F E L I X A. O K O J I E

A G I N G IN S U B - S A H A R A N TOWARD A REDEFINITION

AFRICA:

OF NEEDS RESEARCH

AND POLICY DIRECTIONS ABSTRACT. This paper reviews the trends in population dynamics for the elderly in Sub-Saharan Africa, the changing role of the elderly in family and kinship systems, the place of the elderly in development efforts by national governments, and new directions for research and policy on aging. The paper concludes with suggestions for improving the quality of care given to the elderly. Attention is directed to issues of health, nutrition, housing, social welfare, employment, income and social security, and education and training for the elderly in the region. Emphasis is placed on fostering cooperation between the countries in the area.

Key Words: Sub-Saharan Africa, gerontology, demographic trends, research and policy agenda, social security.

AGING TRENDS AND IMPLICATIONS

It is argued in some circles that developing countries (and by extension Africa) are not faced yet with the problems caused by an aging population (ICSG 1983: 12; General Assembly 1982: 6). This argument is buttressed by a population structure that is growing younger because of falling mortality rates and continued relatively high rates of fertility. The decreasing age structure is further reflected in the fact that the proportion of the elderly in the populations of developing countries as a whole actually dropped between 1950 and 1975 from 7.1% to 6.0%, and the projected figures for 2000 are nearly the same as those estimated for 1950 (UN 1985: 24). It is believed, however, that many developing countries will soon experience substantial jumps in the absolute and relative numbers of elderly in their populations owing to declines in the mortality and fertility rates. Developing countries, as a whole, are expected to account for 61% of the world's elderly by the year 2000 and 72% by 2025 as the survivors of the very large present day cohorts of children and adolescents enter the ranks of the elderly (UN 1985: 23). Indeed population trends indicate that developing countries should start to anticipate substantial increases in the proportion of their populations over the age of 60 in the 21st century. This paper will detail demographic trends as they relate to the aging population in the Sub-Saharan regions of Africa. Sub-Saharan Africa includes all of the independent states of East Africa, Central Africa, Southern Africa and West Africa. The population structure will be analyzed relative to: increases in the absolute numbers of the elderly; Journal of Cross-Cultural Gerontology 3 (1988), 3--19. © 1988 by KluwerAcademic Publishers.

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F E L I X A. O K O J I E

growth in the elderly population as compared with growth in the population as a whole; the relative proportion of the elderly in the total population; changes in overall age structure; and the rural-urban distribution of the elderly. Attention will focus on the social and economic problems that the states in this region are likely to face as the proportion of the elderly in their populations rises. Policies designed to alleviate these difficulties will be suggested.

Population Dynamics in Africa According to United Nations projections for the period 1980--2025, Africa as a whole will experience one of the largest increases in absolute numbers of persons aged 60 and above of any world region. It is estimated that the older population will rise by a factor of 4.4, from 22.9 million in 1980 to 101.9 million in 2025, an increase larger than that projected for the total population (UN 1980: 64). However, as indicated in Table I, the TABLE I Estimated and projected crude death rates, crude birth rates and expectation of life at birth in Sub-Saharan Africa, 1980--1985, 1995--2000 and 2020--2025.

Eastern Africa Central Africa Southern Africa Western Africa Africa

Crudedeathratesper 1000 population

Crudebirthratesper 1000 population

Expectation o f l i ~ at birth~ears)

1980-- 1 9 9 5 - - 2 0 2 0 - 1985 2000 2025

1980--1995--2020-1985 2000 2025

1980-- 1 9 9 5 - - 2 0 2 0 - 1985 2000 2025

17.0 18.2 9.9 17.1 15.6

47.9 44.9 38.6 48.7 45.6

49.2 47.0 61.0 48.5 50.8

11.7 12.9 7.1 11.8 10.8

6.5 7.4 5.4 6.5 6.5

42.9 40.0 34.2 43.0 39.8

27.4 26.4 23.0 26.7 25.5

56.6 54.4 66.6 56.0 57.8

66.6 64.9 72.2 66.2 67.2

Source: Demographic Indicators of Countries: Estimates and Projections as Assessed in 1980, United Nations Publication, Sales No. E.82.XIII.5.

aging of the Sub-Saharan African population will not get under way until well after 2025. In fact, in the period between 1950 and 2000 the average age of the population in the region has been getting younger as continued high rates of fertility have been coupled with mortality rates that have been slowly declining since the mid-twentieth century (UN 1985: 99). Only after the year 2000 when fertility rates are projected to fall quite rapidly will the conditions be set for the aging of the region's population following an appropriate time lag. The current trend is reflected in a decline in the proportion of persons

A G I N G IN S U B - S A H A R A N A F R I C A

5

aged 60 and above in the total population from 5.5% in 1950 to a projected low of 5.0% in 2000. Even by the year 2025, this proportion is only expected to rise to about 6.6%. Long term projections suggest that it will not be until approximately 2075 that declines in fertility occurring earlier in the century will bring the proportion of the 60 and above age group to 16% -- a number comparable to what is found in many developed regions today (UN 1985: 99).

