There is an urgent need for Nigeria to commence action at all tiers of public administration toward comprehensive and coherent social policies and structures aimed at caring for the elderly
By Utiang P. Ugbe*
Social policy refers to the totality of rules, attitudes, and means by which a community responds to human needs of its members. Such needs may include security, nutrition, education, employment, health, inclusion, access to justice, and other aspects of a people’s general wellbeing. This article calls for urgent action toward a coherent and comprehensive public social policy on caring for the welfare of the elderly in Nigeria. Everyone who lives long enough becomes old, because aging is an equal-opportunity angel who visits every living person, without regard to race, ethnicity, nationality, religion, social or economic status, gender, or political alignment. It is, therefore, necessary for Nigerian policymakers to reflect dispassionately on the main message of this article without feeling criticized.
Being a social-commentary, this article is intended to float basic concepts for more in-depth technical conceptual work on the topic of elderly care in Nigeria. I have taken the liberty to cherry-pick my demographic data from open-access sources, and my analysis is limited to the aspects that I chose to emphasize upon. Competent policymakers know that good social policy planning requires the use of reliable demographic data, and any such plan can only be as realistic as the data used to formulate it. This is why one of the fundamentals for a useful social policy on caring for the elderly is the institutionalization and mainstreaming of systematic demographic data-collection and storage by all sectors and all tiers of public administration nationwide.
The age distribution of Nigeria’s population is quite interesting from the viewpoint of economic development planning. The data for 2021 shows the population at slightly above 206 million, out of which about 3% (or about 7 million) is 65 years old or older; about 8% (roughly 16 million) is aged 55 years old or older; about 53% (or 109 million) is aged 15 – 64 years old; and the median age is 18 years. My focus in this article is on the elderly cohort, defined as persons who are 65 years old or older. Scholars would describe Nigeria’s population distribution in graphical terms as being bell-shaped, unlike that of, say, Japan, which is currently mushroom-shaped.
Although Nigeria is hetero-cultural and there are many local differences in how the young are socialized, and the elderly cared for, there is historically a common practice whereby it is the responsibility of the progeny to care for the elderly. In most rural agricultural communities across the country, children, grandchildren, nephews, nieces, or other younger members of a nuclear or extended family, are expected to be responsible for caring for the elderly members of the family. Historically, this has been the cultural practice in any rural community across Nigeria.
So, what is new?
Well, we live in a new era. Nigeria is getting increasingly urbanized, even if very slowly, and the fabric of rural communal life, where the elderly folks are cared for through collective effort of the younger members of the extended family, is beginning to fade away. In urbanized communities, the convergence of large numbers of people of diverse ages, occupations, faiths, ethnicities, nationalities, and socioeconomic classes, has created major undeniable shifts in the social life obtainable. Every aspect of social relations (including how the elderly are cared for) in the urban settlements is dissimilar to what obtains in our rural agricultural communities.
In the 1940s and 1950s, most of the rural populations in Nigerian rural communities were self-employed in subsistent, smallholder, labour-intensive agriculture. “Unemployment” was relatively alien among able-bodied members of the community because almost everyone was a farmer or hunter-gatherer, or was identified with a specified socioeconomic role. In this context, there was little or no mobility of labour, and long-distance travels and relocations were relatively far less frequent. A German sociologist, Ferdidand Tonnies (1855 – 1936), characterized the social setting in a typical rural community – which he termed the gemeinschaft – as close-knit and socially strongly-bonded; anyone who is familiar with rural life in Nigeria would agree with Tonnies that people are more of one another’s keepers than in the urban centres. Tonnies further described social life in urban centres – which he termed the gesellschaft – as increasingly devoid of the strong social bonds of a close-knit rural community. In Nigeria’s urbanizing economy, concomitant occupational skills have pluralized beyond agriculture, with about 77% of the salaried workforce now in non-rural, non-agricultural sectors of the economy. To this category of people, the relative stability of the gemeinschaft is lost and replaced with some of the uncertainties of urban life: the risks of suddenly becoming unemployed, or of sudden displacement due to political instability, or any other unforeseen mishap common to urban life in Nigeria. We see here, clearly, the inverse relationship between urbanization and the potential or real vulnerabilities of the elderly, in the absence of public policy and requisite systemic structures to care for them.
