REPORT ON NATIONAL FOLLOW-UP

Transcription

1 REPORT ON NATIONAL FOLLOW-UP The major achievements reached in respect of efforts to improve the quality of life of older persons during the period , existing gaps and key actions in Jamaica Prepared for ECLAC By: Kristin Fox March 2012

2 Table of Contents Background... Error! Bookmark not defined. List of Acronyms... ii Executive Summary... iii I. Introduction... iii II. III. Overall progress in implementing the Brasilia Declaration... iii Best practices in human rights of older persons... iv IV. Key actions to strengthen the implementation of the Brasilia Declaration... v Objective of Consultancy... 1 Introduction.1 1. National Ageing Situation Methodology... 9 Literature review... 9 Informal Interviews... 9 Secondary data analysis Overall progress in implementing the Brasilia Declaration Inventory Evaluation of the work areas examined Legislative Administrative Programmatic Best practices in human rights of older persons Key actions to strengthen the implementation of the Brasilia Declaration Appendix References Persons interviewed... 39

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4 List of Acronyms CCRP HCDC JADEP JSLC KSA MLSS MoH NCSC NHF NIGold NIS ODPEM PATH PAD PIOJ STATIN UWI Caribbean Community of Retired Persons Hope for Children Development Company Jamaica Drugs for the Elderly Programme Jamaica Survey of Living Conditions Kingston and St. Andrew The Ministry of Labour and Social Security Ministry of Health National Council for Senior Citizens National Health Fund National Insurance Gold National Insurance Scheme Office of Disaster Planning and Emergency Management Programme of Advancement through Health and Education Public Assistance Division Planning Institute of Jamaica Statistical Institute of Jamaica The University of the West Indies ii

5 Executive Summary I. Introduction In Jamaica, the Ministry of Labour and Social Security is the organisation primarily responsible for the welfare of the elderly and its programmes for the elderly are formulated and implemented through the National Council for Senior Citizens. Other governmental organisations such as Ministry of Health also play an important role, while a number of non-governmental organisations provide critical support in the areas of advocacy, research, training and education II. Overall progress in implementing the Brasilia Declaration 1. An inventory of actions/initiatives/programmes identified that no legislation in support of the elderly has been enacted during the period of review. Administrative actions - Vision 20/30, Human Rights Charter and the abolition of public health care fees - have not been specific to the elderly. The National Policy for Senior Citizens was crafted in 1997 has not been updated and serves as the guiding principles for government interventions. However, there is an awareness of the Brasilia declaration and these principles especially the issues of empowerment of older persons and full realization of their rights and potential, and integration of ageing issues into the development agenda are being articulated at conferences and seminars supported by the Council, and targeting both the elderly and the general public during the period In the area of programmatic actions, Jamaica has been quite strong and through the involvement of several government ministries and agencies have implemented wide ranging programmes. i) NCSC has implemented several activities to strengthen health and active ageing, income security, awareness and empowerment of the elderly. Networking with other ministries e.g. Health, other governmental agencies and NGOs has been the key to the NCSC success as this has been the vehicle through which much of its activities have been implemented. The main problem limiting the expansion of the activities is insufficient financial resources. iii

6 ii) iii) Social protection programmes for the elderly are: health insurance - JADEP and NIGold, the National Health Fund (NHF) and Jamaica Government Pensioners Association Health Scheme; income support for the poor elderly PATH; and the govt. pension programme NIS. Concessionary fares on public transport in some urban areas and their environs. 3. Governmental programmatic actions have been supported by activities of nongovernmental organisations such as the UWI and HelpAge International. i) UWI has developed a number of courses/programmes in the area of geriatrics for both undergraduate and post-graduate students. It is also involved in research activities. In the area of public education its activities have complemented or been in collaboration with the NCSC. ii) The main objective of HelpAge in Jamaica is to monitor and support the government s commitment to the Madrid International Plan of Action on Ageing. It has implemented several projects at the community level, targeting vulnerable elderly and empowering them in different ways including improved income security, greater awareness of services available to them, improved advocacy and leadership skills, and improved intergenerational linkages. 4. In general, programmes/initiatives were widely available and accessible except for those targeting specific elderly sub-groups or available only in urban areas. Acceptability was also good but the quality of services was sometimes impaired by insufficient resources. III. Best practices in human rights of older persons 1. Based on the taxonomy outlined in the methodological guide, a number of initiatives put in place to assist older persons could be considered best practices because they each contribute to some aspect of human rights of older persons. But they do not meet most of the content requirements i.e. differences in treatment, reasonable accommodation, autonomy and intergenerational solidarity nor the operational requirements i.e. active participation of the agents involved in the development of the initiative; and transferability to other policy areas or contexts. iv