Increase in Absolute Numbers of the Elderly The rapid increase in the number of persons aged 60 and above projected for the 1980--2025 period are shown in Table II. For the African region as a whole, the total number of elderly will double from 22.9 million persons in 1980 to an estimated 42.7 million in 2000, with a further dramatic increase to 101.9 million projected by the year 2025. For the Sub-Saharan region in particular, the figures are 17.1 million in 1980, 31.8 million in 2000, and 74.8 million by 2025. The most rapid growth is TABLE II Estimated and projected population of all ages and population aged 60 and over, for SubSaharan Africa, 1980, 2000 and 2025. A. Total population (in millions)

B. Population 60 years and over (in millions)

1980

2000

2025

1980

2000

2025

Sub-Saharan Africa

360,964

666,726

1,245,786

17,173

31,809

74,799

Eastern Africa

133,964

250,029

477,919

6,320

11,495

27,215

Central Africa

53,093

91,445

162,170

2,756

4,783

10,631

Southern Africa

32,998

57,981

100,553

2,086

3.680

8,124

Western Africa

141,372

267,271

505,144

6,011

Africa

469,982

852,885

1,541,702

22,934

11,851 42,726

28,829 101,962

Percentage increase between 2000 and 2025 for the regions of Sub-Saharan Africa Population 60 yrs and over Eastern Africa

258

330

Central Africa

205

285

Southern Africa

205

289

Western Africa

257

380

Source: Demographic Indicator of Countries: Estimates and Projections as Assessed in 1980. United Nations Publications, Sales No. E.82.XIII.5.

6

FELIX A. OKOJIE

expected in West Africa where the older population is projected to increase by a factor of nearly 5 between 1980 and 2025. Within West Africa, the Ivory Coast's elderly population is expected to increase by a factor of 6.2, Liberia's by a factor of 5.4 and Cape Verde's by a factor of 5.3 during the same period. Absolute increases in the numbers of individuals aged 60 and above in other regions of Africa are also expected to be substantial: East Africa's elderly population is projected to increase by 82% between 1980 and 2000 and by a further 137% between 2000 and 2025. Similarly, Central Africa's older population is expected to grow by 74% by the turn of the century. The magnitude and pattern of growth is predicted to be similar in Southern Africa, with an increase of 76% projected for the period between 1980 and 2000 and an even more rapid increase anticipated during the following period (UN 1985: 102). The main reason for the steady increase in the numbers of elderly persons in Sub-Saharan Africa is the fact that the cohorts of children who will become the elderly population during the next 45 years have been successively larger. This is a result of the high fertility rates of recent decades as well as rising average life expectancy rates, especially for the young but affecting older age groups as well. The policy implications of the rapid numerical growth of the elderly population in Sub-Saharan Africa during the period 1980--2025 becomes clearer if one considers that this group will increase more rapidly than the population as a whole. Table II illustrates the following patterns for the region: (a) in East Africa, the total population will grow by 258% between 1980 and 2025, while the populated aged 60 and above will increase by 330%; (b) in Central Africa, the total population will increase by 205%, compared to a 285% rise for the populated aged 60 and above; (c) in Southern Africa, the percentage increase for the whole population is 205% and for the elderly component 289% and (d) in West Africa, demographic projections show a total population increase of 257% and an increase in the population aged 60 and above totalling 380% (UN 1985: 105). In addition, the numbers of the very old will grow at an especially fast rate. Between 1980 and 2025, the number of octogenarians will increase by 543% in East Africa, 475% in Central Africa, 410% in Southern Africa, and 670% in West Africa. Corresponding percentage increases for the elderly aged 75 and above are 434%, 385%, 342% and 526% respectively. Nigeria and the United Republic of Tanzania in particular will experience very large increases in the populated aged 75 and above (UN 1985: 105).

