亚开行-斯里兰卡长期护理国家诊断研究（英）-2021.7_85页_2mb

COUNTRY DIAGNOSTIC STUDY ON LONG-TERM CARE IN SRI LANKA

Core Content

This Country Diagnostic Study (CDS) on long-term care (LTC) in Sri Lanka, conducted by the Asian Development Bank (ADB) in 2021, provides an in-depth analysis of the country's aging population, care needs, and the current state of LTC services. The study highlights the growing demand for LTC due to demographic shifts and the need for systemic reforms to ensure sustainable and accessible care for older persons.

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Main Findings

Demographic Trends

• Sri Lanka is experiencing rapid aging, with the population over 60 years of age projected to reach 25% by 2050.
• The proportion of older persons increased from 8% in 2000 to 12% in 2012, and is expected to reach 15.9% in 2019.
• Life expectancy is rising, and is projected to reach 77.8 years by 2050, comparable to OECD member countries.

Care Needs

• The need for LTC among older persons is increasing due to higher prevalence of non-communicable diseases and disabilities.
• 77% of the population lives in rural areas, while 18% live in urban areas, and 4% on estates, contributing to diverse care needs.

Care Supply

• Formal LTC services are limited and insufficient to meet current and future demands.
• Informal care (mainly by family and domestic helpers) remains the primary form of care in Sri Lanka.
• State-funded and private LTC centers provide some daytime and residential services, but are not widespread.

Legal and Policy Framework

• There is no national definition of LTC, leading to confusion among stakeholders.
• The World Health Organization (WHO) defines LTC as activities to maintain functional ability for older persons.
• The National Secretariat for Elders (NSE) and Ministry of Health (MOH) play key roles in LTC policy development.

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Key Recommendations

National Strategy Development

• A nationwide LTC strategy is needed to address the rising demand for care.
• Government leadership is essential in formulating legal, policy, and strategy frameworks to ensure financing, planning, and quality management of LTC.

Multi-Sector Involvement

• Various sectors (health, social protection, urban development, transport) and stakeholders must be involved in LTC planning.
• Public awareness and engagement are crucial for the success of LTC systems.

Workforce Development

• A dedicated LTC workforce should be developed through training for formal and informal caregivers, health professionals, and social welfare staff.
• This includes enhancing skills and knowledge to improve the quality and availability of LTC services.

Sustainable Financing

• A public financing model for LTC should be established to ensure long-term sustainability.
• This would help expand LTC services across the country and support the financial needs of older persons and their families.

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Key Informant Interviews (KII)

• Conducted with 7 key informants, including officials from the National Secretariat for Elders, Ministry of Health, NGOs, and academics.
• Covered topics such as care needs, supply of care, policy and regulatory frameworks, service provision, quality management, human resources, and financing.

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Group Consultations

• Held at provincial, district, and divisional levels to understand the responsibilities and challenges of health and social service officers.
• Padukka, a rural area in Colombo district, was selected for consultations due to logistical constraints.
• The 12 able elders from Padukka participated in a focus group discussion, sharing insights on social problems, family challenges, and community support.

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Data Collection

• A national survey was conducted to gather data on eldercare homes and in-home nursing care services.
• The survey received ethical clearance from the Institute for Health Policy (IHP) Institutional Review Board.

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Challenges and Knowledge Gaps

• Limited data on LTC services and their nature in Sri Lanka.
• Weak family support systems due to migration, urbanization, and shrinking household sizes.
• Gender and poverty are critical factors affecting LTC access and quality.
• Informal care is often not recognized or supported by policy, despite being the main source of care.

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Policy Implications

• The development of LTC systems is essential to support aging populations and ensure social and economic stability.
• Strengthening learning and dialogue among stakeholders is necessary to guide reforms and innovations.
• Gender-sensitive policies and poverty reduction strategies should be integrated into LTC planning to ensure equitable access.

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Conclusion

• The aging population in Sri Lanka presents social and economic challenges.
• A formal and sustainable LTC system is required to address the growing care needs.
• The ADB plays a key role in supporting capacity development and policy reforms in LTC for the region.

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Appendices and References

• Appendix 1: Summary of key informant interviews.
• Appendix 2: Summary of group consultations and focus group discussions.
• Appendix 3: Extract from Sri Lanka Standards 1506:2015.
• Appendix 4: Additional tables and figures.
• References include data from ADB, WHO, UNFPA, World Bank, and UN.

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Glossary

• ADB: Asian Development Bank
• ADL: Activities of Daily Living
• CDS: Country Diagnostic Study
• DMC: Developing Member Country
• ERPO: Elder Rights Promotion Officer
• IADL: Instrumental Activities of Daily Living
• IHP: Institute for Health Policy
• KII: Key Informant Interview
• LTC: Long-Term Care
• MOH: Ministry of Health
• NGO: Non-Government Organization
• NSE: National Secretariat for Elders
• NVQ: National Vocational Qualification
• OECD: Organisation for Economic Co-operation and Development
• PDHS: Provincial Director of Health Services
• PGIM: Postgraduate Institute of Medicine
• PHSRC: Private Health Sector Regulatory Council
• SLAGM: Sri Lanka Association of Geriatric Medicine
• WHO: World Health Organization
• YED MOH: Directorate for Youth, Elderly and Disabled Persons, Ministry of Health