7 2. As a result only two initiatives namely: Senior Citizens Clubs and Older Citizens Monitoring project (OCM) were chosen as best practices. Both these programmes satisfy the majority of the content i.e. differences in treatment, reasonable accommodation, autonomy, intergenerational solidarity, and operational requirements i.e. active participation of the agents involved in the development of the initiative; transferability to other policy areas or contexts; planning; efficiency in the organization of resources; positive impact of its implementation and durability of its application. IV. Key actions to strengthen the implementation of the Brasilia Declaration In order to strengthen the implementation of the Brasilia Declaration, the government will have to introduce and implement a legislative framework to protect the rights of senior citizens against neglect and abuse, improve social assistance and enable the older persons to realize their full potential within an ageing society. The national policy for the elderly must be revise in keeping with international conventions and policies. Programmes will have to be strengthened and expanded and monitoring to ensure adequate implementation must be maintained. Special attention will have to be paid to the disadvantaged including the poor, disabled and shut-ins; improved accessibility of older persons to public buildings, transport and on roads, and the creation of an enabling environment for the elderly to realize their full potential within the society. v

8 Objective of Consultancy The purpose of this consultancy was the preparation of a report on the major achievements reached in respect of efforts to improve the quality of life of older persons during the past five years i.e , and to identify existing gaps and key actions in Jamaica. Specifically, the report and the evaluation of the implementation of the Brasilia Declaration focused on: i) an inventory and assessment of actions aimed at older persons in legal, administrative, programmatic and institutional aspects; ii) iii) the identification and analysis of best practices from the perspective of the rights of older persons; and key actions to be taken in the next five years to strengthen the protection of the rights of older persons. Introduction Jamaica has a population that is ageing quite rapidly. In 2010, the estimated number of persons sixty years and over was 299, 500 i.e per cent of the total population. However, the number of old persons has been steadily increasing, and between 2010 and 2050, the elderly is expected to double both in absolute numbers and as a per cent of the population. There is a predominance of females i.e. in 2010, 135,600 were males and 163,900 were females i.e. a ratio of 45 per cent to 55 per cent or 82.7 males to 100 females. Much of the changes in the population structure can be attributed to declining birth rates and longer life expectancy. The birth rates have declined from 24.8 per thousand in 1990 to 16.3 per thousand in The total fertility rate which was 5.5 in 1975, stood at 2.3 in Life expectancy at birth has also increased and for the period , is estimated at 76.0 and 69.7 years for females and males respectively. In spite of this, the population of Jamaica is still relatively young. In 2010, some 38 per cent of the population was under 20 years old. The majority of the elderly live in the rural areas (JSLC, 2009) and 9.3 per cent of household heads are 60 years and over. 1

9 The level of poverty in Jamaica declined significantly between 1992 and However, since then there has been an increase in the prevalence of poverty to 16.5 per cent in 2009 from 9.9 per cent in 2007.The pattern of poverty among the elderly mirrors that of the population as a whole, increasing significantly from 11.1 per cent in 2007 to 17.7 per cent in 2009, the latest year for with data is available. The main health issues affecting senior citizens are the chronic diseases and the cost of health care. In 2010, they accounted for 35.9 per cent and 54.2 per cent of all new cases of diabetes and hypertension respectively seen at government health centres. The JSLC reported that in 2009, 17.0 per cent and 23.8 percent of the and 65+ reported illness in a 4-week reference period compared with the national percentage of 10.6 per cent. A significant number of the elderly are still employed. In 2009, 109,800 persons 60 years and over stated that they were employed with over 50 per cent of those in the age group years being employed and even among those 80 years and over 13 per cent stated that they were employed (STATIN, 2010). This represents approximately one-third of the elderly being in employment. The Ministry of Labour and Social Security (MLSS) is the umbrella governmental organization with responsibility to effectively manage social protection programmes including those for groups with special needs including the elderly and monitoring the implementation of the Brasilia Declaration. It executes most of these programmes through the National Council for Senior Citizens (NCSC) which works in collaboration with international and local organizations to promote programmes which enhance the well-being of persons within the society who are 60 years of age or older. The National Council for Senior Citizens (NCSC) is the main agency of the government that implements broad based programmes and activities aimed at stimulating active ageing and including these persons in national and community development and life. Most of its activities are coordinated through the Senior Citizens Clubs that are established in all fourteen parishes and are supervised by Parish Organizers. 2

