Long-Term Care in the Developing World Special Article| Volume 19, ISSUE 9, P725-727, September 2018

The Sustainable Development Agenda Needs to Include Long-term Care


      The rapid ageing of populations around the world and the associated shift in the burden of disease from infectious to chronic conditions are creating complex challenges for national governments. Addressing the needs of these older populations in a sustainable and equitable way, will be a fundamental pillar of socioeconomic development in the 21st Century.
      The World Health Organization (WHO) Global strategy and action plan on ageing and health, which was adopted by all the Organization’s 194 Member states in 2016, provides a clear framework for global action. One critical priority is to establish sustainable and equitable long-term care systems in every country. WHO defines long-term care as “the activities undertaken by others to ensure that people with, or at risk of, a significant ongoing loss of intrinsic capacity can maintain a level of functional ability consistent with their basic rights, fundamental freedoms and human dignity”. These activities include both social care and health care, as well as contributions from other sectors, such as education or transport. And these activities need to be effectively coordinated if they are to efficiently, equitably and sustainably meet the needs of older people. This requires the stewardship of governments to ensure that: care is accessible and affordable; the rights of older people to lives of meaning and dignity are upheld regardless of their physical or mental capacity; services are oriented around the individual’s specific needs; caregivers are supported; the workforce (both paid and unpaid) are treated fairly; and older people’s intrinsic capacity is maintained for as long as possible.
      WHO has proposed three inter-related strategies to establish and sustain long-term care systems. System infrastructure needs to be developed and continually improved. The capacity of the workforce needs to be strengthened and families and communities must be supported. And the care and support provided needs to be more person-centred and integrated, underpinned by minimum standards and accreditation for care providers. This paper outlines some of the critical issues confronting governments in countries at all levels of development if this ambitious vision is to be achieved.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the American Medical Directors Association
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • World Health Organization
        World Report on Ageing and Health.
        WHO, Geneva2015
        • Department of Economic and Social Affairs
        World Population Prospects. The 2008 Revision.
        United Nations, New York2009
        • Barnett K.
        • Mercer S.W.
        • Norbury M.
        • et al.
        Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study.
        Lancet. 2012; 380: 37-43
        • Afshar S.
        • Roderick P.J.
        • Kowal P.
        • et al.
        Multimorbidity and the inequalities of global ageing: A cross-sectional study of 28 countries using the World Health Surveys.
        BMC Public Health. 2015; 15: 776
        • G. B. D. DALYs and Hale Collaborators
        Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.
        Lancet. 2017; 390: 1260-1344
        • World Health Organization
        Global Strategy and Action Plan on Ageing and Health.
        WHO, Geneva2016
        • Katz P.R.
        An international perspective on long term care: Focus on nursing homes.
        J Am Med Dir Assoc. 2011; 12: 487-492.e1
        • Kogan A.C.
        • Wilber K.
        • Mosqueda L.
        Person-centered care for older adults with chronic conditions and functional impairment: A systematic literature review.
        J Am Geriatr Soc. 2016; 64: e1-e7
        • Tsutsumi S.
        Long-term Care Insurance in Japan. Understanding the Ideas Behind Its Design.
        Japan International Cooperation Agency (JICA), Tokyo2014
        • Matsuda S.
        • Yamamoto M.
        Long-term care insurance and integrated care for the aged in Japan.
        Int J Integr Care. 2001; 1: e28
        • Maarse J.A.
        • Jeurissen P.P.
        The policy and politics of the 2015 long-term care reform in the Netherlands.
        Health Policy. 2016; 120: 241-245
        • Colombo F.
        • Llena-Nozal A.
        • Mercier J.
        • Tjadens F.
        Help Wanted? Providing and Paying for Long-Term Care.
        OECD Publishing, Paris2011
        • Lloyd-Sherlock P.
        Beyond Neglect: Long-term Care Research in Low and Middle Income Countries.
        Int J Gerontol. 2014; 8: 66-69
        • Rhee J.C.
        • Done N.
        • Anderson G.F.
        Considering long-term care insurance for middle-income countries: Comparing South Korea with Japan and Germany.
        Health Policy. 2015; 119: 1319-1329
        • Aboderin I.
        • Epping-Jordan J.A.
        Towards long-term care systems in sub-Saharan Africa.
        in: Pot A.M. Beard J. WHO Series on Long-term Care. WHO, Geneva2017
        • Gilhooly K.J.
        • Gilhooly M.L.M.
        • Sullivan M.P.
        • et al.
        A meta-review of stress, coping and interventions in dementia and dementia caregiving.
        BMC Geriatr. 2016; 16: 106
        • World Health Organization
        Towards Long-term Care Systems in Sub-Saharan Africa.
        WHO, Geneva2017
        • Lloyd-Sherlock P.
        • Pot A.M.
        • Sasat S.
        • Morales-Martinez F.
        Volunteer provision of long-term care for older people in Thailand and Costa Rica.
        Bull World Health Organ. 2017; 95: 774-778
        • De Henau J.
        • Himmelweit S.
        • Lapniewska Z.
        • Perrons D.
        Investing in the Care Economy. A Gender Analysis of Employment Stimulus in Seven OECD Countries.
        International Trade Union Confederation, Brussels2016
        • De Henau J.
        • Himmelweit S.
        • Perrons D.
        Investing in the Care Economy. Stimulating Employment Effects by Gender in Countries in Emerging Economies.
        International Trade Union Confederation, Brussels2017