Growing Old, Growing Sick: West Africa's Ageing Dilemma ‎

West Africans are living longer, but sickness is claiming a growing share of the extra years. Across the WHO African Region, which includes most West African states, the gap between life expectancy and healthy life expectancy was about 8.5 years in 2019, and wider for women (9.5 years) than men (7.4 years). Progress is also slowest where it matters most: healthy life expectancy at 60 rose by only about 1.9 years between 2000 and 2019.

A region unprepared
An analysis of West and Central Africa found that health systems are not prepared for the needs of a growing older population, and accurate data on illness, mortality and access to care is lacking. The same presentation noted that ageing is not mainstreamed in national development plans.

Ghana shows the hidden burden
Ghana has the best data in the sub-region. A University of Ghana study of people aged 50 and over found self-reported hypertension of 13.68% but field-measured hypertension of 33.93%.

Most older Ghanaians with high blood pressure may not know it. This matters because older adults with self-reported hypertension were at higher risk of stroke, angina, diabetes and cataract.

Detection has improved, but treatment has not. Longitudinal data showed that awareness of hypertension rose from 20% to 57%, yet there was no difference in the share receiving treatment or with controlled blood pressure.

An earlier Ghanaian survey had already found that only 6.2% of people with hypertension had it controlled. That survey is old, but the later longitudinal finding suggests the treatment gap has not closed.

Poverty compounds illness
Old-age income support is thin. The West and Central Africa analysis reported that only about 10% of older people receive an old-age pension. Ghana's labour minister cited ISSA data showing that only 27.1% of older Africans receive old-age benefits, against a global average of 77.5%.

In Nigeria, pension, health insurance and social insurance schemes have limited coverage, leaving gaps for the aged. Analysts have warned that poverty could rise among older Nigerians if pension coverage problems are not addressed.

Bright spots with limits
Two West African countries have tried to protect older people's health. Ghana's National Health Insurance Scheme exempts older people from premiums, and Senegal's Plan Sesame exempts them from user fees. But exemption on paper does not guarantee access.

The same study found that older people vulnerable to social exclusion were less likely to enrol. The researchers urged targeted enrolment of rural elders, women, ethnic minorities and those isolated by lack of social support.

What must change
West African governments should treat ageing as a core health issue, not an afterthought. That means screening for hypertension and diabetes from middle age, making treatment affordable and continuous, extending pensions to informal workers, and taking enrolment to rural communities and Zongo neighbourhoods.

Regional bodies such as ECOWAS and WAHO can help by setting common targets and collecting reliable data on older people.

The question for West Africa is no longer whether people will grow old, but whether they will do so in health or in hardship.

Mustapha Bature Sallama
Medical/Science communicator, Private Investigator, Criminal Investigation and Intelligence Analysis,United States Institute of Peace (USIP), [email protected] +233555275880

References
WHO Regional Office for Africa, Healthy Life Expectancy Regional Factsheet (2019 data): files.aho.afro.who.int

Oga, J.-B., "The MIPAA 15 years later: experiences and lessons from West and Central Africa," NTA Network meeting, 2018: ntaccounts.org

Duker, A., "Risk Factors Associated with Hypertension among Older Adults: Evidence from Ghana," University of Ghana: ugspace.ug.edu.gh/handle/123456789/44765

Tetteh, J. et al., "Self-reported hypertension as a predictor of chronic health conditions among older adults in Ghana," Pan African Medical Journal, 2020;36:4, doi:10.11604/pamj.2020.36.4.21489

"Determinants of change in blood pressure in Ghana: Longitudinal data from WHO-SAGE Waves 1–3": ugspace.ug.edu.gh

"Factors associated with hypertension awareness, treatment, and control in Ghana, West Africa," Journal of Human Hypertension, 2006: ugspace.ug.edu.gh

Kingsley Asare, "Take advantage of digital tech to expand pension coverage in sub-region," Ghanaian Times: ghanaiantimes.com.gh

UPVAC, "Social Security and Social Protection," input to the UN Open-Ended Working Group on Ageing: social.un.org

VOA Africa, "Nigerian Public Affairs Experts Wave Red Flag Over Pension Coverage Issues": voaafrica.com

Parmar, D. et al., "Enrolment of older people in social health protection programs in West Africa," Social Science & Medicine, 119 (2014): 36–44, doi:10.1016/j.socscimed.2014.08.011