National health policy to older people
Published on: Mar 3, 2016
Transcripts - National health policy to older people
NATIONAL POLICY FOR OLDER PERSONS
NATIONAL POLICY FOR OLDER PERSONS
Ageing is a natural process of human development and must be understood in all its dimensions
and effect on national development. As Belize continues to experience reductions in infections
and parasitic diseases, reductions in infant and maternal mortality rates, and further decreases in
fertility-rates, the elderly will be an increasingly larger proportion of our nation’s total
One of the first observations made when attempting to assess the situation of the elderly in
Belize is the lack of comprehensive and reliable data to be used for evaluating and decision-
making. Data collection and dissemination on the elderly is not done in a systematic manner to
ensure quality and timeliness. In addition, it is not always gender and age specific and rarely if
ever includes information on the disabled.
As a developing country, Belize still has a high proportion of persons under the age of eighteen
years and a relatively low proportion of older persons ( see TABLE 1). This has remained
relatively stable over the past four decades. What is less appreciated, however, is that the
absolute numbers of elderly is increasing. Although older persons make up only 6.8% of the
estimated mid year population in 1998, they add up to over 16,000 persons. It is projected that
this population will at least double by 2025.
TABLE 1: NUMBER OF OLDER PERSONS AT SELECTED YEARS
1960 1970 1980 1990 1998
Number 5886 7732 9448 11495 1600+
% 6.5 6.4 6.5 6.1 6.8
Number 2308 3182 4215 5147
% 2.5 2.6 2.9 2.7
70+ as % of
60+ 39.2 41.2 44.6 44.8
It should be noted that those persons over 60 years of age may actually span several decades of
life and that within this elderly population, different age groups may grow at different rates. Over
time, the elderly population itself may grow older on average as a larger proportion survives to
70 years and beyond. In Belize, although the percentage of those 60 years and over has remained
stable, the proportion of those 70 years and over has increased, albeit slightly, over the past four
decades. As our life expectancy (the average number of years a person can expect to live)
continues to increase, the “oldest old” will become a factor that is bound to alter previously held
stereotypes of older persons.
It is interesting to note that although the overall increase in life expectancy for Belizeans
between 1980 and 1991 was 3.4 years, females experienced a considerably larger increase than
males (1.8: 4.1 years). (Refer to TABLE 2). The widening of the gender differential in life
expectancy has been a central feature of mortality trends. Male mortality rates are consistently
higher than female in most countries.
TABLE 2: LIFE EXPECTANCY BY SEX AT CENSUS YEARS
SEX 1991 1980 DIFFERENCE
TOTAL 71.9 68.5 3.4
MALE 69.4 67.6 1.8
FEMALE 74.1 70.0 4.1
An important factor that should be taken into account at the time of analyzing the elderly is their
geographic distribution. Data from the last census indicated that close to 60% of the elderly in
Belize resided in the urban areas. Approximately 40% of the elderly lived in the Belize district.
Issues related to the area of residence of the elderly are accessibility to certain types of living
arrangements and basic services such as water, electricity, health facilities and the type of social
support available. Finally the labour force trends of the elderly are largely determined, in Belize,
by their urban/rural location.
A close look at the leading causes of deaths among Belizeans reveals that chronic and
degenerative diseases account for more than a third of all deaths. These diseases were the leading
causes of deaths among those over the age of 50 years according to the Ministry of Health
statistics. Cardiovascular diseases, malignant tumors and diabetes were also the leading causes of
hospitalization for persons within this age group. Information available from the Belize Council
for the Visually Impaired indicated that in 1996, approximately 25% of the 806 registered cases
of blindness was made up of persons 60 years and over. Of this group, 41% was located within
the Belize district while only 7% were reported as living in the Toledo district. The needs,
problems and priority areas identified by Belize’s National Health Plan (1996-2000) can be
examined at Table 3 below:
TABLE 3: SUMMARY OF HEALTH NEEDS, PROBLEMS AND PRIORITY AREAS
OF PERSONS 50+ YEARS IDENTIFIED BY THE MINISTRY OF
HEALTH IN THE BELIZE NATIONAL HEALTH PLAN 1996-2000
NEEDS PROBLEMS PRIORITY AREAS
Social Security Benefits
Essential Health Care
Public appreciation toward the
Regular medical check-up
Access to comprehensive
essential Health Services
Promotion of Healthy
Prevention and control of non-
Because medical insurance has been generally expensive in Belize, most persons reach old age
with few, if any, benefits. At a time when growth in the older population is accelerating, many
rely upon the help of children or relatives to defray medical costs. A valuable source of health
support for the elderly, particularly those in Belize City and San Ignacio, has been the Centers
for Senior Citizens that offer a range of primary health care programs. The Belize Social Security
Scheme does not target workers’ health since it provides medical care only for injuries suffered
on the job. Given that older persons are not working or are working in the informal sector, this
scheme is of little benefit to them. A National Health Insurance Scheme is presently being
developed. While health care services provided by the Ministry of Health are in theory free of
cost, the cost of special care such as x-rays, must be borne by the recipient. Additionally,
pharmaceuticals must often be purchased by the individual.
