INTRODUCTION

A Situation Analysis

A population and household survey conducted in 1997 by the Ministry of Social Affairs showed that Lebanon has been going through a transitional demographic phase for the past two decades, registering a decline in fertility and mortality rates. As such, longevity has increased among the third age group in Lebanon.

In 1970 the fertility rate was 4.6% - it dropped to 3% in 1997. Life expectancy at birth was 66 years in 1970 while it reached 71 years in 1997.

Based on an estimated official count conducted in July 2001, Lebanon's population is estimated to be 3,627,774 with a percentage of 6.71 % aged 65 years and over. The Lebanese population living below poverty line was estimated in 1999 to be 28% - as such about 68,158 senior citizens could be living under the poverty line (out of a total of 243,423 senior citizens). These figures are probably an underestimation of the real situation today given the prevailing strenuous economic situation.

The percentage of the world's population aged 60 years and above reached 10.3%, 10.2% being males and 10.4% females. As for people aged 65 years and above, the percentage is 6.8% with an almost equal distribution for both genders (6.8% for males and 6.9% for females).

It is estimated that in the coming 25 years (by the year 2025) this increase will account for 13% of the Lebanese population. This indicates that population ageing in Lebanon will be a reality that will have to be dealt with in order to respond to a potential economic and social backlash.

MEASURES TAKEN BY THE REPUBLIC OF LEBANON

In compliance with the international strategy and recommendations set by the World Assembly on Ageing (WAA) aimed at responding to the challenges and needs of population ageing in the XXI century, the Lebanese government decided to establish a Permanent National Commission on the Elderly (PNCE) whose main task would be advisory, acting as an implementing arm to the Ministry of Social Affairs (MOSA).

Being keen on safeguarding the dignity and safety of the elderly person, an in conformity with the ultimate goal of reinforcing a society for all ages where individuals will get older while remaining active and productive members of society, the Republic of Lebanon also participated at the decision making level on regional issues related to the elderly with a number of Arab countries and organizations dealing with the Arab League.
 
 

THE ESTABLISHMENT OF THE PNCE

The PNCE was created by ministerial decree number 31 on 17/2/1999.

Criteria for selecting members were based on the principle of mixing the following three sectors: public, private and non-governmental organizations (NGOs). The public sector is represented with 9 delegates from different ministries and public administration sectors, the NGOs are represented with 3 delegates, and the private sector is represented with 3 expert academicians. The PNCE is headed by the Minister of Social Affairs of the MOSA.
 

Tasks and Role of the Permanent National Commission on the Elderly

Since its inception, the Permanent National Commission on the Elderly (PNCE) in Lebanon was assigned the task of conducting a national needs assessment survey on the status of the elderly people and on existing institutions catering to their needs.

Given the UN resolution to conduct a second World Assembly on Ageing planned to be held in Madrid in April 2002, where member countries will have the opportunity to network and participate in sharing common positions on policy making and programs related to the elderly people; the need to gather data and information on the elderly with the aim of assessing and improving their status becomes imminent.

It is estimated that the elderly in Lebanon represent 6.71 % of its total population - N = 243,423 elderly. However, a national survey has not yet been carried.

The PNCE has determined as a main priority on its agenda, the implementation of a needs assessment study on the status of the elderly people in Lebanon. A consensus on the importance of collecting a quantitative and sound baseline data aimed at orienting the future delivery of programs has been reached; whilst acknowledging that a qualitative approach has so far been used with limited detailed information on vital indicators affecting this growing and substantial percentage of the Lebanese population.

The main goals of this needs assessment study are to establish a sound database on the status of the elderly people in Lebanon and to obtain a preliminary profile on the major health, social and economic problems they face.

This needs assessment study will be the first in a series of other future surveys that will be more focused and detailed according to preliminary findings. It is hoped that initial findings will help the Ministry of Social Affairs upgrade its existing service delivery to this age group.
 

Listing of Major Tasks

To conduct comprehensive field studies and develop recommendations on the following:

a. Number of elderly and their place of residence
b. Medico-social status of the elderly
c. Institutions dealing with the elderly and services offered

In addition to:

a. Being informed on the latest world developments regarding the elderly
b. Developing a strategy for the betterment of the living conditions of the elderly c. Delivering seminars and conferences
d. Launching of public awareness building activities to sensitize the youths and citizens on the importance of promoting the rights of the elderly as opposed to the prevailing charity oriented attitude.

In order to achieve those goals, the PNCE formed the following specialized committees:

a. The research and planning committee
b. The medical and social service committee
c. The legal committee
d. The public relation and communication committee

The PNCE officially launched its activities on 23/6/1999 during a press conference that was attended by the three sectors (public, private, NGOs) and private institutions in order to solicit a wide cooperation and coordination aimed at improving the status of the elderly people by allowing them to maintain a responsible, active and accountable role in society.

The PNCE delivered seminars, conferences and media oriented programs dealing with all the problems faced by the elderly in which many field workers, experts and academicians in the fields of health, social work, culture and economics participated.