Relative Proportion of the Elderly in the Total Population In spite of the considerable numerical increase in the elderly population

A G I N G IN S U B - S A H A R A N

AFRICA

7

projected for the next 45 years, the United Nations average growth rate projections indicate that the dynamics of population growth in SubSaharan Africa will not produce much change in the proportion of the elderly in the general population. Between 1980 and 2025, the percentage of the population aged 60 and above is estimated to shift only from about 4.9% to 6.6% (UN 1985: 105). The explanation is to be found in the region's continuing relatively high fertility rates. Although declines in the birth rate may be discerned from the 1960s onward, the most substantial declines are not projected to occur until after 2000. This relatively late reduction in the birth rate will have the initial effect of increasing the proportion of the adult population aged 15--59 after the turn of the century. Because of the necessary time lag before declines in fertility are reflected in the population age structure, the relative proportion of the elderly will, in most cases, only manifest significant increases after 2025. However, this pattern is not homogeneous throughout the whole region. In some countries, the birth rate is projected to fall quite rapidly in conjunction with socioeconomic development and the proportion of the elderly will reach quite high levels by 2025 (Conde 1971: 18; UN 1985: 106). In East Africa, for example, 19.6% of the population of Reunion and 16.8% of the population of Mauritius may be 60 or above by the year 2025.

Changes in the Overall Age Structure An examination of the relative size of other age groups over time indicates that declines in the fertility rate will have an impact on the area's age structure only after the year 2000. As may be seen in Table III, the proportion of Africa's total population aged 0--14 will remain almost constant at approximately 44% between 1980 and 2000. By 2025, however, the proportion of individuals in this age group is projected to drop to 34%. Concurrently, the population of working age (15--59) will account for almost one half of the total population between 1980 and 2000, but will jump to 59% by 2025. Though there is some regional variation, the pattern of decline in the proportion of children and of substantial increase in the relative size of the population of working age between 2000 and 2025 is typical throughout the area. 1

The Rural-Urban Distribution of the Elderly Apart from the large numerical increase in older persons, one distinguishing feature of the aging situation in Sub-Saharan Africa is that the older segment of the population will remain primarily rural in the coming decades. Recent projections indicate that approximately 64% of the elderly will live in areas defined as rural in the year 2000, compared with

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F E L I X A. OKOJIE

TABLE III Estimated and projected population for the main funtional age groups of total population in Sub-Saharan Africa, 1980, 2000, and 2025 (Percentage of total population) 1980

2000

2025

0--14 15--59 60 and over

0--14 15--59 60 and over

0--14 15--59 60 and over

Eastern Africa

45.8

49.4

4.7

46.0

49.4

4.6

36.3

58.0

5.7

CentralAfrica

43.5

51.3

5.2

43.4

51.4

5.2

34.7

58.7

6.6

Southern Africa

4 2 . 1 51.6

6.3

41.0

52.6

6.4

32.1

59.8

8.1

Western Africa

46.4

49.3

4.3

4671 49.5

4.4

35.7

58.6

5.7

Africa

44.9

50.2

4.9

43.9

5.0

34.1

59.2

6.6

51.1

Note: Sub-Saharan Africa include all regions of East, South, Middle and West Africa. East Africa: Burundi, Comoros, Djibouti, Ethiopia, Kenya, Madagascar, Matawi, Mauritius, Mozambique, Reunion, Rwanda, Seychelles, Somalia, Tanzania, Uganda, Zambia, The Zimbabwe. Southern Africa: Botswana, Lesotho, Namibia, South Africa, Swaziland. Central Africa: Angola, Cameroon, Central African Republic, Chad, Congo, Equational Guinea, Gabon, Sao Tome and Principe, Zaira. Western Africa: Benin, Cape Verde, Gambia, Ghana, Ghinea, Ivory Coast, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Saint Helena, Senegal, Sierra-Leone, Togo, Upper Volta.

58% of the total population (UN 1980: 15). This may be contrasted with the situation in 1980 when 76.3% of the elderly and 71% of the total population lived in the countryside. 2 The data in Table IV clearly indicate great disparities in the rural-urban distribution of the elderly in the region over the next two decades. East, West, and Central Africa showed the highest percentages of their elderly population living in rural areas in 1980 (90%, 83%, and 82% respectively), and this trend continues to the year 2000 when projections indicate that 81%, 71% and 67% of their populations aged 60 and above will be situated in the countryside (UN 1980: 22). Studies have consistently shown a pattern of age-selective migration from the rural areas of Sub-Saharan Africa as predominantly young, fit and better educated males leave to look for employment in the cities. These analyses suggest that the rural elderly are losing a major source of economic and social support (Byerlee 1974: 543--566). In the future, when fertility rates decline more rapidly and new cohorts of the young are no longer large enough to compensate for population losses through