Another crucial area that needs to be addressed is that of financial security for the elderly Many
of today’s elderly were never a part of the formal labour force, particularly the women.
Economic opportunities for the elderly are seriously lacking and need to be encouraged. The
Public Service’s retirement age is 55 years with an extremely low probability of being rehired.
Although Public Servants are awarded a pension upon retirement, it is uncertain whether this is
enough to adequately sustain the individual and dependent spouse. For those individuals who did
manage to get Social Security coverage, the retirement benefits are paid starting at age 65 years.
Considering that the average life expectancy of a male person is 61 years, older persons do not
benefit much from the scheme.
The 1998 Labour Force Survey indicated that older persons comprised approximately of the
labour force. This means that around 37% of persons over 60 years of age, of whom the vast
majority are males, remain in the labour force. The 1991 Census data indicated that more of the
elderly residing in the rural than in the urban areas worked. This probably reflected the rural
population’s greater involvement in the informal sect and hence not being able to have a
The Government of Belize recognizes that:
1. The progressive ageing of the society and the continuing increase in
the elderly population both in absolute and proportional terms are
2. The economic and social impact of this “ageing of populations” is both an opportunity
and a challenge.
3. Older Persons constitute a valuable and important component of a
society’s human resources.
4. All sectors have a responsibility to share and participate in providing for the well being
of older persons.
The National Policy will ensure that the plan for older persons will not be just one of providing
protection, care and residential services, but also of securing their involvement and participation
in the national development process.
IN PARTICULAR, The objectives of the Policy will be to:
Meet the challenge of a growing, healthier and more active elderly population by ensuring that
they are able to meet their basic human needs,
• Provide assistance and protection from abuse and violence and ensure that older
persons are treated as a resource and not as a burden.
• Enhance the self-reliance and functional independence of older persons to facilitate their
continued participation in the family and society.
• Provide older persons with protection and care physically and mentally, through appropriate
support services while preserving their human dignity and providing the circumstance to live
• Guarantee proper resource allocation for the social and economic welfare of older persons
while appropriately respecting their rights, responsibilities and roles.
• Encourage formal and informal services for older persons which recognize the family as the
fundamental unit linking the generations and enhance the ability of the senior citizen to remain in
• Devise strategies and programmes to promote positive images of older persons and combat
negative age stereotypes and age discrimination.
• Promote the concept of “individual responsibility” in preparation for later years.
• Develop and promote programmes to facilitate the participation of older persons in
economic activities and offer opportunities for them to share their expertise, skills and
• Adopt legal measures to promote the welfare of older persons.
• Complement the statements and activities of other related policy statements.
THE PRINCIPLES ON WHICH THE POLICY IS BASED INCLUDE:
A. Individuality - There is a great diversity among older persons and the variation increases
B. Independence - The keystone of policy is to help older persons maintain the maximum
degree of independent living.
C. Choice — Older persons should always participate in decisions affecting their lives.
D. Accessibility - There should not be any discrimination in the availability of services.
E. Role Changes — Older Persons have special needs based on role changes more commonly
found in the later years.
F. Productive ageing - All older persons should be able to live socially and economically
G. Family care - Home is the best place for older persons. Institutional care should be last
H. Dignity — Older persons are entitled to receive services and benefits in a manner which
maintains their human dignity.
I. Religious Freedom — Older persons have the right to choose and practice their religious
The National Policy is multi-sectoral in nature and will need the input of all and agencies of
Government, Non-Governmental/Private Sector Organizations including, health, social welfare,
legal affairs, information and communications, housing and transport.
