Note: this article was originally published in June, 2023
Human Rights Watch recently released a report addressing the inadequacy of basic care for the geriatric population in South Africa.
According to the report, titled "This Government is Failing Me Too’: South Africa Compounds Legacy of Apartheid for Older People”, the South African government has failed to properly execute the Older Persons Act, a law which was established after the country’s apartheid regime.
The law was created to ensure that the country’s aged would be empowered, protected, and would have their rights, status and well-being maintained.
“The South African government should act promptly to make the Older Persons Act meaningful, not just words on paper. Older people have a right to live with dignity,” asserted Noma Masiko-Mpaka, South Africa researcher at Human Rights Watch.
The report’s methodology saw Human Rights Watch interview 63 people between the ages of 60 and 85 in SA’s Eastern Cape, Gauteng and Western Cape provinces, all between September 2022 and May 2023.
The interviewees were racially diverse, comprising a mix of Black African, Coloured, Indian/Asian and White South Africans who lived in the community, rather in residential care facilities.
The organisation also interviewed and consulted a series of other relevant professionals including community organisers, caregivers, researchers, academics, lawyers and non-profit service providers.
Additionally, they reviewed national legislation and reports by governments, academics, international organisations and local groups,
Human Rights Watch is an international NGO dedicated to research and advocacy for human rights. Its membership comprises about 550 professionals of over 70 nationalities.
Since 1978, the organisation has worked hand in hand with the United Nations, rebel groups and corporations, amongst others to influence policy changes and law enforcement.
South Africa’s Compounded Apartheid Legacy
The report sheds light on the lingering effects of the apartheid regime on SA’s older population, most of whom were denied a decent education, occupations and the ability to save for older age.
Worse still, many of them were displaced in their younger years, in the apartheid government’s bid to segregate people on the grounds of race.
Hoping to right the wrongs of the past, the post-apartheid government adopted the 2004 Social Assistance Act, which provides for the Older Persons Grant, a social security entitlement for South Africans aged 60 and above, as well as the Grant-in-Aid for those in need of full-time care and support at home.
The 2006 Older Persons Act took this a step further by guaranteeing older people the right to enjoy community- and home-based care and support services in an environment that is conducive to their changing capacities.
Understandably, the laws are especially supposed to favour the Black African, Coloured and Indian/Asian demographic, even though the enshrine the rights of all older people.
However, the country’s current government policies only seem to be exacerbating the lingering effects of apartheid on the older population, nearly 29 years after the end of the grossly inhumane era.
Hundreds of thousands of older people all over the country lack access to basic care and support services.
Human Rights Watch pinpointed a number of reasons for the unavailability of these services:
· Inadequate government targets which focus on what the government can afford rather than the needs of older people. For example, the government has determined that only 20% of “active vulnerable older persons” and 3% of “vulnerable frail older persons” should have access to services.
· Disparities in plans to increase access to services across provinces.
· Inadequate numbers of social workers.
· Improper or no coordination between government departments tasked with enshrining the rights of older people.
· Strict rules and insufficient funding both restrict the capacity of government-contracted NGOs to deliver the services. Some service centres shared that government funding only covered 40-50% of their costs, and one service centre in Western Cape even has to charge an annual membership fee to help cover their costs. Older people who can’t afford such have no recourse.
To worsen the matter, the government seems to rely heavily on family members to provide home-based care and support, even when they are unable or reluctant to do so.
Even the Grant-in-Aid provision only scratches the surface of older citizens’ needs, providing just 20 hours of full-time care and support per month.
According to Human Rights Watch, the monetary value of 24-hour live-in care for one month can be equated to four years’ worth of the Grant-in-Aid.
Moreover, few older people are even unaware of the Grant-in-Aid or wrongly think that are ineligible, leading them to rely on the neighbours who are gracious enough to help.
Unfortunately, not all of them have it good with their neighbours as there have been cases of rape, gender-based violence, abuse and even killings.
Inadequate housing is another issue older people face, hampering their ability to live independently and within the community. Housing is often unaffordable, inhabitable and/or inaccessible to the geriatric.
“The previous government failed me, and now this government is failing me too,” said Bahija J. a 75-year old female Cape Town resident who has been on the waiting list for state-subsidised housing for 4 decades.
Also heartbreaking is the case of 72-year-old Sylvia Lusiti, a blind woman who lives in a government-provided house with no fence, burglar bars or any form of security.