10 In addition to the work of the MLSS and the NCSC, there are a number of other governmental and non-governmental organisations and international organisations that have responsibility for assisting the elderly in the various aspects of their lives. These include the Ministry of Health (MoH), HelpAge, the University of the West Indies (UWI), specifically Mona Ageing and Wellness Centre and associations to support the elderly such as the Caribbean Community of Retired Persons (CCRP), Association of Government Pensioners, the Association of Retired Nurses, to name a few. 1. National Ageing Situation Jamaica has a population that is ageing quite rapidly. In , the estimated the number of persons sixty years and over was 299, 500 i.e per cent of the total population. However, the number of old persons has been steadily increasing, and between 2010 and 2050, the elderly is expected to double both in absolute numbers and as a per cent of the population (Table 1). There is a predominance of females i.e. in 2010, 135,600 were males and 163,900 were females i.e. a ratio of 45 per cent to 55 per cent or 82.7 males to 100 females. Table 1.Elderly Population and Projections, Year No of elderly 60+ years % of total population Source: Demographic Statistics 2009 STATIN, 2010; Population Projections: STATIN, 2008 Other indicators also point to the rapid ageing of the Jamaican population (Table 2). The median age is expected to increase from 27 years in 2010 to 41.7 years in 2050, while the per cent of person over 80 years is expected to increase from 1.9% in 2010 to 6.8 in More detailed population projections are provided in Appendix 1. 1 The population census was completed in 2011 but the results are not yet available. 3

11 Table 2. Indicators of Ageing 2010, 2030 and 2050 Indicator Median age Ageing index % Over 80 years Much of the changes in the population structure can be attributed to declining birth rates and longer life expectancy. The birth rates have declined from 24.8 and 22.0 per thousand in 1990 and 1999 respectively to 16.3 per thousand in The total fertility rate which was 5.5 in 1975, stood at 2.3 in Life expectancy has also increased due to improvements in health care and socio-economic status. Life expectancy at birth for the period , is estimated at 76.0 and 69.7 years for females and males respectively. In spite of this, the population of Jamaica is still relatively young. In 2010, some 38 per cent of the population was under 20 years old. The increase in the number of elderly is complemented by a steady decrease in the age group 0-14 years, as birth rates and fertility rates decline. Consequently, the shape of the population pyramid is changing with the base becoming smaller while the top increases (Figure 1). 4

12 Figure 1. Population Pyramids for Jamaica, 2000, 2025 and 2050 The majority of the elderly live in the rural areas (JSLC, 2009). However, there are some differences in the distribution of the elderly by sex (Table 2). For males, the elderly represent 10.8 per cent of the male population in KMA and 12.6 per cent in rural areas. On the other hand, elderly females represented a higher percentage of the female population in KMA (13.3 per cent) and a somewhat lower percentage in rural areas (12.5 per cent) i.e. similar to males in rural areas. Some 9.3 per cent of household heads are 60 years and over. 5

13 Table 3. Percentage of population who are elderly by sex and area of residence, 2009 Male % Female % Total % KMA Other Towns Rural Total Source: STATIN. JSLC 2009 Poverty is measured annually through the Jamaica Survey of Living Conditions (JSLC). The level of poverty in Jamaica declined significantly between 1992 and However, since then there has been an increase in the prevalence of poverty to 16.5 per cent in 2009 from 9.9 per cent in 2007.The pattern of poverty among the elderly mirrors that of the population as a whole, increasing significantly from 11.1 per cent in 2007 to 17.7 per cent in 2009, the latest year for with data is available (Table 4). Table 4. Percentage of elderly living below the poverty line, Year Percentage of the elderly below the Jamaica poverty line STATIN. JSLC, 2007, 2008, 2009 The main health issues affecting senior citizens are the chronic diseases and the cost of health care. In 2010, they accounted for 35.9 per cent and 54.2 per cent of all new cases of diabetes and hypertension respectively seen at government health centres. This demonstrates the high level of these diseases among the elderly, but also shows the high demand of the elderly on the health services. The JSLC reported that in 2009, 17.0 per cent and 23.8 percent of the and 65+ reported illness in a 4-week reference period compared with the national percentage of 10.6 per cent. A significant number of the elderly are still employed. In 2009, 109,800 persons 60 years and over stated that they were employed (Table 5) with over 50 per cent of those in the age group 60-6

14 69 years being employed and even among those 80 years and over 13 per cent stated that they were employed (STATIN, 2010). This represents approximately one-third of the elderly being in employment. Table 5. Number and percentage of elderly employed by age group, 2009 Age group (years) Currently employed Nos. a % a Survey data raised to provide national estimates Source: STATIN, 2009, unpublished data The Ministry of Labour and Social Security (MLSS) is the umbrella governmental organization with responsibility to effectively manage social protection programmes including those for groups with special needs including the elderly and monitoring the implementation of the Brasilia Declaration. It executes most of these programmes through the National Council for Senior Citizens (NCSC) which works in collaboration with international and local organizations to promote programmes which enhance the well-being of persons within the society who are 60 years of age or older. The National Council for Senior Citizens (NCSC) is the main agency of the government that implements broad based programmes and activities aimed at stimulating active ageing and including these persons in national and community development and life. To fulfill its mandate, the council collaborates and networks with other key governmental and nongovernmental agencies in order to increase its provision of services and create awareness of the senior citizens themselves and the wider population of Jamaica. Most of its activities are coordinated through the Senior Citizens Clubs that are established in all fourteen parishes and are supervised by Parish Organizers. In addition to the work of the MLSS and the NCSC, there are a number of other governmental and non-governmental organisations including the private sector and international organisations 7

