Health and socioeconomic resource provision for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka

BackgroundThe global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. This necessitates effective services to address the increasing physical and mental health needs of multimorbid and frail older people in LMICs. We review the current provision of health and socioeconomic resources for older people in South Asian countries: Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement. MethodsWe conducted a search of grey and published literature via Google Search and Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, Scopus and Web of Science to extract data on population demographics, human resources, health funding and social security provision for older people. Local informants were consulted to supplement and verify the data. ResultsIn most study countries, care of the elderly is provided by general physicians or primary care doctors, nurses and community health workers, though in very low numbers per capita. The number of geriatricians and specialist allied health professionals were largely unknown, with minimal postgraduate programmes available for specific training in geriatric medicine or psychiatry. Total average healthcare expenditure as a percentage of GDP was between 2.5-5.5%, markedly below the global average of 10.0%, with between 48.1-72.0% of healthcare costs covered by out-of-pocket payments. All countries, except Pakistan, had a social pension offering a minimum level of protection against financial constraints, but with varying coverage of those eligible. Financial provision for people with dementia was only available in India and Nepal. A modest number of state and charity-run care homes were established in all countries, though numbers were disproportionate to the growing number of older adults requiring long term care.ConclusionsInadequate health funding, a lack of specific healthcare and training and insufficient government pension and social security schemes are a current threat to achieving universal health coverage in LMICs. Governing bodies must establish geriatrics and geriatric psychiatry as specialities and scale up training programmes for specific healthcare providers for the elderly. This needs to occur alongside increased social protection provision to improve access to those in need and prevent catastrophic health expenditure.