Key note presentation at Global Health Disparity Conference, North Carolina Central University, United States 5/4/2019 By; Amara Frances Chizoba MPH, AAHIVS, PhD Director, Mission to Elderlies Project Renewal Health Foundation Nigeria www.renewalhealthfoundation.org missiontoelderlies@gmail.com +2347088698103

1. Taking deliberate action to bridge the gap in
health disparity; a lens in health care of the
older persons
Amara Frances Chizoba MPH, AAHIVS
Director, Mission to Elderlies Project
Renewal Health Foundation Nigeria
www.renewalhealthfoundation.org
missiontoelderlies@gmail.com
+2347088698103
Key note presentation at Global Health
Disparity Conference, North Carolina
Central University, United States
5/4/2019

2. Health disparity –what it is
According to National Institute of Aging,
• Health disparities are differences in any health-related
factor—disease burden, diagnosis, response to
treatment, quality of life, health behaviors and access
to care, to name only a few—that exist among
population groups.

3. Health disparity –what it is…
• Health disparity affects

4. Health disparity –where it exists
• Age
• Sex
• Race
• Ethnicity
• Socioeconomic Status (SES)
• Disability status
• Geographic location (e.g., rural
or urban environment)
• Education
• Healthcare (e.g., access, quality)
• Culture (e.g., norms, traditions)
• Health behaviors (e.g. violence,
substance abuse)

5. Lens on Health disparity among the older
persons

6. Gaps in health system structure and preparedness
• The structure of health system focuses on other non- elderly population (children
and other adults)
• There is therefore health disparity gap in health system for care of older adult
• There are very few and in many cases absence of geriatric units and geriatric
clinics in the health centers
• There are insignificant number if geriatricians and health professionals trained on
comprehensive geriatric care
• Health schools also do not have comprehensive curriculum for geriatric training in
pre-service training
• Data capturing tools and reporting for health indices of older adultare not readily
available of used
Lens on Health disparity among older persons-the
reasons

7. Gaps in Health education
• This is skewed to younger adult with more younger adult friendly
languages
Community health outreaches/programs
• This is also skewed for general population making it difficult to target
older adult needs
• There is therefore no or few platform for community health education
for older adults to improve health aging and for the general
population to prevent ageism

8. Gaps in access to health care
• It’s generally more difficult to independently access health care centers for
older adults due to locations needing transportation, patient waiting time,
care coordination and out of pocket spending on health
• More obvious in LLMIC compared to HIC
• Low and middle-income countries;
 Affordability; the greatest barriers appear to arise from the cost of the health-care
visit and transportation, among 60%.
 Accessibility; majority live in rural areas without health access as services are often
concentrated in large cities
• In high-income countries
 the greatest barriers reported by older people appear to come from having been
treated badly by health-care professionals

9. Gaps in medication plan
• As one ages, the changes in the body affects the pharmacodynamic
and pharmacokinetic of drugs
• Some medication ought to be calculated by age with special dosing
needed for older adults
• Adherence are also needed especially for chronically used drugs,
increasing need for adherence support system of older adults
• Issues of co-morbidity and poly-pharmacy are predominant with
gaining affects drug-drug interaction
• The above needs in medication plan for older asults are not yet
critically addressed in practice

10. Gaps in Socioeconomic status (SES)
• SES has gross influences on health
• Older adults face retirements with majority experiencing low income
• Low energy level at such ages also reduces work hours and further
reducing income
• There is therefore higher dependence on government, family and
friends
• However, many countries do not implement cash transfer or other
economic related programs for older adults
• And mismanagement of pension scheme especially in LLMIC further
affects socioeconomic status

11. Gap in universal health coverage plan
• WHO advocates for UHC which is aimed at covering dependent and
vulnerable population – including older persons
• However UHC plans are not readily inclusive of older adults
• For instance, in Nigeria, UHC plan leverages on National Health
Insurance Scheme (NHIS). But same NHIS Community based programs
are made to cover other vulnerable populations like children,
pregnant women, persons living with disability except for older adults

12. Gap in health policy plans and documents
• Policy health care are not clear on older persons caveat
• Health policy documents are well developed and implemented for
other population but gaps are still there for policy documents for
older persons
• Specific policy documents addressing health of older adults are either
newly developed and being implemented or are at stage of being
developed

13. Gaps in researches and research funding
• More of researches are skewed to younger population thus
• WHO and CDC reports keeps expressing continuous paucity of data
for older adults health
• There are low research funds for health of older adults
• Even some global health conferences and meeting unconsciously miss
discussions on health of older adults

14. Gaps in health programs and funding
• The health programs are also skewed to other population compared
to older adults
• Thus funding are more available for other health programs such as
MCH, infectious diseases like HIV and TB, SRH, among others
• Very few funding agencies make funds available for health program
for older adult –eg Long term care (LTC) program

15. Lens on Health disparity among the elderly- the
reasons (WHO World Health Survey 2015);
• Low and middle-income countries;
 Affordability; the greatest barriers appear to arise from the cost of the health-
care visit and transportation, among 60%.
 Accessibility; majority live in rural areas without health access as services are
often concentrated in large cities
• In high-income countries
 the greatest barriers reported by older people appear to come from having
been treated badly by health-care professionals

16. Taking deliberate action to bridge health
disparity gaps
• According to WHO, Comprehensive public health action on
population ageing is urgently needed.
• The CDC’s Healthy Aging Program is taking action on conducting
research on minority populations such as the older adults to identify
and address health disparities.
• Aligning health-financing policies with the goals of universal health
coverage would protect older people from foregoing essential health
care because of the financial costs or from facing severe financial
hardship and even impoverishment due to their needs for care.

17. Taking deliberate action to bridge health
disparity gaps- The WHO 10 priority areas

21. The Mission to Elderlies Project experience
• www.missiontoelderlies.org

22. • Acceptability of health care for older adults
• Community mobilization to create awareness and educate on
healthy aging
• Conducted and ongoing in 5 States
• Foster aging in place services
• Partnering with a geriatric home to encourage home base care
• Day care services provided in geriatric clinic
• Piloted in 5 states
• Elder mentor program
• Piloted in 2 states
The Mission to Elderlies Project experience

23. •Accessibility of health care for older adults
•Start up of geriatric clinics in existing health centers
• Implemented pilot in 5 states
•Training of health providers in care of older people;
• >100 providers trained in partnership with West African
College of Nursing and Medicine
The Mission to Elderlies Project experience

24. The Mission to Elderlies Project experience
• Affordability of health care for older adults
• Enrolment of older adults into National health insurance
scheme (NHIS) to reduce out-of-pocket expenses
 $35 yearly for 107 clients on care
• And monitor quality of service provisions by the health
maintenance organization, hospitals and
• Support pension management schemes fro older adults

25. The Mission to Elderlies Project experience
• Accountability of health care
• Developed data collection and reporting tools
• Train health officers on documentation and reporting
• Collect, analyze and evaluate data
• Use result for research and quality improvement
interventions
 Publications on journals like Lancet
 Contribution for WHO review on models of service delivery for
health of older people in developing countries

26. Call for more actions
1. Act on innovation that bridges health disparity gaps
2. Adapt and scale up effective innovation(s)
3. Support an effective innovation(s)

27. THANK YOU
• www.renewalhealthfoundation.org
• missiontoelderlies@gmail.com
• +2347088698103