15 that have responsibility for assisting the elderly in the various aspects of their lives. Some of the main organisations include: the Ministry of Health (MoH) which provides health care and monitors institutions providing services for the elderly including a regulatory framework on homes for the elderly; HelpAge The University of the West Indies (UWI), specifically Mona Ageing and Wellness Centre with the core functions of research and policy, teaching, health promotion. Associations to support the elderly such as the Caribbean Community of Retired Persons (CCRP), Association of Government Pensioners, the Association of Retired Nurses, to name a few. As the elderly population increases, the private sector is taking a greater interest in this age group and a number of retirement/nursing homes have been established. However, the cost of these is high and they therefore they cater solely to persons with the financial means. Homes for the less fortunate are provided by the government and church organisations. 8

16 2. Methodology The information for this study was obtained using a mixed approach including literature review, informal interviews and analysis of secondary data. Literature review The literature and documentation review included: annual and ad hoc reports from the NCSC, MLSS and the PIOJ statistical reports from STATIN evaluation and survey reports from HelpAge Informal Interviews Key persons at the NCSC, MLSS, PIOJ and UWI were interviewed to elucidate information about the five year period as follows: laws, policies for the elderly, current programmes/activities for the elderly, opinions regarding best practices; prospects for the future. Secondary data analysis JSLC dataset (2007, 2008, 2009) and Jamaica Labour Force survey dataset (2009) were analysed to provide information on the socio-demographic characteristic of the elderly. 9

17 3. Overall progress in implementing the Brasilia Declaration Inventory Table 5 provides an inventory of actions aimed at older persons. Table 5. Legislative, Administrative, Programmatic and Institutional Actions aimed at Older Persons Scope Areas of Work Legislative NONE Administrative Vision 20/30 National Policy for Senior Citizens Human Rights Charter Abolition of user fees at government facilities Programmatic Senior citizens clubs Active Ageing Skills training, debates, recreational tours, exercise, current affairs sessions, board games, quiz competitions and social interaction Community involvement, Parish and National Sport Day. Income Generating Skills training Small grants/projects Concessionary fares on public transport - Kingston Metropolitan Region, St. Catherine Portmore and Spanish Town, Montego Bay Metro, Falmouth and Sandy Bay Hanover. Health Provision of free health care, and health promotion, workshops, clinics Home help service Introduction of age friendly health services-mona Ageing and Wellness Education Educational seminars, Conferences, Information Technology Production of pamphlets and other educational material, Cultural Retention Social programmes NIS, JADEP, NHF, NIGold, PATH, PAD, Food for the Poor, Faith Base Organizations, Service Clubs, HelpAge International, Poor Relief - Ministry of Local Government Golden age feeding programme JADEP - Jamaica Drugs for the Elderly Programme; NHF National Health Fund; NIS National Insurance Scheme; NIGold National Insurance Gold; PATH Programme of Advancement through Health and Education; PAD Public Assistance Division 10

18 Evaluation of the work areas examined. Legislative There were no legislative reforms aimed specifically at the elderly since A regulatory framework for pension schemes was finalized in 2005 and since then, there have been discussions about the government pension scheme especially in regards to the pensionable age and contributions by employees. Other legislation of relevance to the elderly in particular, is the Disability Act which is currently in draft form. Administrative The main administrative rules that have been put in place to protect the rights of the elderly are Vision 20/30, the National Policy for Senior Citizens and the policy on the abolition of user fees at government health facilities. However, the only one that is specific to the elderly is the National Policy for Senior Citizens. The other two are national rules targeting all Jamaicans, the underlying assumption being that all basic rights apply to the elderly. Vision 2030 Jamaica is a National Development Plan for the period which was launched in As part of its vision it states that the governments seeks to create a secure future for our vulnerable population in ensuring that inter alia our elderly and persons with disabilities are fully integrated within society, have access to appropriate care and support services and are treated as valuable human resources. (PIOJ, 2009, p. VI). The document further espouses the guiding principle of equity in which it will facilitate and ensure equality of opportunity and equal rights for all citizens including access to public goods and services such as education and health care. And will promote the human rights of our people, including the poor, and the most vulnerable and marginalized groups. (Vision 20/30 p. 14)The underlying assumption is that all basic rights apply to the elderly and there is no need to have special provision for them. Vision 20/30 can therefore be considered adequate in so far as it does not depart from the provisions of international human rights covenants. Furthermore, it recognizes the importance of planning for the changing demographic landscape the changing profile points to the need for 11