Note that, historically, rural communities in Nigeria were self-governing and largely self-reliant, and the social responsibility for caring for the elderly rested with the young, able-bodied members of the extended family. In urban economies, it is the responsibility of the state to generate tax revenue from the people who are in the workforce (the cohort aged 15 – 64 years), and to prudently provide for various social care programmes, including the care of the elderly. In Nigeria, we are seeing rampant unemployment among population aged 15 – 64 years old – the very cohort that should be in the workforce and contributing the bulk of our collective tax revenue in order to enable public funding of social care for the elderly, among other responsibilities of the state. Not only is this unemployed cohort unable to financially support the elderly in their own families, they are continuing to depend on their elderly relatives who have long retired from the workforce, and on anyone known to them who is still fortunate to be employed.
How big is the task?
An important index to consider in developing a national policy for social care of the elderly is the elderly dependency index (EDI), also known as elderly dependency ratio (EDR), which is derived by dividing the defined elderly population (persons 65 years old or older) by the defined working population (persons 15 – 64 years old). Based on the data stated earlier in this article, the EDI for Nigeria as at 2021 is roughly 0.06 (or 6% if defined as EDR). This statistic can be an over-simplification of the reality or complexity involved, because it does not take into account the workforce participation rates by the different age groups. However, it is a generally very useful because it indicates to the policymaker or development planner the weight of the task to be accomplished. Overall, the higher the EDR, the bigger the number of the elderly to be cared for, relative to the cohort in the workforce. Or, the closer the EDI is to 1, the greater the enormity of the task to be accomplished.
As earlier mentioned, about 3% of Nigeria’s population is 65 years or older, while about 8% is 55 years old or older. These are relatively small numbers, because, as it is well known, the life expectancy in Nigeria in 2022 is only about 55 years (while it is 79 years in the USA, 82 years in the UK, and 85 years in Japan). Given Nigeria’s economic endowment and wealth, the public expenditure required to adequately care for the few elderly people in our midst is easily affordable. Someone might argue that Nigeria’s EDI is only 0.06, and therefore it is not a significant problem worth addressing. That would be a foolish argument, for it is more sensible for Nigeria to start small by caring for the few elderly people in our midst, and to build the expertise and grow the systemic structures as the EDI increases, than to wait until the EDI is very high, by which time it would be nearly impossible to start an entirely new system.
Countries whose population distribution is mushroom-shaped would indicate a higher life expectancy, and a higher proportion of the elderly relative to the total population; their public expenditure on a systematic geriatric care would be much higher. Yet, many advanced economies have, for countries, taken the responsibility to develop systematic geriatric care, and historically, such structures were fully state-funded, until the Reagan-Thatcher era during which some of the systems became privatized or devolved or hybridized in some countries. While some flaws in those hybridized systems was exposed in 2020 by the Covid-19 pandemic, the needed improvements can be made, and that is much better than having no system at all.
Many elderly people who potentially need social care in Nigeria today had diligently served the country for decades, and paid their dues to the system. The monthly pension of a typical civil servant or military retiree is insufficient for them to live on, and most of them have no medical insurance. Their progeny would, of course, care for these elderly ones as required by culture, but remember the high unemployment rate among the population cohort aged 15 – 64 years in Nigeria; in other words, most of those who should be caring for our elderly are financially indigent and dependent on the very elderly who should be getting care. Can we, in clear conscience, abandon these elderly persons without social care? Most advanced economies have social policy and structures for caring for the elderly,
There is an urgent need for Nigeria to commence action at all tiers of public administration (i.e., local, state and federal), toward comprehensive and coherent social policies and structures aimed at caring for the elderly.
What are the needs and challenges of the elderly in Nigeria?
Needs of the elderly in Nigeria include: (i) social activities to enable them overcome loneliness; (ii) appropriate and adequate physical exercise to enable them avoid a sedentariness; (iii) close and careful attention to their mental health; (iv) good nutrition; (v) a safe and secure place to live; (vi) readily-available and appropriate healthcare or medical care, including health education; and (vii) appropriate occupational involvement, suited to the individual, to give them a sense of continued relevance and usefulness to the society.