19,0

44.8

17.2

10.9

23.8

9.9

1035 74

596

9.8

934 88

497

5.3

523 75

301

23.6

622 84

338

12.8

3114 80

1732

38.3

25.2

352

40.7

34.9

2300

525

969

2572

6366

44.5

30.1

45.8

49.8

41.4

2674

627

1263

3127

7691

82.8

55.2

81.0

90.2

76.3

4974 86

1152 84

2232 77

5699 82

15057 83

12.8

25.8

14.5

8.8

16.0

1517

949

691

1009

4166

16.3

29.7

18.3

9.8

19.2

1935

1093

876

1130

5034

29.1

55.5

32.8

18.6

35.2

3452 78

2042 86

1567 79

2139 89

9200 83

33.7

20.6

30.2

37.0

29.9

3991

758

1443

4252

Note: Figures may not add to totals because of rounding. " Number of men per 100 women of the same age group.

37.2

23.9

37.0

44.4

34.8

4409

881

1771

5105

10444 12166

Sex ratio

82

70.9

44.5

67.2

81.4

64.8

8400 91

1639 86

32•4

9357 83

22610 86

Sex ratio Males Females Both Sex ratio Mares Females Both

Rural population

Source: 'Age and Sex Structure of Urban and Rural Populations, 1970--2000: The 1980 Assessment.' (ESA/P/WP.81)

Sub-Saharan 10.8 Africa Eastern 4.5 Africa Central 8.1 Africa Southern 20.9 Africa Western 7.3 Africa

B. Percentage

Sub-Saharan 1382 Africa Eastern 284 Africa Central 222 Africa Southern 437 Africa Western 439 Africa

A. Thousands

Males Females Both Sex ratio Males Females Both

2000 Urban population

Rural population

1980

Urban population

TABLE IV Estimated andprojected urban/rural distribution and sex ratios a for population aged 60 years and over in Sub-Saharan Africa 1980 and 2000.

7z

), Z

7~

),

Z

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F E L I X A. O K O J I E

migration, the problem of age dependency in rural Africa may become even more acute. The available data also suggest that women are not more markedly over-represented among the rural elderly than among the urban elderly. As indicated in Table IV, the average sex ratio (defined as the number of men per 100 women of the same age group) is quite high in both rural and urban areas. A sex ratio of 80 was reported for the urban elderly and 83 for the rural elderly in 1980. Projections for the year 2000 show a ratio of 83 for the urban elderly and 86 for the rural elderly. A similar homogeneity can be observed at the regional level with the exception of West Africa where 1980 sex ratios of 74 and 86 are reported for the elderly population in the urban and rural areas respectively. Similarly, ratios of 78 and 91 are projected for these groups in the year 2000. One major conclusion can be drawn from these statistics. Although the percentage of the aging living in the rural areas is likely to decline over the next several decades, health and social services still must be targeted towards a primarily rural population. This necessity results from the weak service networks existing in the rural areas for the elderly population who will still constitute more than 60% of the population aged 60 and above in Sub-Saharan Africa by the turn of the century.

Implications of Aging Trends in Sub-Saharan Africa Demographic changes in the age structure projected for Sub-Saharan Africa suggest the onset of a range of socio-economic problems that will require attention from the regimes in the region. With regard to the aging population, two issues are of particular importance: a weakening of traditional family and community support systems for the elderly; and age selective migration from rural areas. In the first place, state-based social security systems are not well developed in most countries in the region. Indeed, the extended family and the community still constitute the primary sources of care for the elderly. The projected increase in the numbers of the elderly however suggest that unless family and community traditions of mutual aid can be strengthened, a vast service infrastructure will be required to replace and expand previous informal care-giving patterns. Unfortunately, given the current scarcity of economic resources in the area and the competing demands from a large population of young people, it will be difficult to develop a social security system that provides full coverage for the population. A possible solution to the problem is to strengthen the resources of traditional care-givers rather than to create new institutions. Such a family-oriented policy would include: channelling financial support to families caring for elderly relatives; and implementation of public education programs. Pressure on traditional support networks is exacerbated by the migra-

A G I N G IN S U B - S A H A R A N A F R I C A

11

tion of young people from rural communities to urban areas in search of employment and education. The result is a loss to the agricultural community of a key source of labor and social support for the elderly. Additionally, the available evidence provided by the Food and Agricultural Organization (FAO) indicates that even though older farmers in developing countries continue working as long as they are able, they tend to farm progressively smaller amounts of land. Further, older farmers may be less receptive to the adoption of more efficient new techniques, a factor leading to depressed productivity in the agricultural sector. At the operational level, rural development has been suggested as a policy area with key implications for averting the negative socioeconomic consequences of the current migration trends in the region. By providing employment opportunities, technological support and a service infrastructure, it acts as an inducement for young people to remain in or return to the rural areas (UN 1985:110). For example, Guinea has set up model farms (fermes agropastorale d'arrondisement) in diverse regions of the country. While their initial goal has been to attract graduates in agriculture and zoology, it is clear that they will ultimately provide work for large numbers of young people in the rural areas. A further challenge for policy-makers in Sub-Saharan Africa is to devise programs to facilitate the continued activity of older workers, thereby increasing the productive potential of the economy as a whole. In this regard, regional policies designed to improve production in the rural areas should work to stimulate investment, provide land reform, create a necessary infrastructure and introduce appropriate technologies and basic services.