1. A National Council on Ageing (NCA) will be established and given the responsibility to
ensure appropriate implementation of the national policy, to monitor its implementation
on a continuing basis, and to take appropriate action when necessary to implement the
2. A comprehensive reliable database is considered an essential prerequisite for the
national strategy, and is essential for monitoring and evaluating the national policy.
3. All aspects of the Policy shall ensure gender equality and take into account that
women represent the larger proportion of the older person population and that elderly
women generally have a lower socio-economic status than elderly men.
4. The promotion of activities to safeguard the well being of older persons should be
an essential part of the National Development Plan.
5. The realization of the overall objectives is dependent on the achievement of goals
in nine areas which although presented under individual headings are all
I. National Mechanism
II. Education and Media
III. Health and Nutrition
IV. Social Welfare
V. Income Security
VI. Housing and Environment
POLICY, GOAL, OBJECTIVES AND STRATEGIES
I. NATIONAL MECHANISM
A National Council on Ageing shall be established and will be chaired by the Minister or
his/her designate with responsibility for the elderly. It shall be comprised of fourteen
members appointed by the Minister for a period not exceeding two years, and
representing government, non-governmental and private sector organizations.
Government recognizes the need to create the conditions and possibilities for the full
participation by all in implementing the national policy by providing a national mechanism for
their attainment. The overall goal is to ensure the promotion, implementation, monitoring and
evaluation of the National Policy for Older Persons.
The Council will seek to:
1. Serve as a national advocate on issues related to the elderly including strengthening of all
on-going and future services, and educational programmes whose aims are to support the
elderly and/or those addressing the special needs of the elderly.
2. Promote the development of an integrated strategy for addressing the special needs of the
elderly by ensuring that these needs are incorporated into all governmental, non-
governmental and private sector plans particularly in the areas of housing, transport,
health, social and income security.
3. Encourage and promote a partnership between government, non-governmental and
private sector agencies which will bring about benefits such as subsidies, technical
assistance, income generation opportunities, and psychological support for the benefit of
4. To strengthen the level of coordination and communication between the ministry with
responsibility for the elderly, the National Council on Ageing, and other agencies
working towards the improvement in the quality of life of the elderly.
5. To advocate for the mobilization of financial and human resources from all possible
sources including the public and private sectors, and the international community for the
implementation of the National Policy for Older Persons.
6. Promote the establishment and effective functioning of organizations working with the
elderly, and to promote the development of inter-generational policies in these
7. Ensure the adoption of the International Federation on Ageing/United Nations Principles,
Rights and Responsibilities of Older Persons by all agencies working for the upliftment
of the elderly.
8. Recommend and advocate for:
• the strengthening or the development of policies and strategies for the care, and
protection of the elderly residing in institutions.
• Annual reviews of budget allocations from government for those organizations
working with the elderly.
9. Make recommendations pertaining to the development and utilization of national data
which shall be sex and age specific, thereby contributing towards the development of
age-specific indicators to be used as the basis on which the health and social status of the
elderly can be monitored through sectoral information systems.
10. To develop and establish a Secretariat within the Ministry with responsibility for the
elderly, to ensure the proper implementation, monitoring and evaluation of the National
Policy for Older Persons.
II. EDUCATION AND MEDIA
Ageing is a lifelong process, and preparation for the later stages of life is essential. There is a
need to educate the entire society.
The goal is to increase awareness of the ageing process through the launching and maintenance
of information programmes aimed at public education on the aging process and related issues.
Specifically, educational and media objectives will aim at:
1. Establishment of an information, education and communication programme on ageing to
promote positive images of ageing, and related, planning for retirement and old age, and
recognition for older persons.
2. Incorporation of information on ageing and the value of older persons into primary and
secondary school curricula, as well as development of specialized information and courses on
ageing in post-secondary curricula. Family Life education should incorporate the life stage
approach to promote the concept of “a healthy youngster,” “a healthy older person”.
3. Promotion of life-long education programmes notably by means of non-formal education and
including all aspects of physical, psychological, spiritual, economic and social well-being.
4. Provision of continuing education and retraining opportunities for older persons and
5. Dissemination of facts, information and general knowledge for preparing persons to live a
useful life in their old age.
