal old age income support program’; ‘How to improve
healthcare and long-term care to support an aging population’; and ‘How
to mitigate the slowdown of GDP growth when one of key production inputs
- labour - will start shrinking in the coming years?
The report uses a variety of data sources, but draws mainly from a
special 2006 survey that the World Bank conducted to learn about the
socioeconomic and health status of elderly in Sri Lanka. One of the key
findings of the survey was that the demographic transition faced by Sri
Lanka will be particularly dramatic.
Not only is Sri Lanka’s population among the oldest in the
non-developed world, but the country is also one of the fastest aging
countries in the world and the fastest in South Asia.
Traditionally Sri Lankan families have taken good care of their
elderly family members but the report finds some signs that this age old
support system is under strain. For example the women who are the
primary caregivers report of considerable stress and difficulty in
balancing their careers and working life and caring for both children
and parents. Institutionalization of elderly is a last resort and there
is also evidence that, as in higher income countries, those elderly who
can afford to do so prefer to live alone with their spouses.
Other support systems for elderly will become thus even more
important. But the report finds that formal old age income support
systems have limited coverage and inadequate benefits and are
financially unsustainable. Thus currently most elderly must rely on
family support or very low benefits from the social assistance programs.
Health systems are also not ready to address the needs of an aging
The treatment of non-communicable diseases is outdated and relies on
under-financing and under-treatment of cases, health systems do not
provide continuous or integrated care for the elderly that allow
systematic screening for illness or disability, and many elderly
patients who require secondary prevention do not receive it. Labour
market institutions too force many workers to withdraw from employment
earlier than they want to.
Key Policy Recommendations are to support informal care arrangements
of the most vulnerable of the aged; strengthen formal income support for
elderly; re-orient the health system to respond to an aging population
and countering labour force declines by improving employment,
productivity, and choice.
Under the support for informal care arrangements the report suggests
expanding social welfare and care services targeted at the most
vulnerable, providing community-and home-based support services for the
sick and frail old people, as well as increasing the capacity of nursing
homes to care for old people.
In strengthening formal income support for elderly, the
recommendations are to improve social assistance programs (including
Samurdhi) delivery to old people, integrating retirement schemes for
private and public sector workers, as well as various schemes for
informal sector workers, and encouraging the expansion of coverage by
fiscal incentives such as targeted matching contributions .
Re-orienting the health system to respond to an aging population will
require developing a health system that enables Sri Lankans of all ages
to achieve healthy ageing, minimizing the costs of the health system,
and reducing out-of-pocket catastrophic health expenditure.
Detailed recommendations include strengthening health promotion and
prevention to ensure better quality of remaining life of old people,
using the maternal and child health network of the Ministry of Health
for geriatric assessment, prevention, and rehabilitation, and improving,
and increasing public healthcare expenditure to avoid patients shifting
demand to the more expensive private sector.
To meet the prospects of a shrinking labour force, the report
outlines the following policy actions: increasing participation rates,
particularly of women and of old workers, including by introducing
inflexible retirement ages and increasing part-time/flexible working
opportunities, improving the productivity of the labour force by
improving skills of older workers, promoting formalization of the
economy and improving health outcomes for informal sector workers, and
improving the choices of old workers, allowing formal sector workers
work longer as well as allowing informal sector workers to withdraw from
the labour market if they wish to do so, rather than being forced to
work until health reasons prevent them to stay active.