The Socioeconomic Situation of the Elderly in Sub-Saharan Africa: Problems and Solutions As the population aged 60 and above in Sub-Saharan Africa quadruples during the period 1980--2025, the individual needs of the elderly will also increase for family support, health care and adequate nutrition, housing, social welfare services, employment income security and educational and other training opportunities. To evaluate the problems faced by this growing number of older people, it is first necessary to understand the ways in which the social and economic needs of this population are met in traditional African society. After describing traditional provisions for care of the elderly, this section will focus on the dilemmas facing policy-makers and suggest possible solutions.

Social Security Economic security for the elderly in Sub-Saharan Africa has traditionally been decided according to custom. African societies were organized as

12

F E L I X A. O K O J I E

gerontocracies where the power, authority and life long security enjoyed by the old was the norm rather than the exception (Rubenstein and Johnson 1982: 60). Individuals learned their responsibilities towards their families at a very early age. Parental obligations included providing their growing children with the necessities of life as well as a moral code of conduct, and education. The children in turn were expected to reciprocate by ensuring security for their parents in their aging years. An extended family system provided additional support for elderly people (consensus of country papers presented at the African Regional Intergovernmental Meeting on Aging, Addis Ababa, 1--5 March 1982). According to Bergener (1981), the extended family is a three or four generation unit held together by kinship. In this context, the elderly in Sub-Saharan Africa enjoy special status, surrounded by their numerous children and grandchildren. It is their responsibility to supply the necessary care as their aging relative's strength and self reliance diminishes. The elderly are well-cared for and they generally provide social continuity by instilling in the youth respect for the norms and values of their societies. Jack (1983) expressed the importance of the extended family support system most vividly, declaring: • . . the extended family in which the status of the aging takes support continues to be the basis of African society. It must not be left to disintegrate, instead integration of the elderly into the mainstream must have as its major goal the maintenance of family unity.

However contemporary African gerontologists contend that the family, by itself, cannot meet all the needs of the aging population (Sidky 1985; Hampson 1983; Apt. 1985). With rising population density, industrialization, the western nuclear family syndrome and urbanization also arise a multitude of social problems directly affecting the aging population in Sub-Saharan Africa. As previously noted, educated youths and ablebodied heads of households are flocking into urban areas looking for better jobs, better schools for their children, better health care and better social amenities. This rural-urban drift has left the most vulnerable (e.g. the women, children, and especially the elderly) to fend for themselves. The problem is much worse for the elderly because they are often an invisible population of the poor, hidden by the myth of the protective extended family. In Sub-Saharan Africa, we delude ourselves that the extended family still provides adequate care for our aging population. The reality is quite a different matter. Thus the states in the region must find a way to fill in the gaps and meet the basic needs of their elderly citizens. Needed programs include comprehensive social security and benefits connected with retirement, death, disability and health insurance. While several countries in the region have adopted legislation covering income security benefits, coverage is thus far

AGING IN SUB-SAHARAN AFRICA

13

confined almost exclusively to wage-earners and urban dwellers. Indeed, less than 10% of the population in Sub-Saharan Africa is covered by any form of social security. Of those covered, fewer than 3% actually receive benefits because of mismanagement of the funds or inadequate mechanisms for disbursement. Thus the rural agrarian population, which includes the great majority of elderly persons, remain outside the formal social security system. There is no doubt that the ideal would be the establishment of comprehensive social security schemes covering all the older people in the region with particular focus on the rural population. However, in light of the financial implications of broad-scale income security programs and the decreasing ability of traditional social networks to continue to provide support, income security policies should focus on real income security, rather than simply monetary income security. In this connection, measures should be taken to help older people support themselves through introduction of labor-saving agricultural tools, rural cooperatives and smallscale village industries.