The PNCE has also declared a National Grand Parents Day which is observed yearly on the last Sunday of the month of June. Every year, NGOs, private businesses, the media, MOSA centers and government agencies participate in this event throughout the Lebanese territory.

The Commission has also been observing the International Day of the Elderly on October 1 of each year. In 2001, a national workshop on the situation and needs of the elderly was offered as a first attempt to analyze the real situation of this growing segment of the Lebanese population, shedding more light on:
 

• Main health problems and the importance of preventive medicine
• Existing social and economic status of the elderly and their geographic distribution
• Services offered by the public and private sector
• A law project concerning an optional social security health plan

This workshop generated an important set of recommendations that were tackled by the PNCE and related ministries.

Participation of the PNCE at the International Level

Lebanon participated in the preparatory work of the Second World Assembly on Ageing that was held at the UN Headquarters in New York from December 1014, 2001 with a delegate from the PNCE.

Participation of the PNCE at the Regional Level
 

• The PNCE participated in the Second Meeting of the National Arab Committees that took place on March 19, 2000 in Damascus. The main results were:

• The creation of the Arab League for the National Committees on the Elderly
• Choosing Damascus as the headquarters for the League
• Election of a Board of Directors for the League

• The PNCE sent one delegate to Kuwait to attend a medical seminar from November 18-21, 1999.

• The PNCE also sent two delegates to Iran to attend the First International Conference on the Elderly from November 18-21, 1999.

Studies

The MOSA population and household study conducted in 1997 generated limited information on the status of the elderly in Lebanon. Studying issues related to the elderly is of prime importance in order to draft new policy, secure services and plans in accordance to needs.

- Resource Guide

As such a project for designing a resource guide inclusive of all institutions and associations helping the elderly people in Lebanon became essential, in particular with the aim of obtaining accurate data on their capacity to offer such services, their sources of funding and the problems they commonly face.

- Medico-Social Needs Assessment

Study on the status of the elderly in Lebanon targeting 150,000 elderly persons.

- Elderly Living at Home

Survey of the elderly person living in his/her family to be conducted through the MOSA centers

All these studies are being developed while awaiting administrative, technical and financial support.
 

Participation of the PNCE at the Organizational Level

A steering committee was formed in order to follow-up with the ministries involved in issuing the Lebanese senior citizen card. The PNCE lobbied with the different ministries by sending and following up on the recommendations that were generated from the national workshop. Ministries were encouraged to undertake the necessary steps within their own areas of jurisdiction to achieve the goals stated in the recommendations.

The Lebanese Ministry of Interior sent to all the governorates and municipalities a memo asking them to submit plans of action to be implemented at their own levels: i.e. services that could be offered at the medical and social levels with the possibility of studying a proposal to waive municipality and rental taxes for senior citizens.

The Ministry of Tourism showed its interest to waive entrance fees related to historical and touristical sites. A study is being conducted with the PNCE to assess the legal and administrative processes needed to secure and facilitate such services for the senior citizens.
 

Participation of the PNCE at the Media Level

The PNCE came up with a media plan on the occasion of Grand Parents' Day to sensitize the general public on the importance of keeping the elderly people in their families and of treating them nicely - as such, bridging generations in a society for all ages:

A drawing contest will be conducted in June 2002 with school children, the theme being "Grandpa Grandma and I"

The local authorities, the MOSA centers and the Ministry of Education will all be implicated in the preparatory work. A significant number of Lebanese families will also participate in this occasion.

The best child drawing will be selected and a poster will be printed for this occasion.

An agenda with all also be printed using the drawings of the children's contest.
 

Participation of the PNCE at the Social Level

Senior citizens in Lebanon have very limited access to day care centers catering to their social needs. Most of the retired or elderly citizens suddenly find themselves homebound and cannot generally afford the luxury of joining private institutions for leisure time. This growing portion of the Lebanese society is too often forgotten and has not yet been positioned as a high priority target group on the country's agenda of social and health rehabilitation schemes.

Given the international trend to raise awareness about the new demographic changes tied to population ageing and their emerging needs, the PNCE has been deploying efforts over the past few years to deliver public awareness building and design appropriate projects related to the socio-economic and health needs of the elderly in Lebanon.

Two main projects are being developed to respond to elderly priority needs identified by a group of experts. This national project is targeting the needs of senior citizens living at home by setting-up approximately 40 day care centers within the wider network of the Ministry of Social Affairs Social Development centers spread over the 6 Lebanese Governorates. It will also include a few selected NGOs that fit the criteria for hosting such a project.
 

Participation of the PNCE at the Legal Level

The PNCE is currently working on new legislation and policy-making related to the elderly. It has been following-up the law on the optional social security health scheme for senior citizens and has been trying to coordinate with the respective partakers the enactment of this new law.
 

SERVICES OFFERED TO THE THIRD AGE GROUP

At the Government Level

The Ministry of Social Affairs Contribution

The MOSA has addressed the following medico social and financial needs of the elderly by choosing to contract and be in partnership with NGOs catering to the needs of the elderly:
 

• Contracts made with 14 selected social institutions catering to the needs of 515 elderly persons distributed as such:

• Beirut 50 beneficiaries in 1 institution
• Mount Lebanon 275 beneficiaries in 5 institutions
• North Lebanon 155 beneficiaries in 6 institutions
• Beqaa 35 beneficiaries in 1 institution
• South 25 beneficiaries in 1 institution

• Medicine for chronic diseases and medical consultations are offered through 120 MOSA centers distributed over the Lebanese territory.

