On the 2nd of June, the United Nations Economic and Social Council for West Asia (ESCWA) published a most welcome report setting clear steps for building forward better for older persons in the Arab Region. The MENARAH network lead, Professor Shereen Hussein, has worked closely with the ESCWA team to produce the report. Taking a collaborative and co-production approach, the team worked with stakeholders in three countries in the region (Syria, Egypt and the Kingdom of Saudi Arabia) to develop viable policy and practice recommendations that ensure the dignity and wellbeing of older people in the region. Within the structure of the care ecosystem, the analysis and presentation of findings highlight the crucial role different societal groups play in addressing older people’s priorities and needs. The care ecosystem acknowledges the importance of a strong policy direction while mobilising and harnessing the community and individual efforts. The report focuses, in particular, on two strands of such structure: Social protection and the long-term care economy.

It is well-known that the Arab region is at the cusp of a significant demographic transition occurring considerably fast. On average, the whole region will complete its ageing transition within 36 years, where the percentage of people aged 65 or more will constitute at least 14 per cent of the population in each country in the region. Such change carries opportunities if met with well-prepared policies and practices and far-reaching economic and social implications. However, this is happening against a situation where, despite progress, only 38 per cent of people above the retirement age were receiving a pension in 2020. This level of coverage is significantly below the world average of 78 per cent. On a good note, basic health care coverage across the Arab countries has seen considerable progress, yet such coverage is far from universal. The evidence shows that up to 70 per cent of older people are not covered by health insurance in some countries. These dynamics increase the vulnerability of older people and the reliance on informal networks, especially families, for financial and practical support.

Women in the family usually provide long-term care (LTC). However, with increased urbanisation, social change and dynamics coupled with increased demand for LTC, such support does not appear viable or sustained. The report initiates a vital dialogue about developing LTC markets and economies in the region. Thinking beyond the medical needs of a person and considering the importance of social support to ensure independent and meaningful lives, the LTC market has a pivotal role to play. Furthermore, with high female unemployment rates, developing a range of well-structured LTC services will generate new labour participation opportunities for different segments of the population. The latter will generate fiscal incomes through increasing system contributions and reducing the reliance on social welfare benefits. The experiences of the three case study countries provide clear examples of an emerging LTC market despite the continued importance of the family in aged care.

The report also provides a novel analysis of the fiscal implications of ageing and provides, for the first time, estimates of LTC cost as a percentage of GDP in the three case study countries. The modelling of LTC costs elaborates on previous work conducted by MENARAH core members Mohamed Ismail and Shereen Hussein to estimate the LTC cost in Turkey. The current estimates appear modest compared to those observed in OECD countries; however, they reflect a swiftly shifting picture with expected higher costs in the coming few decades. According to these estimates, in 2019, current LTC spending by the state should have been around $320K, $15M, and $442M per annum each for the Syrian Arab Republic, Egypt and Saudi Arabia to have met the LTC demand. These figures are above any spending on social protection schemes. However, with no data on state spending specific to LTC, it isn’t easy to assess the level of current spending. Furthermore, these figures are expected to change dramatically year on year as countries progress through their ageing transitions. Improving the collection, access and analysis of data on all aspects of ageing beyond national indicators is an area of paramount importance, which Mohamed Ismail has recently discussed in further detail.

The COVID19 pandemic has exasperated the effect of inadequate care ecosystems on older people, from increased rates of mortality and co-morbidity to high levels of social isolation and loneliness to loss of cognitive abilities and onset of dementia. The magnitude of the effect was tremendous, especially on already vulnerable groups of older people. These adverse effects were also pronounced in the availability and accessibility of LTC support, with disruption to both formal services and informal support with limited access to extended families and communities.

The publication of this critical report and the current review and appraisal of the MIPPA provide a catalyst for countries to accelerate their policy and practical responses to ageing while capitalising on their resources, especially the youth bulges. Such response requires acting in multiple directions from collecting and utilising comprehensive data and research, adopting a life cycle approach, building meaningful partnerships with non-governmental organisations and private investors who can provide adequate LTC services and learning from the pandemic.

The report is accompanied by three policy briefs focusing on Ageing Trends, Social Protection and Long-Term Care.

Read the full report here.

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Professor of Health and Social Care Policy, the London School of Hygiene and Tropical Medicine, UK

Shereen Hussein is a Professor of Health and Social Care Policy at the Department of Health Services Research and Policy (HSRP) at the LSHTM. She is a Co-Director of the PRUComm policy research unit. She is also an Honorary Professor at the University of Kent and King’s College London in the UK and the University of Southern Queensland in Australia.

Shereen is a demographer with expertise in labour-migration, sociology and economics. Her primary research revolves around ageing, family dynamics, migration and long-term care. Shereen has previously worked with the United Nations, the Population Council, the World Bank, and the League of Arab States. Her current research focuses on ageing demographics, long term care demand and migration within the UK and Europe and the implications on policy and practice.

Shereen has conducted extensive research on population ageing and its impact on long term care and health policy and practices in the UK, internationally and in the Middle East and North Africa (MENA) region. She has contributed to recent United Nations’ policy response to ageing in the region through collaboration with UN-ESCWA and directly providing expert consultations to several countries in the region including Turkey, Oman and Egypt. Shereen leads many large research projects on ageing and long-term care in the UK and contributes to a large project addressing responses to dementia in developing countries STRiDE. Shereen is the founder and lead of the MENARAH network.