Retirement and Employment Opportunities As the previous section suggests, the absence of a stable social security system makes retirement a risky situation for the aging worker. At retirement, the elderly person is expected to shift the burden of fiscal responsibilities onto the immediate as well as the extended family. The individual is supposed to be active in community affairs and enjoy respect and veneration from the whole clan. Thus mandatory retirement policies have often been justified on the basis of providing jobs for the overwhelming number of unemployed youths in the region (National Report submitted to the World Assembly on Aging, July-August 1982). Governments in Africa often rationalize that older workers must give way to this growing army of unemployed youth. However recent demographic trends, as discussed above, suggest that mandatory retirement will pose serious problems in Sub-Saharan Africa in this decade and beyond if attention is not given to this issue now (Olusanya 1982: 12; Myers 1982: 14). For example, retirement benefits, often paid in one lump sum, are inadequate for the retiree to live on throughout his or her remaining years. This is especially true when the money is not tied to the cost of living index. While retirement benefits must be improved, efforts should be made to ensure the continued participation of the elderly in productive work. In this context, cooperatives and production centers for handicrafts, managed by the elderly themselves, could be organized. Promotion of self-employment opportunities for the elderly would foster independence and selfreliance as well as increasing the productive capacity of the economy in general.

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FELIX A. OKOJIE

Social Welfare The absence of social security and retirement benefits are indicative of an overall need for improved social welfare programs in the region. Rather than establishing state-run welfare systems on a large scale, policy makers should focus social welfare services at the community level within the family system. Given the central role of the family in providing social protection for the elderly and the great cost involved in the creation of large-scale alternative support mechanisms, states should work to strengthen family resources and motivation for continuing their care-giving functions. In this connection, the important role being played by spouses and children in caring for the elderly should be recognized. One way to achieve this goal would be to pay older people's allowances to families with incomes below certain levels that maintain elderly members or grant income tax relief to such families. The preference for community and home aid can also be reflected in an emphasis on home visitations and counselling services, household help, community casework and expanded social and cultural activities within local communities. As one means of strengthening the community base of support for the elderly, social welfare assistance can be channeled through existing local level organizations such as community self-help and voluntary groups. The resources of these organizations should be augmented to enable them to continue their traditional social welfare work with the elderly. In view of the difficulties involved in setting up a comprehensive social security program, initial emphasis should be placed on providing social welfare aid on a case-by-case basis. For example, it would be more meaningful to strengthen social welfare programs to help elderly persons with marginal incomes or those with long-term ailments. Finally, social welfare services should not be designed to function in isolation from other community services. Rather, they should be integrated and coordinated at the community level to reach their target population.

Education and Training Attempts to formulate programs that ensure an economically and politically active role for the aging population are hampered by the fact that 90% of the population aged 60 and above in Sub-Saharan Africa is illiterate. Women in this age group are estimated to be 97% illiterate (UN 1985: 130). As a result, the elderly do not possess the skills necessary to obtain jobs in the modernizing urban environment. The educational imbalance is even more severe in the countryside where the older person's traditional authority regarding the selection of crops, cattle breeding, and land distribution is questioned by a younger generation, eager to implement technological innovations. The elderly are perceived as hindering mechanization and progress.

AGING IN SUB-SAHARAN AFRICA

15

In order for the elderly to participate and receive the benefits from political, social and economic development, literacy training through adult education should be an urgent priority for developing nations. In addition to basic literacy and educational programs, vocational training for the elderly is a necessity for several reasons: to upgrade the technical skills of older workers (including farmers); and to equip them to undertake new occupations later in life. Other aims should include informing the elderly of the availability of social services and the procedures to be used to obtain these benefits. Classes should provide information on proper nutrition. Further, preretirement counselling should be made available for those workers employed in the formal sector. Finally, the scope of educational activities in the field of aging should extend beyond the elderly to the persons with whom they live and who care for them. In this larger context, the central educational objectives should be to eliminate negative stereotypes about aging, to promote intergenerational contact and to make the general public and professional caregivers aware of the specific problems of older persons as well as their productive potential. In this context, Morocco (World Assembly on Aging, 1982), has established the Moroccan National Commission on Aging to promote the organization of colloquia on such subjects as research methods in gerontology and forms of care most appropriate for older persons. In Nigeria, the government aims at establishing geriatric units in teaching hospitals for in-service training of medical staff and to offer courses in geriatric medicine in medical schools throughout the country (World Assembly on Aging 1982: 5). Similarly, it is imperative that a national commission on aging be established in all the countries in the region not only to study the needs of older persons but also to promote programs that will encourage the elderly to participate in decision-making relating to policies which will affect their own mode of living, environment and welfare. Health Care

The issue of health care is critical in a region where it is estimated that the aging population will constitute 10% of the general population by the year 2025 (World Population Prospects 1982: 146). The older population inevitably will be consumers of basic health care services. Yet little data is currently available on the health status of older persons in Sub-Saharan Africa and there is an urgent need for systematic research and epidemiological studies of this population. Indeed, collection of medical, demographic and socio-economic information on the elderly is necessary for both short run and long-range planning efforts. For example, national reports for Ethiopia, Botswana, Rwanda, Senegal, Mozambique and Lesotho indicate that studies on pathologies and health necessities of the aged in these nations are practically nonexistent?