Loneliness, in particular, is a major and growing challenge among the elderly in Nigeria, and it can be brutal to their mental and physical wellbeing. Let us remember that the elderly, too, are people like us who need a social life. They need opportunities to interact and socialize with other human beings. In urban settings, many elderly people, having retired from the workforce, live as empty nesters as the children are grown up and gone in pursuit of careers, perhaps married and occupied with their own nuclear families in a different city or country. Loneliness intensifies when empty nesters become widowed, thereby losing the only constant companionship they still had left. For such elderly persons, even a fleeting interaction with another human being, especially face-to-face or even virtually, can make a big positive difference. Some elderly people in rural communities are even more isolated and lonely because they live in huge houses that they hoped would offer them comfort and security at old age. But the big house offers greater loneliness and emptiness when one’s children and, perhaps spouse, are nowhere to share it with. In the current state of affairs, elderly people living alone in isolated rural homes are likely to become victims of burglary, violent home invasion, kidnapping, and robbery.
Elderly people living in urban places face their own challenges. While I was drafting this article, two elderly men died in their respective houses within the residential estate where I live; each was retired, lived alone, was not financially poor, and had grown-up children who were settled in different cities or countries away from Abuja. Yet, each died alone in his big house, and nobody noticed until the unpleasant stench of putrefaction alerted the neighbours, and the front door was forced open, and an ambulance removed the unsightly corpse to the mortuary. These are two individuals who could probably have afforded to make financial provision for their own geriatric care, whether state-run or privately-run, had such care been available in Nigeria.
In some situations, a state’s involvement in social care does not necessarily imply responsibility for public funding. The state can, for example, make a comprehensive public policy (i.e., a set of rules, regulations, certifications, requirements, and practice directions) on how geriatric care should be provided, and how state agencies, non-governmental entities, faith-based groups, non-profit, or profit-oriented actors can participate. This type of policy would serve as a framework for employers or individuals to design long-term savings or contributory plans toward a person’s old-age care. Clearly, there is a need, and I dare say a growing demand for geriatric care in Nigeria, but the absence of any industry-specific policy leaves room for potential criminal abuse and fraud, if private profit-driven entities venture into the field without any regulation or legal protection of the elderly who would be the clients.
In addition to loneliness, dementia and other mental health issues are more prevalent among the elderly; criminals know that dementia is prevalent among the elderly, this explains why many elderly persons seem to be targeted by digital fraud, identity theft and other scams. We also know that elderly people are typically more vulnerable to viral or bacterial infection and physical diseases, more so during an epidemic, as illustrated by the Coronavirus pandemic.
Personal safety and security are everyone’s primary need, but the elderly are particularly at risk in Nigeria; their homes tend to be more vulnerable to criminal break-ins or attacks by robbers, and the elderly who live alone may not be physically strong enough to fight-off a home invasion, or defend themselves. There is currently no building code (i.e., legal requirement) for multi-floor residential apartment buildings or public buildings to be fitted with electronic elevators or disability wheelchair access ramps which would reduce, for the elderly, the difficulty of entering or exiting such buildings, especially during emergencies.
Geriatric healthcare is another big need among the elderly. This broad term includes all aspects of wellness, including physical, mental, and social aspects. In summary, although the needs of the elderly may be many, they are all interlinked. This explains why the standard (or best) practice in developed economies is the establishment of care homes for the elderly in an attempt to address all of the above-listed needs to some degree. Care homes enable the provision of an all-in-one menu of geriatric care: housing, food, companionship opportunities, and occasional scheduled entertainment; close monitoring to ensure physical and mental wellness; a structured suitable daily schedule of physical exercises, activities or itinerary; and ensuring the safety and security of the residents. On the other hand, some geriatric care operations offer non-residential care, specializing on one or two services, such as home visits to offer mental healthcare, social contact, or medical checkup, food/nutrition service, or emergency response.
What we can do, and how?
The first and most important step is for the government (federal, state and local) to recognize this as an important and urgent issue, and to start developing a comprehensive policy and requisite structures for caring for the elderly. This should include the assignment of specific responsibilities to specific tiers of government. To be clear, fully residential care centers are not the only way to provide care for the elderly; there are, indeed, several creative and effective options for doing so. Geriatric care involves several sub-specializations, and if there is a most ideal system of care delivery, it is one where all the key services are integrated.