6. Mounting of a positive media campaign to increase the acceptance of older persons at the
family and community
levels in their roles as participants, especially sharing of their experiences, knowledge, skills
7. Supporting of a system and methodology for older persons to share their experiences and
knowledge for the public acceptance of their roles.
8. Promote an awareness campaign about the importance of making a WILL and
considerations to be given to affordability.
9. Provide opportunities for exchange of information, visits and skills among older persons,
at local regional and international levels.
To educate the general public with regard to the ageing process starting at an early age and
stressing that it is a natural process the implementing agencies will:
• Increase the knowledge of all persons responsible for providing facts, information, and
advice to older persons.
• Educate the elderly on new developments that will enable them to take part in their family
• Make use of existing resources such as churches, cultural centres, non-formal education
centres and other recreational places as the meeting centres where older persons and their
community can exchange their experiences and information in an attempt to fully involve
the elderly with the community.
• Arrange social events that provide older persons with opportunities to demonstrate their
talents so as to gain public acceptance of their important role in society.
• Launch a nation-wide campaign to make everyone aware of the demographic transition
resulting in the increased elderly population.
• Mobilize a mass awareness campaign as an essential component of the national strategy.
Collaboration with health, education, social and other sectors are essential for the
campaign, in which the mass media, including television, can create considerable impact.
III. HEALTH AND NUTRITION
Health and Nutrition activities will aim to ensure a holistic approach in providing health care to
older persons. In particular such activities will be directed at ensuring that older persons are
enabled to live worthwhile lives through the provision of health maintenance programmes,
physical, mental and pastoral care.
To achieve this goal, two types of health care services need to be organized: home care and
community care including primary, secondary and tertiary services. Both home and community
care needs to be provided in an organized and orderly manner to benefit the recipient. Each
programme designed for this age-group need to have a goal and a plan action that will meet the
needs of the group at which it is targeted.
The National policy will:
(1) Recognize the significance of elderly health services as a part of the integrated primary
health care service system.
(2) Promote Primary Health programmes which emphasize the promotion and preservation of
(3) Establish programmes to rehabilitate the older person when recovering incapacitating
(4) Facilitate in-service training of community health workers in health care senior citizens
especially in the identification of early signs of impairment disability in order to take timely
and appropriate actions.
(5) Launch a campaign on “Healthy Ageing” for school, adult, and elderly populations.
(6) Establish and strengthen mechanisms to provide national indices of health and disability
among the aged.
(7) Encourage and facilitate the development of community based programmes to offer:
• home care
• respite care
• physiotherapy services
• support groups for dementia/mental impairment
• assessment of functional capacity in association with high risk registers
• assisted living care programs
• social interaction/social programs sensitive to their culture and socialization
(8) Develop standards and procedures for the registration and monitoring of homes for older
(9) Enforce Nursing Home Regulations and establish and maintain a monitoring system.
The total well being of older persons in the Country will be ensured by:
• Making constant reviews of the programmes that are designed for their physical,
psycho- social, emotional, mental and spiritual well-being.
• Conducting periodic relevant research on the well being of older persons in particular
those receiving home and community care.
• Developing and implementing public education programmes.
• Empowering older persons themselves to take responsibility for their well being,
using all available resources for personal development and upliftment.
IV. SOCIAL WELFARE
The main goal of programmes designed to meet the social needs of older persons aims at
encouraging independence rather than dependency, preventing crisis as far as possible, and
rehabilitating those in need of special care. The private and voluntary sectors including churches
are recognized as being very important in delivering community-based service.
Legislate, promote, strengthen and expand where necessary “Social Protection Systems” in order
to protect from poverty, people who cannot work due to old age or due to the fact that they are
caregivers to older relatives. The specific objectives of the Policy are to:
1. Strengthen and expand national and community-based social services ensure they
are affordable and accessible.
2. Provide the right balance between public sector intervention, private incentives, and
voluntary effort that encourage the development and provision of opportunities for
3. Place a higher value on social and voluntary services given to older persons by
providing training, adequate compensation (where possible) and a positive public
4. Develop community-based registers of vulnerable older persons at risk, and provide
relevant necessary services.
5. Ensure that “Homes for Older Persons” and Nursing Homes conform national and
international standards and procedures by maintaining monitoring and evaluation
6. Encourage the establishment of activity centres for older persons where they could
spend time during the day becoming economically and socially productive.
