Globally, the ageing population has been increasing faster than projected earlier. The number of people aged 60 and above is much higher than the number of children below five years. With an increasing life expectancy and decreasing birth rate, the demographic structure is changing with a rise in the number of older persons. According to the World Health Organisation (WHO), about 12 per cent of people are aged 60 and above around the world. The number will be almost doubled by 2050. It is projected that 1 in 6 people will be 60 and above by 2030.
Demographic change The similar demographic change can be witnessed in the context of Nepal, too. As per the 2011 census, the number of people aged 60 and above had stood at 8.13 per cent. The 2021 census, however, shows that an annual population growth rate was 0.93 per cent. It was 1.35 per cent earlier. In 2011, the annual growth rate of older persons was 3.13 per cent. With this data, we can assume that Nepal is no exception in changing population structure with a large number of older persons. But we are far behind other countries to manage this growing population.
In Nepal, it is projected that the proportion of older people is expected to double to 18 per cent in 2050. However, the policy and programmes related to older persons are still charity based. The trend of taking older people as a dependent population will be definitely harmful for upcoming years. With this changing population structure, they should be considered as right holders and duty bearers as other age groups. But inadequate rights and deeply rooted ageism are hindering mainstreaming them in national discourse.
After the Madrid International Plan of Action (MIPPA) in 2002, Nepal government also started to work on rights of older persons. The first National Plan of Action on Senior Citizens was prepared in 2002 to make the life of the senior citizens comfortable, secure and respectful and utilise their knowledge, skills and experiences in national development. After that, the experts from Nepal Law Commission were assigned to prepare the first Senior Citizens Act in the country. The Senior Citizens Act, 2006 has many provisions that are in line with the MIPPA.
The MIPPA was developed to respond to the opportunities and challenges of population aging in the 21st century and to promote the development of a society for all ages focused on three areas: older persons and development, advancing health and wellbeing in old age, and ensuring enabling and supporting environments. Similarly, the Senior Citizens Act, 2006 gives priority to dignity, care and empowerment of older persons. To regulate the Act, Senior Citizens Regulations was formulated in 2008. But there are so many policies that are yet to be implemented.
In 2007-2010, the government formulated a three-year interim plan that had provisions of developing legal and institutional mechanism to ensure welfare and rights of senior citizens; expand old age homes, allowances and other economic social security programmes with reviewing the programmes and modalities followed by governmental and nongovernmental agencies. Besides, it included the provisions of providing special facilities to elderly people in hospitals and public transports; formulating policies to respect and utilise the knowledge, skills and experiences of senior citizens in national development.
Gradually, the government has prioritised the health of older persons. In 2007, a free health policy was formulated. The policy aimed at providing free medicine, vaccines and other services to ultra-poor, poor, vulnerable, disable and senior citizens. Similarly, under its social protection programme, the government introduced a health insurance for them in 2017. The policy has now become very effective for one and all, particularly for older persons due to their chronic health condition.
Under this scheme, a family up to five members has to pay Rs. 3,500 to get medical treatment worth Rs. 100,000. And the family with more than five members has to add Rs. 700 per member to be entitled to the insurance coverage from Rs. 20,000 to Rs. 200,000. So far, seven regional hospitals (Patna Hospital, Bharatpur Hospital, Ayurveda Teaching Hospital, Seti Hospital, Bheri Hospital, B. P. Koirala Institute of Health Sciences (Dharan) and Pokhara Academy of Health Science) have geriatric wards. But due to the lack of geriatric health personnel, including geriatricians and geriatric nurses, the wards are not operating as they should have. There are very few geriatricians for the treatment of older persons in Nepal.
Policies in place In addition to these, there are policies in place for the wellbeing of older people in the country. In recent years, the government has formulated various guidelines and procedures in regard with the implementation of geriatric care centres, making available grants for the operation of model village for senior citizens and disable people, providing grants to local organisations working for senior citizens, disabled, children and women, among others.
But all those guidelines and procedures are only limited in documents. Majority of older persons are still vulnerable and marginalised. They are unaware about their rights as well as their duties. It is essential for the developing countries like Nepal to call the UN Convention for ensuring the rights of older people. Each year, policymakers, human rights activists and other stakeholders come together in the United Nations Headquarters in New York for the Open Ended Working Group on Ageing for strengthening the protection of the human rights of older persons. This year also, they will meet in April from 11-14. However, no one has participated in this forum from Nepal for many years. It is time for us to voice for ensuring the rights of older persons.
(Magar is the Chief Executive Officer at Ageing Nepal.)