Policy implications of work on long term care in Senegal

February 20, 2023

The aging of world populations is a reality, and the number of people aged 60 and over continues to increase. According to the United Nations, the population of people aged 60 and over worldwide will reach 2 billion by 2050. 80% of this group is expected to be living in low-income countries. In Senegal, older persons represent about 6% of the general population. According to a 2006 forecast by the ministry of health and medical prevention, this proportion is expected to increase to 9% in 2028 and further to 17% in 2050. Starting from these projections and in line with the international goal of a world where everyone has the opportunity to age in good health and well-being, the Senegalese authorities are considering the concerns of older persons when developing policies and programs. The ideal situation is to have older persons maintain independence and their functional capacities into their golden years. Legally, the rights and well-being of older persons in Senegal are part of the priorities. 

First, at the international level, Senegal has ratified all international and African mechanisms and instruments for the protection of the rights of older persons. These include: The Universal Declaration of Human Rights, the Vienna Plan of Action, the Madrid Plan of Action, the Global Strategy and Plan of Action on Healthy Aging or Aging Well, the Development Goals, the Sustainable Development goals of the United Nations in 2015, the African Charter on Human and Peoples’ Rights of Nairobi on June 7, 1981, the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in West Africa, Resolution on the Rights of Older Persons in Africa in Ghana 2007, African Union Commission: Conference of Ministers Responsible for Social Development Namibia, 2008)

Then in the national context, the first protective framework for older persons is at the top of the hierarchy of norms in the Senegalese constitution. Article 17, paragraph 2 of the 2001 Constitution indicates that the State and public authorities have a duty to ensure the physical and moral health of the family, particularly the disabled and older persons. In addition, the constitutional revision of 2016 included new provisions such as “consolidating citizenship” and “expanding the rights of the citizen.” Thus article 50 of the constitution stipulates that older persons have the right to recognition by the nation and social protection. Therefore, the State and the public authorities ensure their participation in nation-building and in exercising their rights. The articles added to the constitution also contributed to the protection of older persons, more specifically, article 25-1- which provides citizens’ rights over their natural resources and the other laws relating to the care of older persons in different codes such as the penal code, the family code, the Civil Procedure Code and the local authorities code.

We found laws related to the legal and regulatory protection of older persons, such as:

Law n◦ 2010-11 of May 28, 2010, instituting absolute gender parity. 2010

Social orientation law of May 26, 2010; on the promotion and protection of the rights of persons with disabilities, including older persons.

Law 2002-08 of February 22, 2002 repealing and replacing Law 81-52 on the Code of Civil and Military Pensions.

Law No. 75-50 of April 3, 1975 establishing social welfare institutions

Decree number 87-712 of June 4, 1987 on the institutionalization of the national day of older persons.

Beyond the legal framework, the Senegalese authorities have taken into account the concerns of older persons in policies and development programs to improve their well-being of older persons. We have broader national policies and strategies: the Emerging Senegal Plan (ESP 2013-2035) and the National Strategy on Healthy Aging (2017-2022).

The ESP is currently the benchmark for economic and social policy in the medium and long term. The concerns of older persons have been integrated into particular into Axis II “Human capital, social protection, and sustainable development”, the strategic objectives of which are the strengthening of social security for workers and retirees, the improvement of socio- of vulnerable groups and the extension of social protection to the informal sector and to vulnerable groups. This is by setting up basic Universal Health Coverage (UHC) through mutual health insurance.

Concerning the National Strategy on Healthy Aging (2017-2022). The strategic orientations are defined around the foundations of healthy aging.

This focuses on the access to care for older persons and a decent income, the development of psychosocial support, the coordination and financing of actions in favor of older persons, and the contribution of the expertise of older persons.

At the sectoral level (health, social protection), policies are put in place to take care of the well-being of older persons.

In terms of health, the sesame plan, an innovative and relevant social policy was put in place in 2006 to support the well-being of older persons. This plan aims to provide free care to people aged 60 and over in hospitals, health centers and health posts throughout Senegal. This plan resumed in January 2015 as part of another broader policy called UHC (Universal Health Coverage).

The National Health Development Plan (NHDP 2018-2029) pays particular attention to older persons through universal access to quality promotional, preventive and curative health services, without any form of exclusion.

All national health programs (community health, mental health, nutrition, chronic diseases, etc.) take into account the specificity of older persons in developing their strategic plan following the recommendations of the ministry’s authorities in charge of health.

In terms of social protection, the poverty reduction strategy paper (PRSP) and the national social protection strategy (NSPS) within the framework of socio-health protection for older persons undertake to provide retirement pensions for retirees, establish a minimum age for those considered to be older persons, exempt pensions from the compulsory scheme and tax relief for supplementary schemes, improve the management of the health situation of retirees by setting up an effective system of care medicine emphasizing prevention. Added to this is the holding of an inter-ministerial council on social policy and the issue of aging (November 2001), the raising of the retirement age from 55 to 60 in the civil service (2002) and the creation of an Association of Volunteer Corps for older persons (2003).

The Seniors Support and Promotion Project (SSPP) is currently transformed into a Seniors Empowerment Project (SEP). The objective of this project is to improve the living conditions of seniors and ensure their promotion. It focuses on building older persons’ technical capacities in project management and income-generating activities. With this project, older people actively participate in defining and applying policies that directly affect their well-being.

In terms of infrastructure, in Senegal, there are models of geriatric centers (medico-social centers) implemented by the State, which reflects the real political goodwill to support older persons. There are four centers in total, of which three are based in Dakar and the other in the Thiès region; There are also some initiatives of Private Home Care Structures for older persons.

In terms of the protection of the rights of older persons, Senegal has a very important legal arsenal and policies and can serve as a model for the countries of the sub-region.

Thus, despite the efforts made at the national level, older persons, in the vast majority of cases, continue to encounter difficulties in accessing social and medical-health services through:

  • Inadequate socio-health institutions,
  • A lack of retirement homes.
  • The traditional care system does not cover home care and palliative care.
  • Medicines specific to diseases prevalent among  older persons are not included in the national list of essential medicines
  • emergencies such as Covid 19 are not taken into account in the policies
  • Policies focus more on the medical aspect. The social aspect involving family, caregivers, domestic workers, and community life is not well explored.

On the legal level: the legal and institutional framework of the healthy aging policy is not applicable, and the absence of an orientation law on the social protection of older persons. 

At the institutional level: The management of the concerns of older persons is distributed between several ministerial departments without real coordination.

From a financial point of view, the resources, that is to say, the budget allocated to the care of older persons, is very low, and the low interest of international partners for a population is not yet considered a priority.

In view of this problem, the African Population and Health Research Center (APHRC), with the universities of Bristol and Toronto, the Hewlett Foundation, and other partners, are embarking on a collaborative program of research and political engagement in two countries (Kenya and Senegal) to inform and advance the development of transformative and cost-effective systems of care for Africa. The specific objective is to advance the development and adoption of African and national policy or legal frameworks, implementation plans, and budgets to foster the expansion of long-term care provision and social infrastructure. We hope the study results will contribute to developing more appropriate policies for older people to live with dignity.