19 greater concentration on programmes for the elderly, and eventually a leveling in the requirements for infrastructure for children and youth (Vision 20/30 p. 40). However, Vision 20/30 includes the elderly within the most vulnerable category and does not articulate any special programmes. Therefore, it does not explicitly incorporate mechanisms to ensure the effectiveness of its pronouncements. The National Policy for Senior Citizens was developed over 15 years ago and was based on the 1982 Vienna Plan on Ageing. It is the currently the guiding principles for the National Council for Senior Citizens but there is an awareness of the Brasilia declaration because the leadership, i.e. the director and patron of this organisation, have attended and participated in meetings at the which the declaration was formulated. Consequently, these principles especially the issues of empowerment of older persons and full realization of their rights and potential, and integration of ageing issues into the development agenda are being articulated at conferences and seminars supported by the Council, and targeting both the elderly and the general public during the period Furthermore, the NCSC has as one of its objectives to educate the public re the National Policy and the International Plan of Action. The policy, though dated, addresses all the significant areas as outlined in the Brasilia declaration and the programmes now being implemented by the Council have been in response to the principles of the Policy. Abolition of User Fees at government health facilities was launched in early Though applicable to all Jamaicans, it is of particular significance to the elderly who have more health problems, while having less financial resources. However, the underfunding of the health services has created problems in access to services and resources such as drugs, and it has been reported that waiting times have increased significantly. Generally speaking, the abolition of user fees has led to progress in the realization of the rights of the elderly. However, resource constraints have hindered progress. For full realization, the government will have to adopt a strategy for increasing revenue inflows to the health sector while continuing to ensure that good quality health care is affordable to the elderly. 12

20 Programmatic This section first examines programmes offered by the government of Jamaica mainly through its umbrella ministry, the Ministry of Labour and Social Security. It then describes the programmes offered by other organisations, specifically HelpAge. Programmes of the NCSC For the most part, programmes at the parish level are undertaken through the senior citizens clubs. The NCSC has sought the increase participation in its senior citizens clubs programme through active membership drives by the parish coordinators or in response to requests. Each parish has a monthly and an annual general meeting of the presidents and volunteers of its clubs to evaluate the activities and make recommendations for improvement; and to make plans for the year. Unfortunately, the number of clubs and membership has experienced a decline over the past 2 years which has been attributed to the time at which meetings are normally held along with the problem of crime in Jamaica. The NCSC is currently examining this problem with a view to identifying suitable alternatives. The programmes fall under four broad areas 2 namely: Education & Media Intergenerational Activities Health/ Promoting active ageing activities Income Security National Infrastructure Education and Media The education programmes of the NCSC are aimed at the elderly and their carers, and the general public. The elderly and their carers: 2 This is not the grouping used by NCSC which places competitions under Education 13

21 a. Seminars to educate seniors on new developments that would increase their ability to participate in family activities (Table 6). Topics are wide-ranging e.g. wills, rights of the consumer, programmes available to seniors, disaster preparedness, housing solutions. b. Basic computer skills are taught in collaboration with the Library Services. c. Conferences on ageing. These have been held at both the local and national level and included topics such as: the demographic transition and implications for development, Vision 20/30 in the context of the elderly; responses to the Ageing Agenda; and ageing is big business. Other agencies also provide education to the elderly. The Office of Disaster Preparedness and Emergency Management (ODPEM) has information on its website and Mona Ageing and Wellness Centre has produced a number of booklets on specific areas of health. The general public: The NCSC established a national education programme to educate the general public on the ageing process, and the beneficial role of seniors in families and communities. The general public is targeted though the media, schools and places of employment. Activities included: a. Seminars were held at non-governmental, governmental organisations and churches b. Use of print and electronic media to feature seniors giving oral history and personal accounts of their experiences and to showcase their worth and talents. c. Exhibitions to display the work of seniors at libraries and government offices d. Conferences with senior directors of governmental organisations and heads of nongovernmental organisations regarding the Madrid Plan of Action on Ageing specifically the priority areas of: older persons and development; advancing health and well-being into old age; and ensuring and enabling a supportive environment. This was done to raise their awareness and solicit their participation in the implementation of the plan of action. Intergenerational Activities The NCSC has a number of intergenerational activities aimed at bridging the generational gap. These include: Schools Debate, Essay and Posters Competitions, and social interaction. 14

