The demographic ageing may be a relatively new phenomena in South Asian countries. Yet, its onset in Sri Lanka will be more rapid than it has historically been anywhere else in the world.
In the last five decades, Sri Lanka has experienced major demographic changes. Especially the Sri Lankan population’s structure age-wise has witnessed a significant change. Declining fertility and increasing longevity are resulting in ageing of population in Sri Lanka which need serious attention of the Government.
In Sri Lanka relatively large proportions of the population are beginning to be elderly. The projected population in the country shows that the population will suffer major changes in its size and age structure in the coming two decades.
The study shows that the size and share of the elderly group would increase rapidly. Another very important feature of population ageing in Sri Lanka is that the oldest age category (75+) is increasing than the category (60-74) among the elderly group. Further, the ageing process is the rising number of women in the older age group than number of men.
Women are expected to outnumber men in the old ages due to higher life expectancy among females. Consequently, the number of widows is likely to increase in the future and is expected to live longer which is already happening in Sri Lanka. Therefore, the policy-makers should begin to get really worried about the rapid ageing of the country’s population since this will affect heavily on the economy of Sri Lanka.
Sri Lanka’s life expectancy at birth has been steadily increasing over the last three decades and currently hovers around 75 years. This indicates that the over-60 population seems set to increase in the years to come. In fact, it is happening.
The proportion over 60 years has increased from 6.6 per cent in 1981 to 13.93 per cent in 2015, and is predicted to rise to 28.6 per cent by 2050. This pace of ageing is faster than that found in developed countries and is happening while the country is at an earlier stage of economic development.
Pluses and minuses
With the increasing levels of senior citizens, the Government will meet up with problems as well as opportunities. The major challenge of them will be the increasing allocation for pensions and healthcare.
There is no one single authority to handle senior citizens’ pensions but six different pension schemes: Public Service Pension Scheme, Employees’ Provident Fund, Employee Trust Fund, Farmers’ Pension and Social Security Benefit Scheme, Fishermen’s Pension and Social Security Benefit Scheme and self-employed persons’ Pension scheme. They are administered by different bodies. In fact, it’s a fractured system without any coordination among them. In public service pension scheme nearly 1.7 million are covered, that is 100 per cent of public servants. However, it is only one-eighth of entire population in labour force. In 2018, there were 2.9 million older persons in the country and the public service pensioners amounted only to 21.2 % of the total figure.
If we look at the picture in a broader perspective, about 9.6 million people are estimated to be eligible for at least one pension scheme but current enrolees account for only around 56% of eligible people. Only 30 % of the elderly population are provided retirement income. This is not a satisfactory situation for a developing country.
Take for example, farmers’, fishermen and self-employed schemes. In the case of farmers, the coverage of eligible (or entitled) population is 64 per cent but effective coverage is only 38 per cent. In the case of fishing trade eligible population is 46 per cent out of which only 28 per cent effective coverage. Self-employed situation is worse, eligible population coverage is 16.9 per cent but effectively 10.1 per cent are covered.
These statistics clearly show why most of our retirees become dependent on their families or institutions. Only public service employees are secured. Although they do not contribute for the fund, they receive a decent pension throughout their lives and thereafter their successors. In 2018, 9.3% of the recurrent Government expenditure was allocated to public service pensions.
Government involvement
In 1996, the Ministry of Social Welfare introduced a social security and pension scheme that provided a pension for “poor elderly persons who have contributed towards the development of the country” and who had been employed in the informal sector. However, because of financial difficulties, the Ministry was distributing only a small amount of income to a small proportion of the elderly poor.
Ten years later, the Government established a National Charter for Elders. In its preamble, it said: “The mission of the Charter for Senior Citizens is to ensure and reinforce the values of independence, dignity, participation, self-fulfilment, and a good quality of life in the diversity of their situations in a caring, accepting and respecting community.”
We have a National Secretariat for Elders which was established under the Protection of the Rights of Elders Act No 9 of 2000, and functioning under Ministry of Social Empowerment and Welfare.
How far is National Charter for Elders become effective? By 2018, the Ministry has extended support to provide our elders with a Rs. 2,000 grant to 416,000 recipients above the age of 70. Around Rs. 11 billion were allocated for elderly care every year.
There is also an allocation and awarding of self-employment assistance for any of those whom are above the age of 50, islandwide. All those who fall within this purview will be eligible to receive Rs. 20,000 per person, in order to start their own business. However, this grant will be awarded following a screening procedure as the Ministry has limited budget.
Solutions
First, this writer suggests Government should incorporate a National Centre for Creative Aging (NCCA) dedicated to fostering an understanding of the vital relationship between creative expression and healthy aging, and to developing programmes that build on this understanding.
This will promote, across the aging spectrum, equitable access to life enrichment through the arts and affordable options that promote social inclusion. The private sector and the NGOs can help to make this a reality.
Second, we must seriously think and implement a Long-Term Care (LTC) programme in Sri Lanka. We are quite effective in improving maternity and child health indicators at low cost. The need to re-orient the system towards the detection and management of ageing-related health problems should be recognized.
A World Bank national survey on ageing conducted about 10 years ago found that 40 per cent of older persons live with their spouse and children; 37 per cent only with their children; 10 per cent only with their spouse; and 6 per cent live alone. Those living alone or with only their spouse are more vulnerable and more likely to need help. Less than 1 per cent of older persons in Sri Lanka are estimated to live in residential nursing homes.
That means, the family caregivers need more support. Home nursing care services, with availability of day care, rehabilitation and respite care services, can greatly assist families to continue to care for older family members at home. The most vulnerable older persons, who may be living alone or with only their spouse, and destitute older persons, need to be identified and
prioritized for LTC services. Of course, this needs to be accompanied by regulation and close monitoring to prevent abuses.
This writer also recommends the establishment of Elders’ Committees in Grama Sevaka divisions. Older persons’ organisations at the community level have many benefits and could contribute to day care services. They enable social participation, which is health promoting, and mutual support can provide opportunities for income generating activities and savings schemes. They also facilitate easier access to screening for vision impairment and chronic diseases, especially hypertension and diabetes. Older people themselves can provide many services, if supported and coordinated.
What is basically required is few elder community day care centres within local Government area. They can provide older people with both practical assistance and a chance to socialise, with support from trained staff and volunteers, they can enjoy a wide variety of activities which include reading, singing and music, quizzes, gentle exercise, arts and crafts, half-day trips. Senior citizens can be served lunch and refreshments and reasonable charge can be levied from those who can afford. The community-based organisations can also play important roles to make this endeavour a success. The private sector and NGOs also have a role to play and there is scope for the development of small and medium sized business to provide home-based LTC services for those who can afford it.
The Divisional Directors of Health Services, Supervising Public Health Midwives and Public Health Nursing Sisters will also require in-service training for the role of supervision and coordination of home nursing care, and collating data for monitoring quality of care and planning.
Developing a strong day care system includes development of an integrated health information system. Patient held health records can contribute to continuity of care and health care workers, social workers, older persons themselves and caregivers should be encouraged to record their activities and observations.
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