The Republic of Uganda

UGANDA REPORT ON THE REVIEW AND APPRAISAL OF THE IMPLEMENTATION OF THE MADRID INTERNATIONAL PLAN OF ACTION ON AGEING

 By Mr. Herbert Baryayebwa
Commissioner, Disability and Elderly

Ministry of Gender, Labour and Social Development
Department of Disability and Elderly
P. O. Box 7136
Kampala.

Tel. No. 041-4-252952
E-mail: ps@mglsd.go.ug
Fax: 041256374

1.0	INTRODUCTION

The Second World Assembly on Ageing adopted the Madrid International Plan of Action of Ageing (MIPAA).  This plan focuses on older persons in terms of poverty eradication, health promotion, access to food and adequate nutrition, income security, access to knowledge, education and training, HIV/AIDs, housing, support to carers and service providers among others.  Participation of older persons in political, socio-cultural and economic spheres of life has to be emphasized if the rights and needs of older persons are to be adequately addressed.

1.2	Implementation process

Issues of older persons are multi-dimensional and therefore implementation of the MIPAA involves participation of central Ministries, Local Governments, Faithbased Organisations, Non-Governmental Organisations, Community based organizations, the private sector, older persons themselves and the community.  The Ministry of Gender, Labour and Social Development is the lead agency and therefore spearheads coordination of policy.  The Ministry of Gender, Labour and Social Development works closely with Uganda Reach the Aged Association (URAA) and Associations of older persons from grassroot level to district level.  Bottom up approach is used in planning and implementation of programmes for older persons.  Participation of older persons in the process enhances ownership and sustainability of programmes.

1.3	Implementation structure

The Ministry is headed by the Minister of Gender, Labour and Social Development and is assisted by a Minister of State for Elderly and Disability Affairs who is the political head of the Department for Disability and Elderly.

The technical head of the Department is the Commissioner who is assisted by a team of social workers and gerontologists.

The functions of the department among others include:
•	Policy formulation;
•	Development of Guidelines to implement policy;
•	Provision of support supervision to Local governments;
•	Networking with line Ministries, NGOs and other stakeholders;
•	Initiation of laws and review of the existing laws to address concerns and needs of older persons;
•	Design of programmes and activities for older persons;
•	Monitoring and Evaluation.

The Department develops its policies, plans and activities in line with the MIPAA objectives.  The Local Governments private sector, Faithbased Organisations and  Civil Society Organisations implement the programmes for older persons within a decentralized framework.

1.4	   Demographic trend of older persons in Uganda

Like other developing countries, the population of older persons in Uganda is increasing.

According to the 1991 Uganda Population and Housing Census, the population of older persons was 686,260 (4.1%) of the total population of 16,671,705.  This population increased to 1,101,039 (4.6%) as per Uganda Population and Housing Census results of 2002.  The Uganda National Household Survey (UNHS) Report 2005/06 estimated the population of older persons at 1,200,000 of which 53% were female while 47% were male.  This population increase has profound consequences at individual, community and national level.

2.0	LEGAL AND POLICY FRAMEWORK

In order to promote and protect the rights of older persons the Government of Uganda has come up with a conducive legal and policy framework.

2.1	Constitution of Uganda

The Constitution recognizes the rights of older persons and provides the basis for the enactment of laws to address their rights and needs.   Under the National Objectives and Directive Principles of State Policy of the Constitution, it is stated; “The state shall make reasonable provision for the welfare and maintenance of the aged.” 

Article 32 of the Constitution stipulates that; “Notwithstanding anything in this Constitution the state shall take affirmative action in favour of groups marginalized on the basis of gender, age, disability or any other reason created by history, tradition or custom, for the purpose of redressing imbalances which exist against them.”

2.2	The Local Governments Act CAP 243

The programmes of older persons are decentralised.   For effective participation of older persons in decision making processes on matters that affect their lives, older persons are represented at various levels of local government from village to district level.  In line with this,

•	Local Governments Act CAP 243 Section 10 (f) and 23 (6) provide for representation of two older persons, male and female elected by older persons Local Government Councils;

•	The Equal Opportunities Commission Act (2007) provides for monitoring and evaluating policies, programmes, plans, activities, practices, traditions, culture usages and customs to ensure that they are compliant with equal opportunities and affirmative action in favour of groups marginalized on the basis of sex, age, ethnic origin, religion, social and economic standing, gender or any other reason created by history, tradition or custom;

2.3	The National Planning framework

2.3.1	Vision 2025

This is a long term National Development framework.  Its pertinent aspirations are that older persons will have easy access to basic services, infrastructure and other social amenities.

In line with this the vision for the policy for older persons states: A society where older persons age with security and dignity.

2.3.2	The Poverty Eradication Action Plan (PEAP)

	This provides an overaching framework to guide public action to eradicate poverty.  It spells out priority action areas to support, mobilize and empower vulnerable groups to participate in the economic growth and social development process.

	2.3.3	The Social Development Sector Strategic Investment Plan
	
This was developed to implement the PEAP pillar on human development.  It addresses major challenges of inequity, inequality, exclusion, unemployment and low productivity among the poor and the vulnerable.  It articulates interventions for promoting their participation and ability to access basic services.  In order to achieve this, the Social Development Sector ensures that vulnerable groups are protected from risks and repercussions of livelihood shocks by overcoming constraints that impede the development of their productive capacities.