22 The school debates target both Primary and Secondary Schools in a specific parish for the year and provide a topic focusing on the elderly. Schools that are selected must then debate the topic. The event usually takes place at a community centre, whether church hall, school hall. Judges are retired teachers. The NCSC funds the activity, determines the topic and awards the trophy. Unfortunately, funding constraints have prevented hosting of the event since 2009 although plans are afoot to have the competition revived in Essay and poster competition. Schools at different levels are invited to participate. Judging is done by retired persons. This initiative began in 1999 but has not been implemented since However, the NCSC has determined that it needs to assess this activity because it has not been getting the desired results. Social interaction. There are several activities aimed at encouraging social interaction between the elderly and younger persons in Jamaica, namely: Volunteering (a) younger persons who are regular participants of the senior citizens club and (b) younger persons assisting at the activity centres (see Table 6). Senior citizens visiting schools to share knowledge, skills and history; and assisting in various aspects of school life Elderly, either individually or collectively, providing sponsorship of individual children. Active Ageing A number of activities are promoted by the NCSC through the senior citizens clubs and community groups to engage the elderly. These include: Seniors Sports Programme at parish and national levels culminating in National Sports Day. Seniors Spelling Bee Competition held in each parish and at the national level; Regional and national Bible quiz competitions Domino competition - senior men and women domino tournament. Parish Cultural Days in which artifacts, Jamaican folk form and dishes and preserves are displayed. 15

23 Seminars/information sessions. Topics included security measures in the home; how to prepare a will; retirement schemes; alternative energy systems; early stimulation of children; financial management; psychosocial issues that impact on ageing; small business development; men s role in the family and human rights and advocacy, among others. A minimum of one seminar per parish per annum is mandated and funded by the Council, but parishes may have others, depending on the funding. By working with other agencies such are the 4-H club, and Social Development Commission, the Council is able to have additional information sessions as part of these agencies activities. Community involvement activities in which the elderly are involved in an activity of community upliftment such as beautification of green areas within their community, feeding of street people, plastic bottle collection, and painting of public buildings, erecting seating at Health Centre and Post Offices and being part of the management committee of a health centre. Citizens Association /Neighborhood watch meetings. Senior day activity centres provide senior citizens with facilities to meet, socialize and participate in meaningful activities (see Table 6). Centres have been established in all parishes. Health Health activities are offered by NCSC in collaboration with the Ministry of Health. They include: Health education initiatives through health seminars, fairs, clinics and self-health care workshops (see Table 6). Areas of concentration included: mental health; Alzheimer s disease; ageing issues pertaining to physiological and physical changes; fear of death; cancer; menopause and andropause; dental health; nutrition and obesity; personal hygiene and foot care and environmental health. Health information is seen to be of critical importance for the elderly, empowering them to attend to their own health and improve their quality of life (Innerarity, 2010). Home help is a programme operating on a very limited basis and is only available in Kingston, St. Andrew, St. Catherine and St. Ann with fewer than 200 elderly benefitting each year (see Table 6). Practical nurses employed to NCSC visit shut-ins and provide 16

24 services to assist with their health (e.g. bathing, hygiene), domestic (e.g. washing) and personal (e.g. running errands, paying bills) needs. Only four Practical Nurses are on staff at NCSC, therefore they have to target only the persons with extreme needs. Income Security The main activities associated with income generation are skills training. Between 2007 and 2011 over 30,000 older persons have received skills training in a wide variety of skills in agriculture, culinary, craft, dressmaking among others (see Table 6). Small grants have also been given to support income generating activities. To date, there are nearly 300 income generating projects islandwide. Income generation is seen as important in improving the quality of lives of many elderly but also indispensable to the success of the HelpAge supported intervention in their communities (Innerarity, 2010). Indicators of NCSC activities as shown in Table 6 suggest relative stability in the offerings over the period. The most important exception to this is the senior citizen clubs which have experienced significant decreases both in the number of clubs and the membership. The NCSC is aware of the challenges faced by the clubs and is currently assessing the problem. The NCSC also reported that over the past couple years funding constraints have had a negative impact and it has had to rely on its networks with governmental and non-governmental organisations to sustain implementation of its activities. 17

25 Table 6. Coverage of NCSC programme activities, Indicator Snr. Citizen Clubs Membership including shut-ins 30,564 31,911 31,464 27,962 23,518 Volunteers Senior day activity centres Nos. Attending >2200 > > Skills training seminars Nos. trained Income generating projects Information seminars No. participants n.a n.a Golden Age feeding Health Education activities n.a. No. of Referrals 12,978 10,731 10,007 7, Home Help Social Protection The main social protection programmes which benefit the elderly are: National Insurance Scheme (NIS) National Insurance Gold (NIGold) Programme of Advancement through Health and Education (PATH) Public Assistance (PAD) Jamaica Drugs for the Elderly Programme, (JADEP) National Health Fund (NHF); Government Pensioners Health Scheme- a contributory scheme through Sagicor National Insurance Scheme (NIS) is a contributory pension scheme from which contributors can receive a small monthly allowance after age sixty once not in full-time employment, or at age 65 years. However, the system has had the perennial problem of self-employed persons not 18