Furthermore, publicly-funded, state-run care centers are not the only model for providing geriatric care. It is notable that the few existing care centers in Lagos, Ibadan, Abeokuta, Benin City, Abuja, Enugu, Owerri, and Port Harcourt, are all typically quasi-privately owned and operated as partnership ventures of individuals and faith-based entities (e.g., churches), or charitable non-profit organizations. I do not know of any government-funded or state-run care center for the elderly in Nigeria. It is very important for the activities of existing and future care centres and services need to be guided and standardized by appropriate public policies on the subject-matter; but in the current seeming policy vacuum, what formal parameters exist for the accountability and evaluation of the work (actions or inactions) of the existing or future geriatric care providers and services in the country?
Faith-based organizations (Churches, mosques and their affiliates), and specialized charitable (non-governmental) organizations, can take the lead in developing their own organizational policies and structures to provide geriatric care for their own needy members. They may be elderly and needy now, but many of them may have once contributed financially to the local church or mosque for many years during their younger years, and deserve to receive love, support, care, respect and dignity in their old age, especially for those who are unable to care for themselves. Some religious organizations in Nigeria may already be offering sporadic assistance to their elderly members, but there is need for a systemic structure to standardize the care and services provided.
Care of the elderly in our midst should not be occasional or sporadic media publicity stunts. These elderly people are human beings, and we should reflect our own decency by treating them with decency and dignity. Remember, we too will grow old and needy. Some religious organizations are fixated with flaunting lavish and ostentatious propensities, but would not care for the elderly who once contributed their money toward supporting the organization and its growth. Charity (zakat or alms-giving) is a cardinal tenet in Islam, while the parable of the Good Samaritan is a cardinal teaching in Christianity. These two religions can, and should, lead the way in developing systematic structures and services to give care to the elderly among their own membership; let charity begin in their midst. The resources would be available, if the will is there.
The technical expertise and financial and material resources are available in Nigeria for starting at least a rudimentary national system for geriatric care. Employers of labor, in both public or private sectors can devise financial savings plans or joint contributory plans toward an employee’s future geriatric care, while banks and other financial services providers can create innovative investment plans to enable people to save toward old age care. Such funds, like pension funds, would be idle funds which could be invested into the economy to create positive economic multiplier effects. Financially well-endowed individuals can establish foundations and set up elderly care projects as a way of immortalizing their own names or legacies.
In many countries, some property developers design and construct purpose-built residential estates for the elderly – referred to as senior citizens’ housing estates – fitted with all the appropriate geriatric facilities and infrastructure. Such estates make it easy to integrate other geriatric services, such as home nursing, social interactions, group entertainment, group worship, group transportation, vaccinations, and mental health visits by professionals. Given the chaotic, profit-driven proliferation of housing estate development by quack developers, this is not a call for other ill-motivated hustlers to posture as specialists in geriatric services integrated into housing development. Again, this is why we urgently need public services and practice regulations, in order to prevent quackery in the geriatric care industry.
Nigerian colleges and universities should urgently start to train and produce the requisite human capital to provide various levels and types of expertise and technologies to support comprehensive geriatric care. In countries that have an aging population, geriatric care is a major service industry and a major national employer of labor. While Nigeria is still far from achieving a mushroom-shaped population distribution, the number of the elderly in our midst is fast-growing, and we need to prepare now for the inevitable. It is un-African and abominable for our elderly to be abandoned without care in their hour of need. Now is the right time to prepare. Remember, it wasn’t raining when Noah built the ark. Once the rains started, it was too late to build one.
Our national and state legislators and the elected executive officeholders can, and should act on this matter, if only for the sake of their own progeny. Remember, everyone grows old who lives long enough. Therefore, wisdom and good conscience should prompt our leaders to act now in making policies and structures for geriatric care system in Nigeria. There is expertise in the country to evolve the requisite policies and development plans. Let’s act together and win together.
*Utiang P. Ugbe, PhD, a lawyer and economist, is a freelance consultant on socioeconomic development.
Rejoinders are solicited – please send to uugbe@msn.com
