LTC Systems Approaches Seychelles Policies and Practices Conrad Shamlaye Ministry of Health and Social Affairs

Historical background Pre-Independence (1976) – little formal provision Late 70s/80s – Health for All Community health centres and domicialiary health care National and subnational acute care hospitals 80s/90s – Social security and care Universal retirement benefits at age 63 Homes for the Elderly Residential institution for health/social care Home Care Scheme

Policy and legal framework Seychelles Constitution (1993) “the right of the aged to special protection”, “the enjoyment of the highest attainable standard of physical and mental health”; “quality of life of the aged” Policy guidance in different sectoral policies National Development, Family, Gender, Health, Population Legal Provisions Social Security Act (2010), Agency for Social Protection Act (2011), Health Care Agency Act (2013), National Council for the Elderly Act (1997)

Goals Ministry of Health, Ministry of Social Affairs, Social Protection Agency, National Council for the Elderly Goals expressed in general terms Dignity, independence, health and well-being of older persons, financial security Focus on Equity and ease of access based on needs Person-centred health care Supporting care workers Supporting family

Coordination National level Active coordination and oversight limited Periodic sectoral or programme reporting, but little monitoring and evaluation of outcomes and impact District and operational level Maintenance of community level register Inter-professional and intersectoral communication Needs assessment mechanisms in place Care/intervention package not clearly defined Inadequate training and supervision

Challenges Pressure to respond to expanding needs with increasing allocation of resources Resources not being used optimally Care options, unmet needs not recognised Creation of increasing expectations and pressures Programme publicly funded with little or no user contribution Allocation of resources to LTC may leave other populations and programmes underserved Sustainability

Recent development Health and Social Affairs merged into Ministry of Health and Social Services National Policy on Ageing Reforms in public administration and public financial management, including Programme Performance Based Budgeting District Councils with a mandate to develop district plan Role of National Council for the Elderly and civil society to be reinforced and expanded UN SDGs and WHO Global Strategy and Plan of Action on Ageing and Health

Conclusions Strong political commitment and sustained investment are essential to provide for Long Term Care for an ageing population with increasing needs Ensuring equity, quality, integration, participation and sustainability require focussed and specific mechanisms Policies on ageing and LTC must be viewed from the wider perspective of society as well as the life course, and the participation of the older persons In addressing the efficiency and sustainability issues of LTC and competing needs, the gains made through focussing primarily on equity need to be preserved

Thank you