Toward a Fit-for-purpose Policy Architecture on Long-term Care in Sub-Saharan Africa: Impasse and a Research Agenda to Overcome it
Journal of long-term care
Introduction Sub-Saharan Africa (SSA) has featured little in the global discourse on long-term care (LTC) policy thus far -a gap brought to the fore at the 5th International Conference on Evidence-based Policy in Long-term Care in Vienna. With few exceptions, the tremendous breadth and depth of scientific content centred exclusively on Organisation for Economic Co-operation and Development (OECD) countries. Only two contributions focused on SSA, including my own plenary address (Aboderin,
... ss (Aboderin, 2018), upon which this commentary is based. Virtually all conference deliberations, moreover, concerned, in one form or another, the what, where and how of organized LTC provision: what LTC services are needed and appropriate where, how may they be forged or improved upon and, the crucial question, who is to bear their costs. More fundamental questions about the whywhy LTC services are required in the first place -appeared not to merit much discussion. A need for such services per se seemed broadly accepted in both OECD public and policy domains: it went without saying. These conference parameters crystallized what is, arguably, the major challenge facing LTC policy in sub-Saharan Africa: a virtual lack of robust debate and policy architectures on the what, where and how of organized LTC provision, because the why has not yet been resolved. My aim in this commentary is to reflect on this impasse and its key drivers and to propose a set of required research approaches to overcome it. In so doing, I attempt to construct an argument for SSA as a whole, albeit a cautious one, as it does not capture the immense diversity in economic, geographical and social contexts that exists among the region's 51 states. Nonetheless, I consider an SSA-wide assessment justified for two key reasons: Context: Perspectives from sub-Saharan Africa (SSA) have featured little in the expanding global debate on long-term care (LTC) policy thus far -despite SSA countries' embrace of global commitments on the development of equitable and sustainable LTC systems. Objective: Building on insights derived from ongoing analyses of relevant literature and policy frameworks, stakeholder engagement, as well as personal experience, this commentary examines the lack of a fit-forpurpose policy architecture on LTC in SSA at both regional and national levels. Method: The analysis assesses the nature and drivers of this policy impasse and pinpoints an agenda for research to help overcome it. Findings: LTC in SSA is provided overwhelmingly by families, with available evidence pointing to inequitably distributed deficits in the quality of such care and negative impacts on unpaid family carers. Governments have forged a spectrum of frameworks that speak to questions of LTC. Yet fit-for-purpose provisions that consider a need for expanded organized care and support provision to reduce quality deficits and costs on carers are widely lacking. The impasse may be rooted in a lack of awareness of relevant evidence, as well as in political views that resist organized care provision as an imposed western model that counters African values and as a distraction from priority child-, youth-and gender-focused development agendas. A concerted research effort that examines the compatibility of organized LTC provision with African family norms and its relevance for broader social and economic development in SSA is required to address the policy impasse. Limitations: This overview is an exploration of the agenda, leading to suggestions for ways forward, and not an empirical research report.