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

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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

9. Thank you