Interventions for older people in sub-Saharan Africa

Between 2015 and 2050 the number of people aged 60 or more in sub-Saharan Africa is projected to roughly quadruple, reaching over 160 million. Hitherto, international development priorities have focussed on people at younger ages. There is now an urgent need to address this new challenge. It should not be assumed that policies for older people that proved effective in other world regions will be suited to sub-Saharan Africa. Current knowledge about "what works for older people" in the region is very limited.

We plan to address this knowledge gap by looking at the effects of three different policies for older people (screening for chronic health conditions, providing basic pensions and extending health insurance coverage) in two quite different countries: Ghana and South Africa. Using survey data that permit analysis over time, we plan to assess impacts of these policies on different aspects of older people's health and well-being. We will pay particular attention to high blood pressure (hypertension) and depression, as these conditions are closely linked to older people's general health and quality of life. Rather than collect our own information, we will make use of a number of existing surveys.

Building on insights we generated in a previous study, we will:

1) Examine and seek to explain changing patterns of hypertension among older people in Ghana and South Africa. Hypertension is the leading cause of death and serious illness among this group: understanding these patterns will support the development of more appropriate policy responses. We will look at who has hypertension, who is aware they have the condition and who is effectively managing it.

2) Assess the impact of screening for hypertension in South Africa on older people's awareness, treatment and control of the condition.

3) Assess the impact of Ghana's expanding national health insurance scheme on older people's health and wellbeing, including hypertension and depression.

4) Assess the impact of South Africa's old age grant on the health and wellbeing of older people, with a particular focus on depression and risk of death.

Our overall aims are to generate valuable research insights and to ensure these are effectively communicated to appropriate policy-makers. As such, a large part of the project will involve engaging with key global, regional and national policy-makers, including workshops, briefing papers and interaction through social media.

We plan to develop the non-academic impact we generated in our first SDAI study. This study's explicit focus on policy interventions will enhance its potential impact. Lloyd-Sherlock (LS) has overall responsibility for impact. The budget includes specific impact time allocations for different team members. We will focus on impact generation in Ghana and South Africa, through "national impact-leaders" (Twine and Amoakoh-Coleman) with support from LS and other team members.

During inception, LS will work with the national impact leaders to develop national impact plans. These will build on stakeholder engagement in the first project. We will hold national stakeholder consultations during inception, and dissemination workshops in the final 6 months. These will enable continual stakeholder engagement and dialogue through the project.

Ghana is the only sub-Saharan African country in a translational research initiative with WHO and Age UK. Our previous study fed into this initiative and we will develop this role. Amoakoh-Coleman is based at the University of Ghana's School of Public Health, which has close and extensive ties with government policy makers, including the national health insurance agency.

In South Africa we will build on our previous engagement with government departments, NGOs and the national media. We will use the University of Witwatersrand's strong stakeholder networks. There are particular opportunities to influence the Ministry of Health to develop NCD screening programmes, contingent on our findings.

During inception we will create a database of policy-makers and stakeholders in the region. We will email a questionnaire and engage with members of the database on a regular basis. We will establish a stakeholder advisory group with whom we will engage a more intensively basis. We will hold stakeholder workshops in the final 6 months at: (i) at the London offices of HAI; (ii) Nairobi (African Population and Health Research Center); (iii) Geneva (WHO, ILO and UNRISD).

We will build on relationships with global stakeholders, including:

WHO: Since his secondment in 2011-12, LS still works closely with WHO. The directors of the WHO SAGE survey and Department of Ageing and Life Course were involved in our previous project and co-authored outputs. LS is contracted by WHO to support a new global strategy on older people's health. WHO have expressed a strong interest in collaborating with this project (see letter of support).

HAI was a key partner in our previous project, including a joint policy brief. HAI have expressed interest in collaborating with this project (see letter of support). Separately, LS is contracted by HAI to act as a senior academic adviser for a project assessing links between social protection and access to health services for older people in Ethiopia, Tanzania, Zimbabwe and Mozambique. There will be opportunities for synergies between these 2 projects, in terms of analysis, dissemination and regional impact.

To influence policy across sub-Saharan Africa, we have contracted Dr Aboderin from the African Population and Health Research Center. She is the leading global authority on older people in the region, with access to unparalleled networks. She will be a regional impact broker, also supporting a regional workshop and the production of a regional policy brief.

We will develop and extend our existing project website. We will include a new interactive facility for user comments.

We will publish a policy brief for each area of analysis. As in the first project, we will publish these jointly with stakeholders enhance their reach. We will translate the briefs into French and Portuguese (LS speaks both) to reach non-English-speaking stakeholders.