7. Promote programmes to enhance the collaboration among Government, family
units, private sector, Non Government Organizations and community groups in
caring for older persons.
8. Encourage the establishment of Senior “Clubs” nationally.
In order to achieve the goals of the social welfare policy all relevant agencies will work together:
• To review periodically the social welfare programmes offered by Government
and other agencies in order to respond to the changing social, cultural and
economic conditions in an attempt to expand and strengthen and suggest ways of
• To ensure that there is adequate representation of older persons in all family
related programmes offered at National and Community levels.
• To develop a system to monitor and set standards for the establishment and
operation of homes for older persons, nursing homes and Day Care Centres.
Government will also encourage and support the efforts of Non-Government Organizations
(NGO’s) in establishing community-care and social service programmes.
V. INCOME SECURITY
The main goal is the promotion and support of reasonable and sufficient income for older
persons. The emphasis is on promoting the concept of “productive ageing” and ensuring full
participation by Older Persons.
To achieve this there should be the promotion of a:
1. Pension Plan which includes as far as possible universal coverage, indexation
portability, supervision and control supported by necessary legislation.
2. A system to facilitate convertibility.
National policy objectives will ensure that older persons:
1. form part of a Skills Bank;
2. are allowed to develop their talents and show their potential;
3. are allowed the opportunity to utilize their talents for benefit of their family, themselves
4. be allowed to receive financial assistance;
5. receive training opportunities and technical advice and guidance, for self-employment
6. suffer no gender or other form of discrimination in programmes designed for their
7. benefit from tax incentives given by the government to organization for their support
to elderly programmes and or organizations.
8. encourage service providers to offer discounts and benefits to senior citizens.
Government will enact legislation to synchronize the compulsory retirement age for workers and
the commencement of receipt of Social Security retirement benefits.
For Income Security Government, Non-Governmental Organizations and Private Sector should:
• Work closely with employers and trade unions.
• Organize fund foundations for rendering assistance to the senior citizens with no
income or to those with insufficient income or to those with no patrons.
• Determine an effective and flexible strategy for possible continuation employment of
older persons after their retirement age, in appropriate roles and positions according to
their aptitude and ability.
• Organize local clubs for the elderly in order to provide income-supplementing
• Encourage the young to start saving and investing early in their careers to provide for
their retirement years.
• Equip both young and old with financial techniques, in order to deal with inflation.
• Incorporate self-employed citizens into existing social security system.
The family is recognized as the fundamental unit of society linking the generations. The specific
goal is to provide family support mechanisms to give the older person a feeling of importance in
the family affairs while enabling the family to meet the needs of the older person.
The National policy aims to:
1. Develop and enhance skills whereby the older person may fulfill his or her role as
family leader, counselor, and caregiver.
2. Create a supportive environment when formulating socio-economic development
policies and programmes that will enable adult members of economically deprived
families and older persons who work in the home an opportunity to function to the
best of their abilities.
3. Support and develop the appropriate mechanisms to assist disadvantaged families
and elderly persons caring for children, dependent older persons, disabled
members, including those affected by HIV/AIDS and encourage both men and
women to share the responsibilities.
4. Give due recognition and encouragement for the valuable contribution that older
persons make to families and society, especially as volunteers and caregivers.
5. Develop a social support system, both formal and informal, with a view to
enhancing the ability of families to take care of older persons within the family.
6. Enhance, through appropriate mechanisms, the self-reliance of older persons, and
create conditions that promote quality of life and enable them to work and live
independently in their own community as long as possible or as desired.
7. Improve the situation of older persons, especially in cases where they lack
adequate family support, including rural Older Persons, working Older Persons,
those affected by natural or man-made disasters, and those who are, physically
or psychologically neglected, or abused.
8. Promote, enhance and support family care giving.
9. Establish support groups for families with special problems and special
care-giving needs, such as those having to deal with dementia and physical
To achieve the goals:
• Government will promote social policies encouraging the maintenance of family
solidarity among generations with all members of the family participating. The role
and contribution of the non-governmental organizations in strengthening the family as
a unit will be stressed at all levels.
• Protection and assistance will be given to the family so that it can continue to care and
provide for its older members.