26 contributing to the scheme. Consequently, approximately 69,000 pensioners over 60 years (23 per cent) received NIS benefits in The PATH programme targets the elderly living in poverty. It uses a means test based on its Beneficiary Identification System to identify elderly in need of assistance. There have been problems with the system because elderly 3 considered to be in need were rejected based on the BIS. However, adjustments were made so that needy elderly were not discriminated against based on their BIS score. The availability of an appeal system has also helped to reduce discrimination. The PATH allocation is relatively small, but in conjunction with other benefits such as JADEP and NHF they help to relieve the situation of elderly with financial constraints. However, there is still a large gap in the coverage of the elderly by these programmes (Table 7). Table 7.Social Protection Coverage Gap: Income Support for Elderly (Jamaica 2010) Population 60 years and older 298, 060 No. NIS Pensioners 60 years and older 84,817 No. PATH Beneficiaries 60 years and older 58,133 Number persons 60 years and older covered by NIS and PATH 142,950 combined Number persons 60 years and older not covered by NIS or PATH 155,110 Percentage population 60 years and older covered by NIS and PATH combined Percentage population 60 years and older not covered by NIS or PATH Source: Innerarity, 2010 National Insurance Gold (NIGold) is a health plan that offers coverage for medical benefits to pensioners under the NIS. It covers doctor s visits, prescription drugs, diagnostic services, dental and optical services, surgeons fees, and hospital room and board. The Jamaica Drug for the Elderly Programme (JADEP) which began in 1996 targets persons 60 years and over with specified chronic diseases. Under this programme, the elderly pay nominal 3 Mainly elderly were asset rich but cash poor but were rejected based on the number of assets 19

27 prices for prescribed drugs which are available at public and private sector pharmacies. Like JADEP, the National Health Fund targets all persons with specified chronic diseases. Its guiding principle is universal coverage. Table 8 shows that the coverage by the health insurance programmes is quite high, but the elderly still report that they have problems obtaining the drugs because of shortages at their provider. Table 8.Coverage of the Elderly by Government Health Insurance Programmes, 2010 Age Nos. Government Health Insurance Programmes group JADEP NHF NI GOLD Nos. % Nos. % Nos. % ,463 59, , , ,255 40, , , ,674 41, , , ,668 71, , , Total 298, , , , Source: Innerarity, 2010 Other social protection programmes include a golden age feeding programme for indigent elderly and shut-ins. In Table 9, each activity is evaluated based on the criteria of availability, accessibility, acceptability and quality. The majority of the programmes/initiatives are widely available and accessible and non-access is probably due either to choice or lack of awareness of them. 20

28 Table 9.Availability, Accessibility, Acceptability and Quality of Programmes for the Elderly Areas of Work Availability Accessibility Acceptability Quality Senior citizens clubs Widely available in both urban and rural areas It includes both the Highly acceptable mobile elderly and Good. Main problem is that it is mainly the older Intergenerational Schools debate, Essay and poster competition, social interaction Active Ageing Debates, recreational tours, exercise, current affairs sessions, board games, quiz competitions, Sport Day, Community involvement Income Generating Skills training Small grants Concessionary fares on public transport Health Health promotion Education Educational seminars Production of pamphlets and other educational material Social programmes JADEP NHF NIGold PATH, PAD In specific parishes Widely available in all parishes shut-ins Includes elderly and young persons All senior citizens interested in participating may do so Available in all parishes All senior citizens interested in participating may do so In selected urban areas Accessible to all and proximate rural areas persons living in only those areas Widely available in both All senior citizens urban and rural areas interested in participating may do so Widely available in both All senior citizens urban and rural areas interested in participating may do so National programmes JADEP, NHF universal. NIS & PATH accessibility restricted. Acceptable The variety of activities appeal to different interests of senior citizens and are age and gender sensitive Highly acceptable 4 Acceptable as bus fare considerably lower Highly acceptable Highly acceptable Highly acceptable. Some stigma associated with PATH elderly (70+) involved Supported by NCSC staff but competitions experiencing problems Supported by NCSC staff, the seniors citizens and a network of volunteers Good. NCSC networks with other agencies e.g. 4- H clubs, RADA to encourage these activities Good, government need to have buses in other parishes or collaborate with private owners (Transport Authority) Good. Elderly consider information useful for improving quality of life Good. Elderly consider information useful for improving quality of life Problems with access to prescription drugs under JADEP and NHF. 4 An external evaluation of HelpAge project found that these activities had a high level of acceptability 21

29 Other programmes The main non-governmental activities specifically targeting the elderly have been implemented by the University of the West Indies and HelpAge. University of the West Indies The Mona Ageing and Wellness Centre in the Department of Community Health and Psychiatry has as its areas of focus: teaching, research and education. Teaching. The Centre offers several courses in ageing to medical and non-medical undergraduate and post-graduate students. In collaboration with the medical faculty, a programme in Family Medicine with a fellowship in Geriatrics has been developed. Research. The Centre was actively involved in several research projects with the main partner WHO. There was also collaboration with a Montréal group on a Caribbean-wide study. Education. The centre collaborates with NCSC and other organisation in implementing educational activities such as Ageing careers week, health fairs and seminars across the corporate area giving information and talks on ageing and retirement. HelpAge The main objective of HelpAge in Jamaica is to monitor and support the government s commitment to the Madrid International Plan of Action on Ageing. To this end, it has embarked on projects in communities across Jamaica. Table 10 lists the projects and the locations they serve. Table 10. Projects implemented by HelpAge between 2007 and Project Location When Older Citizens Monitoring project KSA, St. Catherine Reducing the impact of migration South West St. Andrew Alleviating poverty and Socio-economic marginalization of vulnerable Multigenerational households St. Catherine HIV survey KSA, St. James, St Catherine, Westmoreland Disaster Risk Reduction Portland, St. Catherine On-going 22