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F E L I X A. O K O J I E

Currently, the elderly population in Sub-Saharan Africa is still highly dependent on traditional practitioners. However an increasing number of individuals in this age cohort will be dependent upon a decreasing number of traditional healers. Increased preventive and curative health care programs will have to be given policy consideration before the shortage becomes acute. Given the problems associated with biological aging, the development of medical and social support for home health and long term care programs will contribute to the effectiveness of traditional ways of caring for the elderly. In this connection, traditional healers can be initiated into basic modern techniques through health education and nutrition programs. In sum, the primary concern of policy makers in the health sphere should be the collection of information on the health needs of the elderly and the provision of an effective network of primary health care at the community level. Emphasis should also be placed on preventive health measures, health education campaigns, removal of financial barriers to health service utilization, and the training of primary and specialized health workers in principles of geriatric medicine and the precepts of traditional medicine. Housing and the Environment

Housing shortages in Sub-Saharan Africa affect the elderly as well as the general population. The serious deficiencies of housing units in the region require construction of an overall plan for improving housing in both rural and urban areas. One of the main policy concerns should be to provide a public service infrastructure and to strengthen the resources available to families sheltering older relatives. Specific strategies should include: halting the proliferation of uncontrolled settlements; construction of larger housing units with cheaper materials in urban areas; upgrading rural housing in the context of self-help programs and rural development projects; expansion of public housing in general; provision of subsidies and other financial assistance to households accommodating older relatives; and the promotion of the mobility of older persons within their communities through improved access to transportation facilities. Research

In the developed as well as the developing countries of the world, scientific and technological revolutions have given rise to the knowledge and information explosion of the twentieth century. Researchers and governments in Sub-Saharan Africa can maximize the use of this technology to study different aspects of the aging process. It is imperative that international private and public organizations make funds available for

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this purpose. In this regard, a small United Nations trust fund for aging has been used extensively to help Third World countries initiate or expand basic research efforts. Ghana, for example, has been given a grant to study "Research into the Impact of Social Change on Aging," and Malawi is conducting an analysis of the impact of aging on rural development (UN 1985: 18). To ensure an integrated approach to the problem of aging, inter-agency cooperation between national governments can be used for monitoring and evaluation purposes as well as to coordinate all activities relative to aging. In this connection, a Sub-Saharan aging data bank should be established to facilitate the retrieval and dissemination of information on aging in the region. Conclusion

In formulating policies and undertaking research in the sphere of aging studies, African decision-makers must work within several parameters of tradition and social change. Since the family and community traditionally have constituted a strong social support network for the elderly while new government-based social services entail high social and economic costs, a primary focus should be on strengthening existing family and community resources. At the same time, policy-makers and researchers should take cognizance of the extent to which such factors as migration, urbanization and industrialization have weakened traditional social structures and the bonds of family solidarity. Basically, programs should emphasize both coordinated research efforts to determine the magnitude of unmet needs and the provision of necessary services at the community level, avoiding the removal of older persons from their familiar environments. The population trends for the elderly in Sub-Saharan Africa are a manifestation of the social destiny of today and future years. Yet, like so many destinies, they can be influences, improved, planned and prepared for. It is in the light of this challenge and the tremendous potential of these trends as they impact on health service utilization, research, policy directions and the needs of the elderly that this paper is conceived. The goal is to sensitize national governments and public opinion to the plight of the elderly and to ensure that the aging population of future years will be able to survive, contribute according to their capacities and be served according to their needs and the resources of their society. The worst disservice that could be done to the elderly people in Sub-Saharan Africa would be to perpetuate the myth that old age is a cut-off point in a person's life that implies a radical change in lifestyle, needs and behavior. There are well-intentioned and humanitarian impulses underlying this way of thinking but it cannot serve as an inspiration for policy. Rather it should be balanced against the recognition that aging is a subjective concept both for the individual and with regard to the attitudes

