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9 September 2022

Three dimensions of long-term care provision in middle-income countries:a a view across Africa, Latin America and Asia

Markus Kraus , Institute for Advanced Studies , Austria

Monika Riedel
Institute for Advanced Studies


Background: Many countries around the world, and particularly low- and middle-income countries, are experiencing a rapid process of population aging and thus an increase in long-term care (LTC) needs. This will pose enormous challenges to social security systems in these countries and has generated a debate about the best design to meet these needs, resulting in different designs of long-term care services/systems.

Objectives: This analysis aims to identify and assess gaps and deficits in the provision of LTC services in nine middle-income countries (MIC) across Africa (Algeria, Nigeria, South Africa), Latin America (Brazil, Colombia, Mexico) and Asia (China, India, Turkey). In this context, the principles of access for LTC services for elderly persons are assessed.

Methods: In order to investigate the principles of access for LTC services in the selected MIC, a new analytical framework was developed by modifying the universal health coverage monitoring framework into a LTC provision framework. For this purpose, the three original dimensions were partly redefined into: (1) legislation and entitlement, (2) conditions for access and (3) availability. Data were retrieved via desk research. The information was collected in three steps: First, relevant reports by international organizations and corresponding websites were searched for information on LTC services in the selected MIC. Second, a literature search using a fixed set of search terms was conducted for each MIC. Third, after synthesising the collected material, several country experts were asked to verify the collected information for each MIC.

The retrieved documents were hand-searched following the general approach of content analysis.

Results: With respect to dimension (1), the analysis shows the following: despite many countries aiming to implement welfare services for the elderly population, specific legislation on LTC is rare across the selected MIC. Hardly any country has established legal entitlements to specific LTC services. However, reforms concerning LTC services are beginning to prepare the ground for public provision of LTC services in some countries, e.g., Mexico and China.

Regarding dimension (2), it was found that LTC services are provided at most to persons in need of care lacking a family, emphasising the large importance of (younger) family members as carers in the selected MIC. The most common conditions for access to institutional care are a minimum age and little or no income. About dimension (3) it can be concluded that institutional care facilities are usually concentrated in urban or wealthy areas in the selected MIC. In many cases they exist in the capital region only, but even their capacities are limited. Home-based care is hardly available at all.

Conclusions: The selected MIC provide at most a very narrow set of LTC services which is too piecemeal to be considered an LTC system. Especially, the lack of available LTC capacities will pose several challenges for MIC and their population. The fast increase of care needs in MIC demands immediate and comprehensive development of LTC systems and creation of LTC service capacities.


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