| dc.description.abstract | Background: Awareness of ageing in Africa emerged in the early 1980s and was launched by the 1st UN World Assembly on Ageing (WAAI) in Vienna in 1982. Lack of progress in policy action led to the 2nd UN assembly on Ageing (WAAII), the ensuing Madrid International Plan of Action on Ageing in 2002, and the African Union Policy Framework and Plan of Action on Ageing in 2003. The AU plan recognises the ongoing demographic shift that will represent a major resource challenge for African countries in years to come, where the proportion of old people is expected to rise from 8% to 19% by 2050 and the proportion of children expected to fall from 33% to 22% (UNDP, 2009). Moreover, an epidemiologic transition is ongoing where non-communicable diseases will represent an increased challenge to public health.
Nigeria in a health-political context: The Federal Republic of Nigeria, comprising 36 federating States and 744 local government areas (LGAs) are each responsible for all financial aspects and the provision of Primary Healthcare (PHC) Services. In spite of the Bamako Initiative (1987), the Draft Nigeria National Policy on the Care and Well-being of the Elderly (2003), the Ouagadougou- and Abuja declarations (2008), issues of human development and health, least of all that of older persons, have remained a low priority. Today, key social determinants to ill-health and a deep-rooted culture of corruption challenges the implementation of the Nigeria National Strategic Health Developing Plan (NSHDP) 2010-2015 aim to improve the health situation of Nigerians by strengthening their access and availability to PHC services, especially at the grass-root level.
Identified problem areas: A changing societal environment, influenced by a demographic and epidemiologic transition, impacts the health-needs and the provision of quality healthcare to members of households and the community as a whole. In addition, there is an ongoing, steadily increasing rural-urban migration which challenges the extended family systems traditional role as healthcare provider for old family members. In a country with weak PHC structures, mainly financed by out of pocket payment, old people are dependent on functioning informal structures in times of illness and ill-health. A society in transition impacts on the vulnerability of old people and increases their need of social protection and provision of healthcare services that are socio-cultural acceptable and sensitive to local traditions, norms and values.
The autonomy of State- and LGAs on how to prioritise and implement strategies for PHC services are emphasised in NSHDP. One of the strategies is to empower communities, and to stimulate for community participation and ownership, despite lacking a clear policy framework where the Draft Community Development Policy is yet to be finalised. Interestingly, ongoing social, demographic- and epidemiologic changes are only limited discussed and reflected in the NSHDP. This opens for exploring the potential of Community Based Health Care and how the model could be suited to assist old Igbo people, through services and healthcare, complementary to that of family care, within their communities and homes.
The main aim of the study is to explore the potential of Community Based Healthcare (CBHC) services to elderly Igbo people, complementary to that of family care, in a rural community undergoing societal transitions. The study design is explorative and descriptive. The methods comprise semi-structured in-depth interviews and conversations with different groups of participants holding various roles, and focus-group discussions with old Igbo people. The study is conducted in a LGA in Imo State of Nigeria. Findings: Elderly Igbo people experiences a marked decline in family care and support, inconsistent with their needs. CBHC as a method is found to be viable, and regarded highly acceptable by old people. It can easily be adapted to normative traditions of care, and is therefore culture-sensitive. However, there are identified huge barriers to the implementation of the model. These are rooted both in its principles and practicalities. Conclusion: There are several challenges ahead, needed to be solved, before considering elderly people as group equally entitled to healthcare as for the youths, women, and children | nor |