30 The Older Citizens Monitoring project by HelpAge International involved monitoring, by older people and other citizens, of how governments, international bodies and local authorities are acting on the commitments they made at the Second World assembly on Ageing in Madrid in It was conceived to ensure that Governments social policies and programmes are effective in relation to the attainment of adequate social protection coverage for the population of older persons, particularly those that are excluded and living in conditions of poverty. (Innerarity, p 2) In Jamaica, a pilot project was designed to empower older citizens to monitor access and delivery of three government social assistance programmes Jamaica Drug for the Elderly Programme (JADEP), National Health Fund (NHF), and the Programme of Advancement Through Health and Education (PATH) from which they could receive benefits (Innerarity,2010. p 2). Between 2007 and 2010, the project was expanded into 8 new communities in collaboration with other NGOs. An evaluation found that the programme, though operating in only a few areas of Jamaica, was successful in meeting its objectives, e.g.: facilitating registration of older persons in JADEP and NHF but not PATH because of its rigorous requirements, developing advocacy skills and empowering older persons (Innerarity, 2010). Therefore the project was meeting the problem that the initiative sought to serve. It was accessible to all the older persons in the communities served and received positive views from the target group. By networking with other agencies, it helped to strengthen institutional arrangements between the agencies to facilitate and enhance implementation. The Migration project involved parents, grandparents and caregivers in three inner-city Kingston communities where 75 per cent of families have been affected by migration. In total 1,500 multigenerational households and 7,500 people took part. Project activities included: counselling for families a career guidance programme with schools community information fairs to provide basic health checks and information on government social assistance programmes 23

31 a short feature documentary on the impact of migration on families of Jamaican origin training in small business development and the use of remittances Caregivers who participated in the project also received training in parenting skills. As a result, they said they could cope better with their caring responsibilities. The training also increased life prospects for the children in their care. The project has been successful in reducing the negative impact of migration in multi-generational households. The main aim of the project Alleviating poverty and Socio-economic marginalization of vulnerable Multi-generational Households was to contribute to the government s goal of reducing poverty through increased social inclusion, improved access to services and reducing intergenerational poverty. An evaluation of the project found that: Respect for older persons increased within households and within the wider community and there was a strengthening of relationships Earning capacity of older persons was strengthened Intergenerational relations were strengthened Leadership and advocacy among older persons were enhanced. The Disaster Risk Reduction project is designed to reduce the risk of vulnerability to natural hazards and assist in disaster preparedness. The groups targeted under the project are older persons, farmers, children and persons with disabilities. Some of the key activities include: vulnerability capacity assessment, community disaster response team training, emergency market mapping analysis for the agricultural communities, disaster preparedness training. The project is designed to facilitate strategic alliances and partnership with the Office of Disaster Planning and Emergency Management (ODPEM) and to collaborate with the Parish Disaster Committees in Portland and St. Catherine. The key implementing partners in the project are the Jamaica Red Cross (ECHO Project) and St. Catherine Community 24

32 Development Agency (USAID/OFDA). The main advocacy thrust is the inclusion of vulnerable groups of persons in disaster risk reduction initiatives. 25

33 4. Best practices in human rights of older persons Based on the taxonomy outlined in the methodological guide, a number of initiatives put in place to assist older persons could be considered best practices because they each contribute to some aspect of human rights of older persons. Documentation for these initiatives is limited, however, on the face of it, they do not meet most of the content requirements i.e. differences in treatment, reasonable accommodation, autonomy and intergenerational solidarity. Also, they did not meet many of the operational requirements i.e. active participation of the agents involved in the development of the initiative; and transferability to other policy areas or contexts (Table 11). Based on this evaluation, two initiatives namely: Senior Citizens Clubs (Appendix 2) and HelpAge International projects meet most of the criteria. HelpAge has several projects all of which have similar underlying principles. Therefore only one project is highlighted here namely: Older Citizens Monitoring project (OCM) (Appendix 3). It has been chosen because it has been evaluated, and the evaluation showed that the initial project was successful, was replicated successfully in other communities and activities under the project have been sustained even after the project officially ended. Presented in Table 12 is a detailed description of the initiatives, using the evaluation criteria. 26