“Sri Lanka will need to take appropriate policy measures
in advance so as not to slow down economic growth, minimize impact on public
health and pension spending and reduce the burden on families,” said Naoko
Ishii, World Bank Country Director for Sri Lanka. “Investing in healthy
and productive aging is essential– and specially, given the speed of population
aging, inaction is not a viable alternative.”
The report examines four key challenges and the related issues
of How to reinforce traditional family support to old people; How to improve
formal old age income support program; How to improve healthcare and long-term
care to support an aging population; and How to mitigate the slowdown of GDP
growth when one of key production inputs – labor – will start shrinking
in the coming years?
The report uses a variety of data sources, but draws mainly
from a special 2006 survey that the World Bank conducted to learn about the
socioeconomic and health status of elderly in Sri Lanka. One of the key findings
of the survey was that the demographic transition faced by Sri Lanka will be
particularly dramatic. Not only is Sri Lanka’s population among the oldest
in the non-developed world, but the country is also one of the fastest aging
countries in the world and the fastest in South Asia.
Traditionally Sri Lankan families have taken good care of their
elderly family members but the report finds some signs that this age old support
system is under strain. For example the women who are the primary caregivers
report of considerable stress and difficulty in balancing their careers and
working life and caring for both children and parents. Institutionalization
of elderly is a last resort and there is also evidence that, as in higher income
countries, those elderly who can afford to do so prefer to live alone with their
spouse.
Other support systems for elderly will become thus even more
important. But the report finds that formal old age income support systems have
limited coverage, inadequate benefits and are financially unsustainable. Thus
currently most elderly must rely on family support or very low benefits from
the social assistance programs. Health systems are also not ready to address
the needs of an aging population. The treatment of non-communicable disease
is outdated and relies on under-financing and under-treatment of cases, health
systems do not provide continuous or integrated care for the elderly that allow
systematic screening for illness or disability, and many elderly patients who
require secondary prevention do not receive it. Labor market institutions too
force many workers to withdraw from employment earlier than they want to.
Key Policy Recommendations are to Support informal care arrangements
of the most vulnerable of the aged; Strengthen formal income support for elderly;
Re-orient the health system to respond to an aging population and Countering
labor force declines by improving employment, productivity, and choice.
Under the support for informal care arrangements the report
suggests expanding social welfare and care services targeted to the most vulnerable,
providing community-and home-based support services for the sick and frail old
people, as well as increasing the capacity of nursing homes to care for old
people.
In strengthening formal income support for elderly, the recommendations
are to improve social assistance programs (including Samurdhi) delivery to old
people, integrating retirement schemes for private and public sector workers,
as well as various schemes for informal sector workers, and encouraging the
expansion of coverage by fiscal incentives such as targeted matching contributions
.
Re-orienting the health system to respond to an aging population will require
developing a health system that enables Sri Lankans at all ages to achieve healthy
aging, minimizing the costs of the health system, and reducing out-of-pocket
catastrophic health expenditure.
Detailed recommendations include strengthening health promotion
and prevention to ensure better quality of remaining life of old people, using
the maternal and child health network of the Ministry of Health for geriatric
assessment, prevention, and rehabilitation, and improve, and increasing public
healthcare expenditures to avoid patients shifting demand to the more expensive
private sector.
To meet the prospects of a shrinking labor force, the report
argues for the following policy actions: (i) increasing participation rates,
particularly of women and of old workers, including by introducing inflexible
retirement ages and increasing part-time/flexible working opportunities, (ii)
improving the productivity of the labor force by improving skills of older workers,
promoting formalization of the economy and improving health outcomes for informal
sector workers, and (iii) improving the choices of old workers, both allowing
formal sector workers work longer as well as allowing informal sector workers
to withdraw from the labor market if they wish to do so, rather than being forced
to work until health reasons prevent them to stay active.
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