Evaluating and replicating local accountability platforms for residential care homes and social care services.

Lead Research Organisation: University of East Anglia
Department Name: International Development


More people aged over 70 live in developing countries than in developed countries and many of these people need social care. It is sometimes assumed that families in developing countries are more willing and able to offer this support, without recourse to the private sector. In fact, the evidence says otherwise. Over the past decade or so, there has been a very rapid expansion of private provision, including care homes, in many developing countries. Many of these care homes are subject to little, if any, regulation, and there is evidence that service quality is very uneven. Government capacity to enhance regulation is limited and the issue has remained a low policy priority (at least until the Covid-19 pandemic).

Following research in the Argentina city of La Plata, we worked with local organisations, including care home directors and a community group run by older people to develop an innovative, locally-owned project for improving information sharing and quality accountability. Launched in 2019, it consists of a simple, interactive information-sharing platform (http://www.redmayorlaplata.com/).

The site provides information about local care homes that have agreed to a published set of quality principles. It enables service users to provide feedback about providers. Complaints are investigated and providers removed from the site if they are confirmed. The site has other features, including general information for service users to support the selection and assessment of social care providers. By the end of 2019, the site was receiving over 12,000 hits a month and had received over 50 messages about service quality. These included examples of abuse, which were followed up and led to the exclusion of the providers in question.

We feel there may be benefits in extending this activity to other cities in Argentina and beyond. Before promoting this approach, we require more robust evidence about how it was developed, how well it is working, what effects it has had and how easily it may be replicated elsewhere. Part of the funds we are requesting are to support this evaluation.

The Covid-19 pandemic is hitting care homes in Latin America hard and there is growing interest in new ways to improve quality and accountability in the sector. Since we submitted the preliminary proposal, several organisations in Argentina and elsewhere have committed to developing new projects in different cities, based on our experience in La Plata. Part of the funds we are requesting will be to observe and conduct a light-touch review of these new extension activities in Argentina. We will use funds from a separate grant (already awarded) to support similar work in Brazil.

We will present the results of our analysis in a number of different formats, both for academic audiences and for other types of audience with potential to apply these findings to future extension activity in Argentina, Latin America and beyond.
Description By supporting and studying their development and use by the public, we have demonstrated the need for local civil society information networks on long-term care facilities for older people in different countries in Latin America.
Exploitation Route we are seeking new funds to further develop these platforms
Sectors Healthcare

URL https://frente-ilpi.com.br/
Description We contributed to the development of a new, user-driven national data base on care homes for older people in Brazil and a similar digital platform in Argentina. These are being widely used by the public in both countries, as other sources of information about these facilities do not exist.
First Year Of Impact 2021
Sector Healthcare
Impact Types Societal,Policy & public services

Description Develop national network of care homes in Brazil to address COVID-19 pandemic
Geographic Reach South America 
Policy Influence Type Influenced training of practitioners or researchers
Impact The National Front for Long-Term Care Facilities. One key focus of this project is that many care homes are unregistered with government agencies, impeding quality assurance and meaning that reliable information on facilities was often unavailable to the general public. This limited the capacity of many government agencies to respond to the crisis. The joint coordinator of this project, Karla Giacomin, led the development of a new, grassroots initiative to support long-term care facilities in Brazil in the context of the pandemic: The National Front for Long-Term Care Facilities (NF-LTCF) (https://frente-ilpi.com.br/). This GCRF project cannot claim full responsibility for this achievement, but did make significant contributions. In terms of funding, part of Giacomin's work, along with part of Lloyd-Sherlock's support of NF-LTC was paid through this grant (in keeping with national dissemination and engagement practices). These activities have also been supported by the Bahia State project team. Indicators of impact of NF-LTCF include: Producing the first national data base on long-term care facilities (with 8,000 providers), and now accessible tor the public. Reaching more than 600,000 different people and organisations through the NF-LTC website and other social media platforms. Becoming the main source of information about COVID-19 in care homes, providing support and emergency training manuals, videos, etc., etc. The recent launch of the NF-LTC's remodelled online platform was widely reported by major national media. Advocacy at all levels, including bringing about eight special meetings of the National Congress's Committee on Human Rights, focussing on the needs of care homes in the pandemic. This has led to numerous new pieces of emergency national legislation, including the provision of US$37 million of emergency funding to support the most vulnerable care homes. All the above has contributed to a much lower rate of COVID-19 mortality in old age care homes than that reported in high-income countries and in middle-income countries. It has been estimated that for 2020, there were around 883 deaths attribtable to COVID-19 among a national survey of 60,000 care home residents (in other words, 1.5% of residents died from COVID-19) (http://www.ggaging.com/details/1660/en-US/estimates-of-infection-and-mortality-from-covid-19-in-care-homes-for-older-people-in-brazil). In the UK and other high income countries, around 10 per cent of older people in residential care had died of COVID-19 by April 2021. The difference between Brazil and these countries was not because Brazil was less affected by COVID-19 in 2020: it had one of the highest per capita COVID-19 death rates in the world. Studies demonstrating the significance of NF-LTC in limiting deaths (and not authored by members of this project team) include: https://www.sescsp.org.br/files/artigo/02028d4c/ca1c/455c/b778/d8e30e24e538.pdf https://www.arca.fiocruz.br/bitstream/icict/43526/2/nota_idoso_equipe_gise_14.09.2020.pdf
URL https://frente-ilpi.com.br/