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FELIX A. OKOJIE

a n d b e h a v i o r of society. T h e r e f o r e , a n integrated a p p r o a c h to research efforts a n d policy directions for the elderly m u s t be i m p l e m e n t e d throughout the region. NOTES As the proportion of the population of working age increases, the total dependency rate (defined as the ratio of persons aged 0--14 and 60 and above to those aged 15--59 will in fact improve. For example, the total demographic dependency rate for the continent is projected to decline from 984 in 1975 to 688 in 2025, while the aged dependency rate (defined as the ratio of those aged 60 and above to the population aged 15--59) will increase only slightlyfrom 97 to 112 (UN 1985: 107). 2 Owing to the difficulty of defining rural and urban areas and of predicting future urbanization and migration trends, the figures given in this section are to be regarded as only indicative. 3 Ethiopia. 'Country Paper on Aging Persons in Ethiopia', paper presented by the Minority of Labour and Social Affairs at the African Regional Intergovernmental Meeting on Aging, Addis Ababa, 1--5 March 1982. Botswana. 'The General Situation and Issues Relating to Aging and the Aged in Botswana', paper presented at the African Regional Intergovernmental Meeting on Aging, Addis Ababa, 1--5 March 1982. Senegal. Country paper presented on same occasion. Lesotho. Country paper presented on same occasion. Rwanda, paper presented at the International Center of Social Gerontology Working Group on Aging and Development in Africa ('La Situation des personnes agees au Rwanda.') Versailles, France, 4--6 May 1983. R E F E R E N C E S CITED A.S.I.A. 1985 Aging Populations in Developing Nations: A Strategy for Development Support. Washington D.C.: A.S.I.A. Apt, N. 1985 Changing Family Patterns and the Impact of Aging in Africa. In Graying of Nations II. US Senate Special Committee on Aging. New York, July 12. Bergener, M. 1981 Aging in the Eighties and Beyond. p. 384. New York: Spring Publishing Company. Byerlee, D. 1974 Rural-Urban Migration in Africa: Theory, Policy, and Research Implications. InternationalMigration Review Pp. 543--566. Coude, J. 1971 The Demographic Transition as Applied to Tropical Africa. Paris: OECD. Flesch, J. 1985 African Gerontology. France: I.C.S.G., 4, November. Hampson, J. 1983 Old Age: A Study of Aging in Zimbabwe. Gerie, Zimbabwe: Mambo Press. I.C.S.G. 1983 Aging and Development in Africa: Conclusions of the Working Group. Versailles, France: May. Jack, P. 1983 Aging and Development in Africa: Conclusions of the Working Group. In The International Center of Social Gerontology Working Group on Aging. Versailles, France, 4--6 May. Myers, G. 1982 The Aging of Populations. In International Perspectives on Aging: Population and Policy Challenges. New York: United Nations Fund for Population Aging. National Federation of Senegalese Retired Persons Association (NFSRPA) 1983/84 'Rapport de Synthese du Seminaire National Sur les Problemes des Personnees Agees et Leur Participation au Development du Senegal...'. Aging InternationalVol. 10(4).

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Olusanya, P. 1982 Aspects Demographiques de la Population Vieillissante dans les Pays Africains. Paper presented at the Regional Intergovernmental Meeting on Aging. Addis Ababa: March, p. 8. Rubenstein, R., and P. Johnson 1982 Toward a Comparative Perspective on Filial Response to Aging Populations. In Aging and the Aged in the Third World. Part I. (Studies in Third World Societies). J. Sokolovsky, ed. Williamsburg: College of William and Mary. Sidky, A. R. 1985 The Role of the Elderly in Promoting Economic, Social, and Cultural Development. Paper presented at the International Congress of Gerontology Program for Developing Countries, July. United Nations 1985 Trust Fund Activities in Africa, 1983--1984. Bulletin on Aging Vol. X, No. 1. United Nations Department of International Economic and Social Affairs 1980 Demographic Indicators of Countries, Estimates and Projections as Assessed in 1980. U. N. Publications Sales No. E.82.XIII.5. United Nations Department of International Economic and Social Affairs 1984 Periodical on Aging. Vol. 1, No. 1. United Nations Department of International Economic and Social Affairs 1985 The World Aging Situation: Strategies and Policies. U. N. Publications Sales No. E.85.IV.5. United Nations Food and Agricultural Organization 1982 Aging Population and Rural Development. U. N. Document A/Conf. 113/8. February. United Nations Department of International Economic and Social Affairs 1982 World Population Prospects, Estimates and Projections as Assessed in 1982. U. N. Publications Sales No. E. 83.XIII.5.

Center on Health and Aging, Atlanta University, U.S.A.

Aging in sub-Saharan Africa: Toward a redefinition of needs research and policy directions.

This paper reviews the trends in population dynamics for the elderly in Sub-Saharan Africa, the changing role of the elderly in family and kinship sys...
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