• Joint contracts between the MOSA, associations and NGOs are honored for helping in supporting the cost of health and leisure related projects (270 joint contracts).

• Nutrition and other in-kind donations are offered within joint programs between the MOSA and a selected number of NGOs. A joint partnership was forged with one NGO to help 100 elderly within their families by providing them with health, nutrition and clothing assistance. This initiative represents a pilot project aimed at designing a model by which the elderly can have a decent and good quality of life within his own family.

The Ministry of Public Health (MOH) Contribution

The MOH reimburses fees for certain diseases necessitating long-term stay in elderly homes, orphanages, rehabilitation centers, and mental health institutions.

It reimburses a fixed rate of about $10 per day per elderly residing in elderly homes.

The MOH covers 85% of the hospitalization bill for patients not covered by the social security or by any other health institution or insurance scheme. It also participates in the coverage of some chronic medicine for elderly on an out patients basis.

As such the MOH provides support to 22 institutions targeting 2310 elderly persons throughout the entire Lebanese territory:

• Beirut 375 beneficiaries in 2 institutions
• Mount Lebanon 1550 beneficiaries in 11 institutions
• North Lebanon 120 beneficiaries in 4 institutions
• Beqaa 120 beneficiaries in 3 institutions
• South Lebanon 145 beneficiaries in 2 institutions

The Ministry of Finance Contribution

According to the end of service (retirement) law, an employee who has put in a minimum of 20 years of work is qualified for retirement or end of service benefits.

At 64 years of age, he/she qualifies for retirement benefits (if a civil employee), judges qualify at the age of 68 and the army at 58 years.

The Ministry of Finance undertakes these steps:

The total number of retirees in Lebanon is 48,000 (MOF count). Distributed as follows:

• 12,000 from the civil sector
• 36,000 from the army (they obtain a retirement salary + benefits in addition to health and social benefits to them and their dependents)

Existing Schemes:

1. End of service scheme effective as of 1 /5/ 1965
2. Family and educational assistance effective as of 1/11/1965
3. The health scheme and maternity coverage whose implementation has been delayed since 1970
4. The on the job emergency and occupational disease scheme that never got implemented since its endorsement

All these laws are only applicable to employed people only. As for the elderly who are not working, they have no coverage and no laws exist to protect them (health and work related). The recent passing of law number 248 on August 9, 2000 (optional social security health plan) will provide the uninsured elderly with an alternative for coverage. In the second article of this law, it is stipulated that every Lebanese citizen is eligible to qualify for this optional plan according to the following criteria:

1. Has reached 64 years of age

2. Is not a direct or indirect beneficiary of the following services:

• Government cooperative
• Army, internal security forces, general security forces, or national security forces
• The national social security fund
• Orders and syndicates (professional orders) if they offer health services to their own retired employees

MPs recently approved a law project aimed at integrating the optional social security health plan in the health and maternity scheme. Currently efforts are being deployed to issue a special decree for this.

Services Offered by the Private Sector

- Services offered by NGOs

Institutions, centers and houses dealing with the elderly in Lebanon

These institutions and centers dealing with the elderly carry different names for services offered according to their own capacity and the support they receive from government institutions or from civil societies (at the individual or institutional levels.)

Services are divided according to the type of assistance provided: i.e. in-house (housing, food, medicine, medical services, social, home health, house calls) in addition to providing a training and internship platform to institutes and universities, allowing students to acquire hands on experience in this field.

Those institutions are about 35 catering to the needs of 3000 elderly (estimated number due to lack of accurate data and resource guide.)

As for day care centers, some offer one daily meal, leisure, outings and intergenerational social programs.
 

Insurance Companies

They extend medical care and hospitalization assistance based on individual or group contracts. The number of beneficiaries varies according to insurance companies depending on age groups and the length of membership. Elderly people cannot adhere to these companies if they are not wealthy and companies do not recognize the medical needs of the elderly people at a time when they need them the most for hospitalization and medical interventions which are often too expensive. In Lebanon, many insurance companies exist but for profit only.

The Lebanese Geriatric Society

On March 1, 2000 and after major efforts deployed by geriatricians in Lebanon this Society was founded.

It helps in preparing and delivering seminars, conferences and workshops. It also raises public awareness building among the civil society and promotes the right of the elderly people to remain in their families. It also supports the elderly person inside institutions and outside these through prevention programs.
 

Nursing Schools and Other Medical Specialties

Geriatric care was included in the curriculum of nursing schools and other medical and paramedical specialties in Lebanon.

CONCLUSION

The Lebanese government is aware of the increase in the number of elderly among its population and is responding to the situation accordingly through the implementation of a national plan action. Added efforts are being deployed with contingency plans being prepared in order to effectively respond to the upcoming demographic, economic and social changes.