• Older Persons will be recognized as an important age group in all poverty alleviation
policies and programmes.
• Training and retraining programmes will include components about ageing and older
persons, especially women.
• Tax exemption and other incentives will be encouraged to assist in the development of
community-based programmes for older persons undertaken by the private sector and
VII. HOUSING AND LIVING ENVIRONMENT
The goals are to:
1. Enable older persons to have access to adequate, affordable and accessible
2 . Encourage and support initiatives to assist older persons to continue living
in their own home as long a possible, and to promote alternative
accommodations where their home is no longer suitable or desired.
The Objectives are to:
1. Provide support for older persons so they may continue living in their own homes
as long as possible or to choose alternative accommodation if their homes are no
longer suitable or desired.
2. Monitor the national housing situation of older persons, and in collaboration with
the Housing and Planning Department, collate relevant statistics.
3. Ensure that older persons’ housing needs are incorporated into national housing
development plans including assistance for general repair.
4. Promote the need for alternative housing schemes for older persons appropriate to
community and national development plans.
5. Encourage the need for greater mobility for older persons at Work, at buildings
where social and health services are provided and on public transport by erecting
ramps and rails where necessary.
6. Liaise with organizations representing the disabled to ensure provision of access to
public buildings which can accommodate wheelchairs.
7. Promote community education on personal security in the home and community.
Ensure that accommodation for older persons is adequately provided for in the
National Disaster Preparedness Plan and in times of national disaster.
8. Under circumstances where an elderly person cannot be placed in family settings,
efforts will be made to establish institutions for the elderly.
To achieve the objectives Government and the private sector will work together to:
• Address the physical, psychological and social implication of providing shelter for
• Plan and introduce, through a national housing policy that also provides for public
financing and agreements with the private sector, housing of various types suitable
for the status and degree of self-sufficiency of the older person.
• Coordinate policies on housing with those concerned with community services
(social, health, cultural, leisure, communications) so as to secure, when possible,
an especially favorable position for housing older persons vis-à-vis dwelling for
the population at large.
• Encourage financial institutions to increase the age ceiling on the loan level on
money for building, for example, an extra room and/or adaptation of the older
The aim is to promote the legal framework to protect the rights of older persons.
The specific objectives are to promote:
1. Laws and regulations regarding retirement and post-retirement benefits and
2. The establishment of a system of universal social insurance for the elderly
3. The enforcement of the section of the Maintenance Law covering the
maintenance of parents and grandparents.
4. A revision of the existing Pension Legislation and its amendments, with
provision made for periodic review and revision of this legislation
5. Legislation to ensure equitable access for older persons to social welfare
6. A revision of the existing laws to ensure protection of the property rights of
7. The review of the law to extend the exemption of estate duty now applicable
to husband and wife only, to other older persons living together.
8. Develop a national definition of elderly for Belize.
9. Regularize the age for entitlements of benefits under pension schemes.
The Ministry of Human Development and the National Council on Ageing will work closely
with the Law Revision Commissioner and the Attorney General’s Office to establish a
mechanism to examine and adjust legislation which relates to older persons.
Policy needs to be informed by accurate and dependable data on the situation of regarding older
persons — their capabilities, potential and needs. Research is also required on ways of
integrating older persons into mainstream of economic, social and political life and its
implications for intergenerational cooperation and/or conflict.
The goal is to provide the data necessary for formulating, implementing, monitoring and
evaluating policies and programmes.
Specifically, research objectives will aim at identifying:
1. the implications of the ageing of the population;
2. the problems, needs and strengths of older persons in the society;
3. the skills, expertise, talents and knowledge of older persons which could be
beneficial in national development programmes;
4. the relative efficiency and effectiveness of alternative “age care” methods (e.g.,
commuinity care vs. care in a institution); and
5. the strategies for appropriate allocation of resources to service the needs of older
6. the priority needs through research and data collection.
To achieve the above-stated objectives:
• The Central Statistical Office will be provided with resources and required to
periodically collect, analyze and document relevant data on older persons.
• All the Age Care Organizations should collaborate with Central Statistical Office
and research oriented institutions in designing research projects and identifying
• The knowledge obtained should be utilized in formulating and fine-tuning the
Policy on Older Persons, developing appropriate programmes for older persons
and making sound decisions in resource allocation for the effective
implementation of these programmes.