In the absence of government support, South Africa’s vulnerable older people mostly have to fend for themselves.
“The government doesn’t have any responsibility for us. As older people, we have to take care of each other. We only have ourselves,” said 70-year-old Thembisa Loyila.
Africa’s Abandoned Older Population
Based on the Human Rights Watch’s findings, it is clear that South Africa’s support for its older population is merely token.
However, as the saying goes, half a loaf is better than none. The mere fact that there are laws in place—although poorly enforced—is already a step in the right direction as many African countries cannot boast of the same.
A 2021 report by F. Akosua Agyemang, a senior lecturer in the University of Ghana’s Department of Social Work, explored the gaps in caregiving for older adults in Africa.
According to Agyemang, these gaps are largely a result of dwindling extended family support systems, an attribute many Africans used to (and to some extent, still) take pride in.
While the developed world relies heavily on public or private healthcare facilities for old age support, Africa and other parts of the developing world have always traditionally regarded old age support as a familial responsibility.
However, presently, African families are becoming increasingly nuclear, placing more focus on the smaller family unit rather than the larger.
This is in part due to factors such as urbanisation and the inability to take care of the extended family.
The latter factor is tied to the financial, psychological, social and physical toll placed on the caregivers, who are more likely to be women and girls.
Furthermore, most family caregivers are unequipped to deal with complex health issues common in the aged, and may even take advantage of those placed in their care, resulting in elder abuse.
Moreover, our society seems to be shifting more and more from communal living to individualism, an issue that is widely charged to modernisation.
Consequently, Agyemang posits that governments, corporations, religious groups and communities have the onus of establishing proper long-term care programs or facilities for aged persons who are no longer able to care for themselves.
In the continent’s established middle-income countries like Mauritius, Seychelles and South Africa, such care facilities exist—although their propriety is evidently questionable in the latter country.
A 2006 report by the US National Research Council Committee on Population also acknowledged the presence of notable formal pensions and social welfare schemes in Botswana and Namibia.
In a few other African countries, there are gradual efforts to provide community supports.
In Ghana, Agyemang cited groups such as Members of the Veterans Association of Ghana, Care for Aged Foundation and Association of Ghana Elders.
Notwithstanding, these efforts are not nearly enough. Older people are poorly cared for across the continent and may even have to deal with negative stereotypes that further push them into isolation.
A 2022 report on old age support in East Africa revealed that in 2013 alone, 765 older people were killed in Tanzania because of suspicions that they were witches.
505—more than 60%—of these fatalities were women, highlighting how much women get the short end of the stick when it comes to old age support.
All of the aforementioned reports also shed light on the inaccessibility of proper healthcare to older people, either owing to poor health insurance coverage, elder abuse in health care facilities or the poor state of the facilities available to them.
The Way Forward
While identifying the problem is an integral step in the journey to finding a solution, inaction only concretises the problem.
As Agyemang rightly posits, the way forward must include joint efforts from the government, the private sector and the larger community.
However, the solutions must be spearheaded by the governments.
Government agencies need to properly assess the extent of the problem in their respective countries, and enlist the help of relevant NGOs and the general public to tackle it.
If the older population is regarded as an important part of the society, not just for their past (and present) contributions to national development, but on the basis of their humanity, perhaps African governments will see the need to put them in consideration when it comes to budgetary and legal provisions.
Social policies must not only be made, but also enforced.
Provisions should not be made in a shabby manner, but should be properly thought out and executed.
If healthcare or social workers are to be enlisted, they must be adequately trained and equipped to deal with the pressing needs of the older population.
Additionally, there must be checks in place to ensure that no elder abuse is occurring. These workers must be adequately monitored and held accountable.
If financial provisions are to be made, they must be sufficient and the government and/or community must do their best to make older people aware of their entitlements, because what good are rights if there is no awareness of them?
The governments should also put in place programs that prepare the current generation for old age. Factors such as saving schemes, healthy eating and physical fitness should be emphasized by the government.
As for the larger community, they should regard older people as a vulnerable group too and do what they can to support them through community funds and active participation in care services.
They can also strive to tackle negative stereotypes or plain ignorance by championing awareness about the humanity and needs of the older demographic.
Step by step, Africa can once again ensure the protection of its older population.
Sources: Human Rights Watch, AARP International, PubMed Central