         2.3.4	Other Sector Plans

	Other sector plans to implement the PEAP include Plan of Modernisation of Agriculture, Water and Environmental Sanitation, Education Sector Investment plan, Health Sector Strategic Plan and Justice, law and order sector among others.  Concerns and needs of older persons are being integrated during review of these planning frameworks.

3.0	GUIDING PRINCIPLES IN THE IMPLEMENTATION OF PROGRAMMES FOR OLDER PERSONS

The Department of Disability and Elderly provides a framework for responding to the issues, concerns and needs of older persons.  The following are the guiding principles.

3.1	Rights based approach

The principle promotes rights based approach to programming by seeking to realize the rights of older persons who are often vulnerable.

3.2	Independence
This principle emphasizes active ageing, productivity and self sustainability of older persons in all spheres of life.
3.3	Respect for older persons
This principle ensures that older persons are protected from any form of abuse so as to reduce on their vulnerability.

3.4	Family and Community Based Care
The principle emphasizes the family as the first line of support while community support is the second line.  It also emphasizes community based care approach to programming as opposed to institutional care of older persons.

3.5	Partnerships
This principle promotes partnership in service delivery and care for the older persons.  It emphasizes that stakeholders work together to ensure that older persons access services and help them to maintain the optimum level of physical, mental and emotional well-being to prevent or delay the onset of illness.

3.6	Intergenerational linkages
This principle emphasizes engagement of older persons in community activities together with different age group towards creating a society for all.

4.0	PRIORITY AREAS OF FOCUS

The department focuses on the priority areas that seek to improve on their quality of life.  This will be achieved through:
•	Economic Empowerment of older persons;
•	Strengthening the Formal and informal community support institutions;
•	Enhancing Access to Social Services such as health, water and sanitation, food and nutrition, shelter, recreation, leisure and sports, education and training;
•	Psycho-Social Support
•	Care and support of older persons with disabilities;
•	Research and information dissemination.

5.0	FORMATION OF ASSOCIATIONS OF OLDER PERSONS

The Associations have been established from village level to district level.  They were formed due to the following reasons:

•	to mobilize older persons to participate in development activities;
•	to promote interaction and intergenerational linkages;
•	to enable Government extend special services to them among other vulnerable groups;
•	to use Executive Committees of the associations as electoral colleges for electing their representatives to Local Councils;
•	to facilitate older persons to form savings and credit Cooperative Organisations (SACCOS) to access Government loans known as “Prosperity for all”

6.0	HEALTH SERVICES FOR OLDER PERSONS

Assessment of health needs of older persons

Studies have indicated that the most pressing problem identified by older persons in Uganda is poor health.  Therefore Government with support from World Health Organisation conducted a study to assess the health needs of older persons..  The main findings were as follows:
•	The rate of morbidity was high since the majority (91%) had experienced illness episodes a week prior to the study.  They mainly suffered from different diseases although the commonest were painful legs (23%) and backache (20.4%);
•	The problem of impairment was high among older persons and physical disability ranked highest (56%);
•	Accessibility to available health services was difficult and this was mainly due to high poverty among older persons;
•	The available health services were far away and lacked relevant drugs and specialized personnel to manage diseases that attack older persons;
•	Other health related problems included inadequate food, lack of firewood and poor sanitation.  The facilities for human excreta disposal were not suitable.   Older persons had squatting difficulties;
•	The majority (78%) of older persons had lost relatives due to HIV/AIDs.  They reported a burden of looking after orphans.

Recommendations

•	The health services for older persons should be integrated into the general healthcare system;
•	Geriatrics should be integrated in the training curriculum for health personnel;
•	A list of essential drugs should include drugs for treatment of diseases of older persons;
•	Health problems of older persons should be covered during surveillance of other health issues in the community;
•	Food and nutrition programmes should target older persons among other vulnerable groups;
•	Extension workers in health and community development should be sensitized about health needs of older persons so as to be able to integrate health issues of older persons in their plans and budgets at various levels of local government;
•	HIV/AIDs programme should be extended to older persons;
•	Needs of older persons should be considered during construction of pit-latrines.

The results of the assessment of the health needs have been used in review of policies, development of social programmes and curriculum development.

7.0	CERTIFICATE COURSE IN GERONTOLOGY

The Ministry of Gender, Labour and Social Development in collaboration with HelpAge International and UNFPA has supported training of staff in Gerontology at the University of Malta.  The knowledge and skills attained have been used to develop a six week Certificate Course in Gerontology at Nsamizi Institute of Social Development.  Participants are usually drawn from Government institutions and NGOs involved in implementing programmes for older persons in Uganda.

8.0	CASH TRANSFER PILOT SCHEME

The Ministry of Gender, Labour and Social Development with funding support from DFID and HelpAge International is in the process of piloting a cash transfer  scheme targeting chronically poor households including these headed by older persons.  For a long time, it has been recognized that lack of cash among people in chronic poverty makes it difficult for them to benefit from mainstream development programmes.  The scheme will be piloted in 6 districts.  The lessons learnt from the districts will be used to expand the project to more districts in a planned, controlled and systematic manner.

9.0	WAYFORWARD

•	Strengthening sensitization of local governments and stakeholders to integrate programmes  of older persons in sub-county and district plans;
•	Build capacity of stakeho9lders at all levels to enhance delivery and utilization of services for older persons;
•	Promotion of research and dissemination of best practices and experiences on older persons to support interventions;
•	Strengthen collaboration and networking for collective utilization of resources for provision of quality services for older persons;
•	Establish a coordinating body between Government departments, other service providers and older persons.  It will act as a body at national level through which the concerns, problems and needs of older persons will be communicated to its agencies for action.